INFECTION PREVENTION
How surgical drapes help to reduceS SI risk
Surgical site infections cost the NHS around £758 million every year and contribute to the growing problem of antimicrobial resistance. Suzanne Callander finds out how the use of incise drapes can help reduce the risk of infection.
Surgical site infections (SSIs) affect around 5% of all surgical patients and their impact is wide-ranging, having an adverse effect on both patients and the NHS. A SSI will affect the quality of life of the patient. It doubles the risk of mortality and increases length of hospital stay following surgery. For the NHS, the minimum cost of treating a SSI is £3,000. The financial burden of SSIs to the NHS is approximately £758 million per year.1 Further, and of growing importance, is the contributory effect that treating SSIs has on antimicrobial resistance (AMR). Overuse and misuse of antibiotics is driving the continued increase and emergence of new, resistant and multi-resistant bacteria, which is now growing at a faster pace than the speed of development and release of new drugs. In 2013, the Chief Medical Officer for England issued a stark warning about increasing AMR, stating that within 20 years the currently available antibiotics may no longer work and that we may be heading for a ‘post antibiotic era’ unless action is taken. There have been no new antibiotic class discoveries since the introduction of daptomycin in the late 1980s and all the classes of antibiotics in use today are now beginning to show some resistance. One of the recommendations on AMR made in the Chief Medical Officer’s annual report in 2013 was to improve how
infections are prevented and managed and, at an Association for Perioperative Practice (AfPP) event Kat Topley, clinical efficiency manager at 3M, argued that clinically, more needs to be done to prevent healthcare- associated infections (HCAIs). “Clinicians need to be looking to implement optimal infection prevention and control practices to help reduce the spread of multi-resistant organisms and to help prolong the life of current antibiotics,” she said. “If we can do something to reduce HCAIs we should do it.” SSIs are often highlighted as being the most avoidable HCAI. “We know when the window of risk for an SSI occurs, so infection prevention practice – both before and during surgery – is a hugely important factor in SSI reduction,” continued Kat Topley. According to the National Institute for Health and Care Excellence (NICE)2
most SSIs
occur as a result of contamination of a surgical incision from microbes originating from the patients own body, so it is important to reduce microbes for the duration of the surgery. Infection caused by micro-organisms from an outside source following surgery are less common.
The Centres for Disease Control and
Prevention (CDC) backs up this statement. It says that the risk of SSI is linked to the number of skin microbes present on the patient’s skin and that the risk of SSI can be
measured according to three distinct variables: the dose of microbial contamination; the virulence of contaminating microbes; and the resistance of the host.3
Human skin harbors up to 100,000 microbes per square cm, yet just 100 microbes per square cm can result in an SSI.4
Existing tools
According to the National Audit Office (2000) around 30% of infections can be prevented through application of existing knowledge and tools. These tools include incise drapes which incorporate an adhesive, breathable, film that prevents moisture build up under the surgical drape, helping to ensure that the drape stays in place throughout a surgical procedure. NICE recommends that if an incise drape is required for surgery an iodophor-impregnated drape should be used, unless the patient has an iodine allergy.
While surgical skin preparations do help reduce microbes on the skin surface, bacteria in the deeper skin layers will remain. and these microbes will recolonise the skin surface over time. However, evidence presented by Casey et al in 20155 demonstrates that iodine released from 3M Ioban 2 antimicrobial incise drapes is able to penetrate these deeper skin layers at a concentration required for microbial death. Antimicrobial efficacy of iodine-
impregnated incise drapes against MRSA was evaluated by Casey et al in ex vivo studies following application of the surgical incise drape for various times on the surface of donor skin. This research found that iodine from the iodine-impregnated drape was present at levels required for microbial death at depths of 1000 to 1100 µm, reaching the deeper skin layers. By contrast, chlorhexideine gluconate (CHG) skin preparation is only able to permeate skin at a concentration required for microbial death to a depth of 300 µm. The study concluded that the use of ioban 2 antimicrobial incise drapes suppresses microbial regrowth at and around a surgical incision site, making its use preferable to the use of a standard drape or non-use of a drape. “Our ioban antimicrobial infused incise
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WWW.CLINICALSERVICESJOURNAL.COM MARCH 2017
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