Beyond skin deep

New strategy lowers surgical site infections

Your skin is one of the largest and heaviest organs on your body and serves as the first line of defense against germs, harmful substances and environmental factors such as the sun or wind. In the operating room, this layer of protection ironically becomes one of the biggest sources of complications.

Over the course of an average day, most active individuals come into contact with 300 surfaces every 30 minutes, exposing them to 840,000 microorganisms that may cause infection or illness.

“This is always a risk, and it primarily comes from having your skin incised,” said Rita Jay, director of outpatient surgery at UF Health Jacksonville. “All of the bacteria on the skin can certainly enter that wound, so it’s important to decrease as many of the microorganisms from entering that wound as possible.”

Surgical-site infections, or SSIs, occur in 2 to 5 percent of all patients undergoing inpatient surgeries nationwide. They can lead to prolonged stays, additional surgeries, increased use of antibiotics, disability among patients and even mortality. According to the Centers for Disease Control and Prevention, SSIs also cost up to $10 billion annually to treat.

Over the past year, UF Health Jacksonville’s surgical clinics have been giving patients the antiseptic chlorhexidine gluconate, or CHG, at no cost in an effort to reduce SSIs. “It is especially designed for the bacteria on our skin,” said Delia Card, assistant nurse manager for Pre-Admission Testing. “What I tell my patients is that it’s like Dial soap on steroids. It is especially designed to kill the bacteria on our body.”

UF Health Jacksonville formed a task force of hospital administrators, surgeons, nurses and others involved in surgeries to analyze processes and procedures. As a result, the antiseptic is now being provided to patients in 26 practices and through Pre-Admission Testing at the hospital.

“It’s not just about giving a bottle of CHG to a patient and telling them to use it. It’s getting them to understand why it’s important and emphasizing the role they play in their own safety,” Jay said.

Patients receive the liquid antiseptic in a 4-ounce bottle. They are instructed to use half of it the night before and the other half the morning of surgery. Patients who are immobile, bedbound or are in a wheelchair are given 12 CHG cloths with similar instructions. Six wipes are used the night before surgery, and the other six are used the day of the procedure. “You never use the soap or cloths on your face or above the neckline. It doesn’t touch your face, hair or genitals,” Card said.

Clinicians also disinfect patients with the cloths at the hospital before their procedure. A 4-ounce bottle of CHG costs about $2, and a 12-pack of antiseptic cloths costs slightly more, but hospital administrators have decided to add the expense to the organization’s budget. “If we can stop one postoperative infection, we have already gotten our money back,” Card said.

Since the initiative began, postsurgical sepsis infections have dropped from 4.7 percent in 2015 to 1.62 percent in 2016. So far the program has about a 68 percent compliance rate, but as that improves, clinicians hope the SSI rate will too. “Something we never take for granted in the operating room is the teamwork required to accomplish what we do,” Jay said. “This initiative is something we can’t do in isolation. It takes the entire team.”