Bacteria Basics in Skin Prep

This article appeared in the March 2016 issue of Surgical Products. To see more, click HERE.

Reducing surgical site infections (SSIs) and healthcare associated infections (HAIs) has always been a challenge in healthcare. Although new technology has helped reduce risk for some areas of medicine, the elusive SSI is still a reality for one in three surgery patients. To find where these bacteria hide, Surgical Products connected with the infection experts.

How has research created awareness to the bacteria patients bring into the surgery on their skin?

Dr. J. Hudson Garrett Jr., PhD, MSN, MPH, FNP-BC, CSRN, PLNC, VA-BC, vice president of clinical affairs at PDI, Inc.: Current research continues to highlight the role of the patient’s own skin in contributing to the risk for the development of SSIs. The human skin serves as a natural barrier to infection when it is intact, however during surgery, the skin is compromised, which can allow currently present pathogenic flora to enter the surgical site and cause SSI. This risk factor is a fundamental reason why preoperative skin cleansing prior to the surgical procedure can be helpful in reducing the risk for SSI.

The medical profession continues to recognize the significant impact of SSIs to the patient, as well as the associated mortality and morbidity. The use of preoperative bathing to cleanse the skin is well accepted and supported in the clinical literature and evidence based clinical guidelines.

Where do bacteria commonly hide on patients?

Garrett: Bacteria are found everywhere on the human skin, and most bacteria serve an essential function to protect us from infection. The most heavily colonized area on the human body is typically the groin due to the skin folds, moisture-rich environment, and hair follicles. This site is very difficult to perform adequate antisepsis on as well. Other heavily colonized areas can include the rectum and abdomen.

Caroline Johnson, BSN, RN, a technical service specialist at 3M Infection Prevention Division: Many facilities may have a preoperative antiseptic bathing protocol in place, but bacteria found in other reservoirs such as the nose may be overlooked. Staphylococcus aureus is the leading cause of SSI and is commonly found on the skin and also present in the nose in approximately 30 percent of the population. Nasal colonization with S. aureus is a well-documented risk factor for infection and reducing bacteria present in the nose can help reduce SSI risk.   

What methods are currently available to prep patients for surgery?

Garrett: There are many antiseptic formulations available to perform skin antisepsis prior to surgery. Currently available solutions include alcohol, PVP iodine and Chlorhexidine containing antiseptics. The majority of facilities use a Chlorhexidine gluconate containing solution that is easily applied to the patient’s skin and has the synergistic effect of Chlorhexidine gluconate and Isopropyl Alcohol.

Johnson: Effectively reducing bacteria and achieving persistence in the nose to reduce infection risk can be challenging because the nose is a unique and complex environment that is much different than that of the skin. Historically, a topical antibiotic ointment has been used to prior to surgery, but requires patients to complete an outpatient dosing regimen. This strategy is reliant upon patient compliance, which can be difficult to validate, instead of putting control in the hands of the healthcare provider. 

How can surgical teams make sure patients are complying with patient prep procedures?

Garrett: Patient education is critical to ensuring the success of a preoperative skin cleansing that is performed by the patient. Patients must be fully aware of the importance of adherence to the process and technology should be utilized to improve compliance. There are new capabilities to send the patient text and email reminders to perform the procedure and be compliant with the preoperative instructions provided by the surgeon.