Issue link: https://beckershealthcare.uberflip.com/i/824946
67 Executive Briefing Controlling these factors is essential in reducing the risk of SSIs. Patient Clinical staff Hospital environment Bacterial contamination can occur from the: Dose of bacteria Virulence of bacteria RISK OF SSI X Patient risk factors "As the only nasal antiseptic supported by 10 investigator-ini- tiated clinical studies, 3M Skin and Nasal Antiseptic provides a simple and clinically effective solution for nasal decolonization, which as part of a comprehensive protocol can help reduce the risk of SSIs," said Ms. Anderson Manz. Pre-operative showers, baths or wipes are used to cleanse and reduce the bacterial load on the skin. Preoperative bathing with CHG is effective in reducing skin flora; the same effect is not achieved with the use of soap alone. 20-22 "While the skin can contain over 1 million bacteria per square centimeter, when an implant is involved as few as 10 microbes per sq. cm to cause an SSI," 23 said Ms. Anderson Manz. "Reducing the number of microorganisms can reduce the risk of infection." Use of a non-rinseable form of CHG (2 percent impregnated cloths) results in a significantly better reduction in skin flora compared to 4 percent CHG showers. 24 A recent systematic re- view that included studies with consistent bathing protocols of two pre-operative baths found that the use of 2 percent CHG cloths significantly reduces SSI risk. 25 Minimize bacterial contamination from the patient's skin Proper surgical skin preparation can further reduce bacterial contamination of the surgical site. Effective surgical skin anti- septics should be fast-acting and have persistent activity to reduce microorganisms to sub-pathogenic levels with minimal skin and tissue irritation. 26 "While surgical skin preps help to reduce bacteria on the skin, they do not sterilize the skin, so there will still be some level of bacteria remaining," said Ms. Anderson Manz. "One effec- tive method to help prevent residual skin bacteria from being carried on gloves and instruments into the surgical wound is to apply an incise drape as part of the skin preparation process." An incise drape provides a sterile surface to the wound edge, locking any remaining bacteria underneath. An antimicrobial incise drape contains an antiseptic in the adhesive layer and has the added advantage of killing bacteria left on the skin after application of the skin prep. In a recent ex vivo study on human skin, the iodine in an iodine-im- pregnated surgical incise drape was shown to be present at con- centrations effective against MRSA at a depth of 1,000 microns, in the deeper layers of the skin where hair follicles are present. 27 Several new studies further outline the impact of using an anti- microbial incise drape. A randomized controlled trial compared microbial wound contamination in hip preservation surgery us- ing 3M™ Ioban™ 2 Antimicrobial Incise Drapes compared to using no incise drape at all. The study showed that the Ioban 2 antimicrobial incise drape was significantly more effective at re- ducing microbial wound contamination compared to not using an incise drape. 28 In a recent study of patients undergoing cardiac surgery, 3M Ioban 2 antimicrobial incise drape was associated with a signifi- cant reduction (71 percent) in the overall incidence of SSIs when compared with the use of a non-antimicrobial incise drape. 29 Maintaining normothermia The clinical benefits of normothermia maintenance in surgical patients is well established, and temperature management is included in clinical practice guidelines worldwide. Maintaining a patient's normal body temperature, or normother- mia, has been shown to correlate with decreased SSI rates 30-32 ; it can also help reduce blood loss 33,34 , shorten the length of hos- pital stays 35 , and help hospitals avoid additional costs. 36 Increas- ingly, the practice of prewarming, or actively warming patients before surgery, is being recognized as an effective way to head- off unintended hypothermia before it can begin. Prewarming with a forced-air warming system before surgery can reduce an anesthesia-induced decline in core temperature called "redistribution temperature drop" experienced by anes- thetized patients. 37,38 Prewarming coupled with intraoperative FAW can prevent unintended hypothermia in procedures over one hour in length while reducing the frequency of hypother- mia's associated negative outcomes. "Redistribution, not heat loss to the environment, is the dom- inant cause of intraoperative hypothermia, especially in short- er duration surgeries," said Al Van Duren, director of scientific affairs & education with 3M Health Care. "Even vigorous intra- operative warming cannot rapidly reverse the effect of redis- tribution; therefore, continuous intraoperative normothermia in adults is virtually impossible without prewarming."