Becker's Clinical Quality & Infection Control

67 Executive Briefing Sponsored by: S urgical site infections are among the most common healthcare-associated infections, accounting for up to 21.8 percent of HAIs, according to a study by Magill et al. 1 SSIs not only cause increased morbidity and mortality for patients, but also increase the cost of delivery of care due to hospital readmissions, increased length of stay, 2, 3 and operative revisions, such as removal of hardware in orthopedic surgery infections. 4 Up to 60 percent of SSIs are preventable and are penalized in the Value-Based Purchasing and Hospital- Acquired Condition Reduction Programs. 5 These conditions are not reimbursed by Medicare and include SSI following certain orthopedic procedures, as well as other surgical procedures. 6 Although the Institute for Healthcare Improvement, The Joint Commission and others have made recommendations leading to successful interventions to improve patient outcomes and reduce infection risk, 7, 8 the prevalence and high cost of infectious complications warrant continuing effort to prevent hospital-acquired wound infections in surgical wounds and wounds caused by device insertion. One area of active research is antimicrobial dressings with the purpose of protecting the wound, promoting an optimal healing environment and reducing the risk for potential microbial growth under the dressing. Preoperative skin antisepsis is recommended to reduce the risk of infection, but the skin's endogenous flora — the primary pathogen source for SSI — quickly regenerate. 9 The use of antiseptic dressings can help reduce regrowth of bacteria on the skin. 10 Postoperative dressings ideally help protect the wound against infection, 11 and newer types of dressings have incorporated antimicrobial agents in pursuit of this goal. Although Staphylococcus is thought to be the major pathogen in SSIs, other pathogens are also frequently found in wounds, suggesting that an antimicrobial choice should include coverage for both gram-positive and gram-negative bacteria. 12 Two commonly used antimicrobial agents used in antiseptic dressings are silver-based products and CHG. CHG has been shown in multiple studies to be an effective antiseptic. CHG molecules have a positive charge, binding strongly with negative charges in the cell walls, causing cell death. The broad-spectrum activity of CHG includes an antiseptic effect against bacteria and yeast. 13 CHG has also been found to be effective as part of a prevention bundle. Schweizer et al 14 found that the use of CHG bathing, intranasal mupirocin and antibiotic prophylaxis prior to surgery led to a decrease in complex S. aureus wound infections. The effects of CHG on microbial growth under dressings has also been studied. In a healthy human study, Bashir and colleagues 10 found that CHG was effective in suppressing bacterial growth under occlusive dressings. The ReliaTect® Post-Op Dressing with CHG was designed to provide many of the components of the ideal postoperative dressing, as described by Dumville et al 15 in a Cochrane Review. These attributes include the ability to absorb and contain exudate without leakage, impermeability to water and bacteria, suitability of use with different types of wound closures, avoidance of wound trauma during dressing changes, and lower frequency of required dressing changes. 11,16,17 In addition to these dressing characteristics, the ReliaTect® Post- Op Dressing with CHG prevents external contamination of the wound through the functions of two different layers: the outer film layer and the adhesive layer. The outer film layer serves as a barrier that is impermeable to external contaminants, including fluids (waterproof), bacteria, viruses and yeast. 18 The inner adhesive layer contains CHG. In vitro tests have demonstrated that ReliaTect® Post-Op Dressing with CHG inhibits microbial colonization within the dressing. 18 A novel post-op dressing with CHG to reduce post-op contamination risk RELIATECT ® POST-OP DRESSING WITH CHG The ReliaTect® Post-Op Dressing with CHG was designed to provide many of the components of the ideal postoperative dressing, as described by Dumville et al 32 in a Cochrane Review. These attributes include the ability to absorb and contain exudate without leakage, impermeability to water and bacteria, suitability of use with different types of wound closures, avoidance of wound trauma during dressing changes, and lower frequency of required dressing changes. 23,33,34 In addition to these dressing characteristics, the ReliaTect® Post-Op Dressing with CHG prevents external contamination of the wound through the functions of two different layers: the outer film layer and the adhesive layer. The outer film layer serves as a barrier that is impermeable to external contaminants, including fluids (waterproof ), bacteria, viruses, and yeast. 35 The inner adhesive layer contains CHG. In vitro tests have demonstrated that ReliaTect® Post-Op Dressing with CHG inhibits microbial colonization within the dressing. 35 This antimicrobial recommended 4-log reduction microorganisms rapid; clinically In addition absorptive. of blood, amounts ReliaTect® visualization assessment; changes direct observation for SSI detection. and moisture contaminants. absorption help the exudate ReliaTect® 7 days, cytotoxic, providing ReliaTect® accommodate in x 5.9 Comprehensive protection 18 Reduces 99.99% of the following bacteria within 1 day GRAM-NEGATIVE BACTERIA > Escherichia coli (ATCC 8739) > Pseudomonas aeruginosa (ATCC 9027) > Klebsiella pneumoniae (ATCC 4352) > Enterobacter aerogenes (ATCC 13048) GRAM-POSITIVE BACTERIA > Staphylococcus aureus (ATCC 33591) > Staphylococcus epidermidis (ATCC 12228) > Enterococcus faecalis (ATCC 51575) OTHER > Candida albicans (yeast) (ATCC 10231) S

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