Infection prevention
Could pre-operative body washing help prevent SSIs?
Surgical site infections remain one of the most common adverse events affecting patients undergoing surgical procedures. Dr. Kayleigh Cox-Nowak examines the evidence for pre-operative decontamination to reduce micro-organisms as potential pathogens on the skin and mucous membranes.
Surgical site infections (SSIs) have been described as “the most preventable healthcare- associated infection (HCAI)”1 cause of morbidity.”2
and “a preventable Yet SSIs are the third most
common nosocomial infections, accounting for up to 16% of all infections acquired in hospital settings.3
Strategies to reduce SSI rates
should address both pre- and post-operative factors. This article examines the evidence for pre-operative decontamination regimes, which include an antiseptic body wash and intranasal topical product to reduce micro-organisms as potential pathogens on the skin and mucous membranes.
Healthcare-associated infections Healthcare-associated infections (HCAIs) are defined as “infections occurring in a health- care setting, that were not present prior to a patient entering that care setting.”4
HCAIs
pose a serious risk to patients and can cause significant morbidity and even mortality to those affected. The emergence of new infections like SARS-CoV-2 heighten the risk, as seen in the recent COVID-19 pandemic. It is therefore not surprising that infection prevention and control remain a key priority for the NHS. A recent study found that for every 20 hospitalised patients, at least one acquired a preventable HCAI.5
In addition, it is estimated that up to 3.5% of patients who acquire an HCAI die as a result of their infection.4 Pre-
pandemic data (2016/17) suggests there were an estimated 834,000 HCAIs across all NHS hospitals in England, costing the NHS £2.7 billion; and accounting for 28,500 patient deaths.4 Besides the terrible impact on patients and their families, HCAIs incur a considerable financial burden to the NHS. The costs to manage a patient who acquires an HCAI is around three times higher than that of managing a patient without an HCAI.4
In patients undergoing cardiothoracic or orthopaedic surgery, screening forS. aureus nasal carriage and decontaminating carriers resulted in a substantial reduction in hospital costs. This approach resulted in a cost saving of almost £3,000 per cardiothoracic patient compared to the non-screened and non-treated patients.
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www.clinicalservicesjournal.com I July 2023
Surgical site infections SSIs remain one of the most common adverse events affecting patients undergoing surgical procedures5
, even though evidence suggests
that approximately 60% of SSIs could be prevented.6 The United Kingdom Health Security Agency
(UKHSA) describes SSIs as post-operative wound infections which occur within 30 days of surgery (if no implant was used); and within one-year in implant procedures. SSIs are defined by the UKHSA according to standard clinical criteria for infections that affect the superficial tissues (skin and subcutaneous layer) of the incision and those that affect the deeper tissues (deep incisional or organ/space). The latest UKHSA data compares the SSI risk in the current financial year to the previous one, by category. In 2021/22, 6 out of 10 SSI categories saw increases in risk. These include hip replacement (up to 0.44%), knee replacement (0.35%), reduction of long bone fracture (0.54%), Coronary Artery Bypass Graft (2.7%), cardiac
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