Becker's Clinical Quality & Infection Control

15 INFECTION CONTROL Hot Weather Can Increase SSI Incidence by Nearly 30% By Anuja Vaidya A new study published in Infection Control & Hospital Epidemiology links high temperatures to an increase in risk of surgical site infection-related hospitalizations. Researchers used the National Inpatient Sample database to identify all hospital discharges with a primary diagnosis of SSI from 1998 to 2011. They used data from the National Climatic Data Center to estimate the monthly average tem- peratures for all hospital locations. The study shows that SSI incidence is seasonal, with the highest SSI incidence occurring in August and the lowest in January. Researchers found there were 26.5 percent more SSI cases in August than in January. Additionally, the odds of a hospitalization with a primary diagnosis of SSI increased by around 2.1 percent with every 5 degree Fahrenheit increase in average monthly temperature. Temperatures above 90 degrees Fahrenheit increased the odds of a SSI-related hospital admission by 28.9 percent compared to temperatures below 40 degrees Fahrenheit. n Mandatory Use of Bouffant Caps Does Not Impact SSI Rates, Study Shows By Anuja Vaidya E liminating the use of traditional surgical skull caps in favor of bouffant caps does not reduce the rate of surgical site infections, according to a study published in Neurosurgery. Hospital organizations have increasingly mandated the use of bouffant caps in place of surgical skull caps. Researchers examined SSI data at a single site with 25 operating rooms from January 2014 to March 2016. In February 2015, the hospital's policy changed to make use of bouffant caps compulsory. The researchers studied SSI rates for 7,513 patients in the 13 months before the policy change and for 8,446 patients in the 13 months after. The study shows SSI rates increased by 0.07 percent overall for all operating room cases. However, research- ers did not note a statistically significant difference in SSI rates before and after the bouffant cap policy imple- mentation. n AORN Experts Respond to Study on Bouffant Use and SSI Rates By Heather Punke E xperts from the Association of periOp- erative Registered Nurses sent a letter to the editor of the journal Neurosur- gery in response to a study published in the journal that found use of bouffant caps does not impact surgical site infection rates. In the study, researchers tracked SSI rates in one hospital 13 months before and 13 months aer it banned surgical skull caps from its operating rooms. ey concluded the "elimination of traditional surgeon's cap did not reduce infection rates." e study's authors wrote that AORN's Guideline for Surgical Attire "mandated the use of bouffant caps to prevent SSIs" and urged organizations to stop using skull caps. In the letter to the editor, AORN calls these statements "unequivocally incorrect" and goes on to say AORN "does not specify the type or style of head covering that should be worn." Instead, the guidelines say, "A clean surgical head cover or hood that confines all hair and completely covers the ears, scalp skin, side- burns, and nape of the neck should be worn," as hair carries bacteria that could cause an SSI. "We don't specify how you do it, we just say cover your hair, all of your hair," Lisa Spruce, DNP, RN, AORN's director of evidence-based perioperative practice, tells Becker's. "It's up to the facility to determine what's the best way to get everyone's hair covered." Dr. Spruce, one of the letter's authors, says it's a "myth" in some facilities that AORN mandates the use of bouffants over skull caps. Some organizations have stopped allowing skull caps in the OR because they are not always efficient at covering all of a person's hair. And while the study's authors concluded eliminating use of the skull cap did not re- duce SSI rates, AORN experts looked at the data and came to a different conclusion — there was a slight improvement in SSI rates aer seven weeks of bouffant use in all class I OR cases and aer five weeks of bouffant use in spine procedures. "If you look at the scatter plot they provided, it shows SSI rates went down when everyone started wearing a bouffant," Dr. Spruce says. "ey misinterpreted the evidence." e reason for the delay in SSI rate reduction indicates it can take weeks or months to get everyone compliant with a new mandate, ac- cording to Dr. Spruce. "It takes a few months for everyone to be compliant, and then you naturally see improvement," she says. In the future, Dr. Spruce and AORN would like hospitals to form multidisciplinary teams when deciding what kind of head covering can be used in the facility, rather than handing down a mandate with no discussion. Everyone who wears hair covering in the OR — surgeons, nurses, anesthesia professionals — should be consulted before a decision is made. AORN experts also noted SSI prevention needs a bundled approach and "covering and containing hair is a reasonable and prudent measure." "ere is no harm in doing so, but the bene- fit to all patients is a reduced risk of exposure to potentially pathogenic organisms that live on the hair, skin, ears and facial hair of perioperative team members," the letter concludes. n

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