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The Number One Threat to Surgical Patients
Of the approximately 60 million inpatient and ambulatory surgical procedures performed in the U.S. every year,1,2 surgical site infections (SSIs) occur after 2.6% to 5% of them,1,3 translating to at least 1.5 million SSIs every year.4 SSIs can add 7 to 10 days to a patient's length of stay5 and increase costs by an average of $25,546.3 Patients who develop an SSI are also "twice as likely to die."6 |
CDC RECOMMENDATIONS FOR PREVENTION OF SURGICAL SITE INFECTION
7. Require patients to shower or bathe with an antiseptic agent on at least the night before the operative day.5 Category IB†
† Category IB - Strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and strong theoretical rationale.
IHI FIVE MILLION LIVES CAMPAIGN
In its Five Million Lives Campaign, the Institute for Healthcare Improvement (IHI) includes a recommendation to fight MRSA infection.12
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The Source of SSIs
Most SSIs come from bacteria already found on a patient's skin. Multi-drug resistant organisms such as MRSA, VRE, and Acinetobacter are just some of the SSI-causing pathogens that can be found on a patient's skin. |
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A Costly Problem
SSIs are costly for both patients and hospitals. Consider this: SSIs may account for as much as $10 billion annually in direct and indirect medical costs.7 Cardiac surgery deep sternal and deep leg SSIs can add $55,000 to $85,000 to hospital cost per patient,3 and orthopedic SSIs can increase costs by over 300%.8 Even reimbursements to hospitals are being affected. Starting October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for certain conditions not present upon admission, including mediastinitis (an SSI from heart surgery).9 |
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The Human Cost
Patients who develop SSIs are:6
Twice as likely to die
60% more likely to spend time in an ICU
Over 5 times more likely to be readmitted
A study of elderly patients found SSI due to S. aureus was responsible for more than a 5-fold increase in mortality,10 and another study shows methicillin-resistant S. aureus (MRSA) in a surgical wound resulted in over a 12-fold increase in mortality compared to patients without an SSI.11
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| 1. DeFrances CJ, Hall MJ, Podgornik MN, 2003 National hospital discharge survey. CDC, National Center for Health Statistics, Advance Data from Vital and Health Statistics. No. 359;8 July 2005:14. 2. Hall MJ, Lawrence L, Ambulatory surgery in the United States, 1996. CDC, National Center for Health Statistics, Advance Data from Vital and Health Statistics. No. 300;12 Aug1998:7. 3. Stone PW, et al., Am J Infect Control. Nov 2005;33(9):501-9. 4. Figure calculated by multiplying SSI rate from ref. #5 by surgical procedure numbers from ref. #1 and #2. 5. Mangram AJ, et al., Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention, Hospital Infection Control Practices Advisory Committee, Atlanta GA. 6. Kirkland KB, et al., Infect Control Hosp Epidemiol. Nov 1999;20(11):722-4. 7. Urban JA, Surg Infect. 2006 Jun;7 Suppl 1:S19-22. 8. Whitehouse JD, et al., Infect Control Hosp Epidemiol. 2002 Apr;23(4):183-9. 9. Federal Register, Vol. 72 No.162, 2007 Aug: 47201-47205. 10. McGarry SA, et al., Infect Control Hosp Epidemiol. Jun 2004;25(6):461-7. 11. Engemann JJ, et al., Clin Infect Dis. 1 Mar 2003;36(5):592-8. 12. Getting started kit: Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) Infection: how-to guide. Protecting 5 million lives from harm campaign, Institute for Healthcare Improvement (IHI), 2006. 13. Edmiston CE, et al., Skin antisepsis: efficacy of innovative chlorhexidine-impregnated surgical skin wipe (CIW) compared to traditional chlorhexidine surgical prep (TCP). Abstract presented at Surgical Infection Society (SIS) Annual Meeting, April 2006. 14. Time Kill and MIC Testing conducted by an independent laboratory; data on file. 15. Testing conducted by an independent laboratory; data on file. 16. Ryder M, Improving Skin Antisepsis: 2% No-Rinse CHG Cloths Improve Antiseptic Persistence on Patient Skin Over 4% CHG Rinse-Off Solution. Poster presented at Association for Professionals in Infection Control and Epidemiology (APIC) June 2007. 17. Edmiston CE, et al., Comparative of a new and innovative 2% chlorhexidine gluconate-impregnated cloth with 4% chlorhexidine gluconate as topical antiseptic for preparation of the skin prior to surgery. American Journal of Infection Control(AJIC). Mar 2007;35(2):89-96. 18. Maki DG, Paulson DS, Prospective evaluation of 6 preoperative cutaneous antiseptic regimens for prevention of surgical site infection. Poster Presented at SHEA Conference, March, 2006. 19. Rhee H, Harris B, Preoperative Skin Preparation Protocol Results in Reduced SSI Rates. Presented at Institute for Healthcare Improvement (IHI), Orlando, FL, December 2007. 20. Livingston B, Challenges and Experience with Implementing Patient Preoperative Skin Preparation in a Veterans Administration (VA) Health System to Prevent Surgical Site Infections. Poster presented at Association for Professionals in Infection Control and Epidemiology (APIC) June 2007. 21. Eiselt D, Presurgical Skin Preparation with a Novel 2% Chlorhexidine Gluconate (CHG) Cloth Leads to Decrease in Surgical Site Infection Rates in Orthopedic Surgical Patients. Poster presented at Association for Professionals in Infection Control and Epidemiology (APIC) June 2007. 22. Edmiston C, et al., Comparison of a New and Innovative 2% Chlorhexidine Gluconate (CHG) Impregnated Preparation Cloth with the Standard 4% CHG Surgical Skin Preparation. Poster presented at the 2007 Association of periOperative Registered Nurses (AORN) Congress, Orlando, FL Mar 2007. |
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