SURGICAL SITE INFECTIONS


cuts through the skin at around five minutes post application. As the surgical procedure continues it is important to look at the effect of the operating theatre environment, including ‘fallout’ of bacteria onto the skin around the wound edges. It should be noted that this is of particular importance when using the PI compounds as they are de activated by human plasma proteins. Any haemoserous fluid leaking from the wound will negate any initial antimicrobial effect of the solution. Finally, the effect on skin bacterial counts after dressings have been applied with wound edges not closed may also have an impact on outcome. It was therefore decided that for


reduced numbers of skin bacteria to have an effect on SSI outcome, the chosen times would be the most relevant times to test. It is worthy of note that although two hours post application is not necessarily a critical time in respect to wound infection rates, it was chosen to determine if there could be a predictable curve for any increase in bacterial counts. As already described, there is no


reliable evidence to support pre-test showering with an antiseptic, and as this was not standard procedure in the hospital, the subject was not discussed with patients and they were left to shower/ wash as they would normally do. A total of 300 samples were taken


from areas of abdominal skin 2 cm x 1 cm along the mid line running superior to inferior using a sterile technique. These areas were marked with a surgical skin marker to ensure that further samples were taken from the same areas. A sample from every area was taken prior to any skin prep being used and a surface count recorded using a Bacteria Specific Rapid Metabolic Assay (BSRMA) as this has been proven to be a far more reliable and accurate way of counting CFU’s than either culture or Polymerase Chain Reaction (PCR).52,53 All areas were prepared for surgery using one of the chosen skin antimicrobial preparations. Due to colour variations in the liquid preparations it was impossible to blind the study. Post application of the surgical skin preparations, swab counts were again taken from each site after five minutes, one hour, two hours and


safety


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For more information on the complete range of surgical blades, handles, scalpels, disposable, fine and retractable scalpels please go to our website.


In response to the EU Sharps Directive 2010/32/EU Swann-Morton have launched the KLEEN Blade Management system consisting of their standard blade enclosed within a protective cartridge thus supporting safe handling when fitting and removing the blade from your existing surgical handles. Complimented by Retractable Safety Scalpels, single use Blade Removers and “Cygnetic” they can now offer a complete range of compliant safety solutions.


Swann-Morton can offer in house sharps safety training in line with the new Directive so contact us on sharpssafety@ swann-morton.com for more information.


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www.swann-morton.com OPERATING THEATRE l JULY 2018 l 33


four hours. The graph below shows the average skin bacterial counts for the three types of surgical skin prep.


Results


All CFU counts were averaged from the group counts. It is noteworthy that in every group - and at every time differential - the results of 98% of the samples were within 5% of the mean average count. CHG 2% is effective until around four hours post- operatively, when CFU counts begin to rise again. After an initial 90% reduction in CFU counts at five minutes, the count continues to fall to a low of 91.5% reduction at two hours, before increasing again to a 63% reduction at four hours.


70% ethyl alcohol liquid showed an


initial reduction in CFU counts of 49% at five minutes. However, between five minutes and one hour post- application the CFU counts increased to a level 18% above the pre-treatment counts. This decreased to 5% above pre-treatment levels at two hours post-application and to 3% above the pre-treatment counts, at four hours. The 5th generation SiQuat


t


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