Prevention of surgical site infections (Updated)

“The morbidity for 2018 in the US was 157,500 for surgical site infections (SSI), with an estimated mortality of 8,205. 11% of all deaths in intensive care units were associated with SSI. It is a burden for the patient with an additional 11 days of hospitalization for each SSI and a burden to the system with an overall cost of $3.2 billion per year.”1

A collection of 50 PubMed citations has been compiled related to prevention of surgical site infections (SSIs). This material is an update to a 2018 post.

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Effectiveness and uses of Chlorhexidine Gluconate (CHG)

Skin preparation in the hand surgery clinic: A survey of Canadian plastic surgeons and a pilot study of a new technique. (2018). Canadian Journal of Infection Control, 33(2), 102.

Randomized, Prospective Study of the Order of Preoperative Preparation Solutions for Patients Undergoing Foot and Ankle Orthopedic Surgery. (2016). Foot & Ankle International /, 37(5), 478.

Reducing Mediastinitis after Sternotomy with Combined Chlorhexidine-Isopropyl Alcohol Skin Disinfection: Analysis of 3,000 Patients. (2016). Surgical Infections., 17(5), 552.

Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit? (2013). American Journal of Infection Control : Applied Epidemiology in Health Care Settings and the Community, 41(S5), S49.

Chlorhexidine is a better antiseptic than povidone iodine and sodium hypochlorite because of its substantive effect. (2013). American Journal of Infection Control : Applied Epidemiology in Health Care Settings and the Community, 41(7), 634.

BNurs. (2019). Antimicrobial-resistant bacteria (AMRB): Chlorhexidine Gluconate Body Washing Intensive Care (ICU) Settings

Nnaji. (2019). Surgical Site Infections: Intensive Care and Chlorhexidine Gluconate Bathing.

Manuel. (2018). Bloodstream Infections (Pediatrics): Chlorhexidine Gluconate Bathing.

Moola. (2018). Multidrug-Resistant Organisms: Chlorhexidine Gluconate Bathing.

Moola. (2018). Central Line-Associated Bloodstream Infections: Chlorhexidine Gluconate Bathing.

PubMed Search for additional literature on CHG usage

(((Chlorhexidine Gluconate OR chg)) AND (use or usage or uses)) AND procedure*

https://www.ncbi.nlm.nih.gov/pubmed?otool=emorylib

What is the evidence for using tap water vs sterile water to flush feeding tubes?

The type of feeding tube seems to determine whether water or sterile water should be used.

Below are several results from the Joanna Briggs Institute (JBI) database, which includes “selected clinical topics in evidence based recommended practices, evidence summaries, best practice information sheets, systematic reviews, and more.” You should have access to JBI and to the documents below using your Healthcare ID and password.

Nasoenteric Tube Feeding
Enteral Tube Feeding
Percutaneous Endoscopic Gastrostomy: Tube Blockage

For additional results, access JBI and search for feeding tube and limit to the types of evidence you seek.

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Important message for Emory Decatur Nurses.

The links will not work for you. To access these articles contact the Emory Decatur Library:

Emory Decatur Hospital
Jessica Callaway (Jessica.callaway@emoryhealthcare.org)
404.501.1628

Hospital-acquired pressure ulcers

Dramatic Reduction in Hospital-Acquired Pressure Injuries Using a Pink Paper Reminder System. (2018). Advances in Skin & Wound Care., 31(3), 118.

Implementation of a Nurse Driven Pathway to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive Care Setting. (2018). Journal of Pediatric Nursing., 41, 104.

Does Incremental Positioning (Weight Shifts) Reduce Pressure Injuries in Critical Care Patients? (2017). Journal of WOCN : Wound, Ostomy, and Continence Nursing., 44(4), 319.

Predictors of superficial and severe hospital-acquired pressure injuries: A cross-sectional study using the International Pressure Ulcer Prevalence™ survey. (2019). International Journal of Nursing Studies., 89, 46.

Reducing Pressure Injuries in a Pediatric Cardiac Care Unit: A Quality Improvement Project. (2018). Journal of WOCN : Wound, Ostomy, and Continence Nursing., 45(6), 497.

INTERPROFESSIONAL STRATEGIES SUCCESSFULLY REDUCE HOSPITAL-ACQUIRED PRESSURE INJURY PREVALENCE IN A REGIONAL NONTEACHING HOSPITAL…WOCN Society’s 49th Annual Conference, Salt Lake City, Utah, May 19-23, 2017. (2017). Journal of WOCN : Wound, Ostomy, and Continence Nursing., 44, S35.

Outcomes of a Quality Improvement Program to Reduce Hospital-acquired Pressure Ulcers in Pediatric Patients. (2018). Ostomy/wound Management., 64(11), 22.

Pressure Injuries: Preventing Medical Device Related Pressure Injuries.
Wound Healing and Management Node. Haesler, E. [PhD].
[Evidence Summaries]
AN: JBI18873
Year of Publication
2017

Use of mobility subscale for risk assessment of pressure ulcer incidence and preventive interventions: A systematic review.
Mordiffi, Siti Zubaidah [MHlthSc(Edun), BN, OTNC, RN.]. Kent, Bridie [PhD, BSc(Hons), FCNA(NZ), RNT, RN.]. Phillips, Nicole [PhD, MNS, GDipAdvNsg(Educ), BN, DipAppSc(Nsg), RN.]. Tho, Poh Chi [AdvDipNsg(Ortho), RN.].
JBI Database of Systematic Reviews & Implementation Reports. 9(56):2417-2481, 2011.
[Systematic Reviews]
AN: JBI5804
Year of Publication
2011

Prevention of surgical site infections (SSIs)

A collection of 71 articles in PubMed has been compiled on prevention of surgical site infections (SSIs). It consists of systematic reviews, meta-analyses, and guidelines from various sources, including Cochrane, WHO and CDC. There is a wide variety of topics: sterile technique, patient engagement, coated sutures, operating room traffic, preoperative bathing, physician 360-degree reporting, forced-air warming, dressings, teamwork and collaboration, and much more. Articles on usage of antibiotics are not included.

To read abstracts and access full text (where available), first go to Emory’s instance of PubMed and copy/paste this URL into the same browser window. Use the “Find It @ Emory” button to access an article’s full text.

The Agency for Healthcare Research and Quality (AHRQ) has several reports and information on prevention of SSIs. Here are some items from their website:

Toolkit to Promote Safe Surgery helps identify opportunities to improve care and safety practices and implement evidence-based interventions to prevent SSIs. The toolkit includes two guides, supplemental tools for each guide, and 15 instructional modules within three phases (on-boarding, implementation, sustainability) to support change at the unit level.

Toolkit to Improve Safety in Ambulatory Surgery Centers addresses what can be done to prevent SSIs and other complications.

Proactive Risk Assessment of Surgical Site Infections in Ambulatory Surgery Centers includes a list of patient factors that make them high-risk, such as obesity, but also includes things that staff do that lead to increasing rates of infection, such as “fail to remove watch/jewelry/fake nails.”

Creating a Culture of Safety in the Ambulatory Surgery Environment Implementation Guide states that an anticipated benefit for ASCs participating in the program includes a reduction in SSIs and other surgical complications.

Advances in the Prevention and Control of HAIs includes a chapter entitled “Development and Implementation of a Consensus Algorithm to Optimize Preoperative Antimicrobial Prophylaxis and Decrease Gram-Positive Surgical Site Infections for Cardiac and Orthopedic Procedures.”

AHRQ has an ongoing safety program for improving surgical care and recovery. One outcome of the 5-year project will be creation of a toolkit. Visit their website for information on the project and how to enroll a hospital in the program.

Risk factors for developing clostridium difficile (aka c. diff) and/or risk stratification for development and reoccurrence of C. Diff

This collection contains 36 articles on risk factors for developing clostridium difficile (aka cdiff) and/or risk stratification for development and reoccurence of cdiff.

Here is one search technique that was used to find articles in PubMed: ((“Clostridium Difficile”[Mesh] OR “clostridium difficile”[ti] OR “c diff”[ti] OR cdiff[ti]) AND (“Risk Factors”[Mesh] OR “risk factors”[ti]) AND (systematic[sb] OR Meta-Analysis[ptyp])) OR ((“Clostridium Difficile”[Mesh] OR “clostridium difficile”[ti] OR “c diff”[ti] OR cdiff[ti]) AND ((risk OR risks) AND (stratify OR stratifies OR stratified OR stratifying OR stratification)))

To access the collection and to read abstracts and access full text (where available) using the Find it @ Emory button, please first open Emory’s instance of PubMed. Once you have accessed PubMed, copy/paste the following url into the same browser window: https://www.ncbi.nlm.nih.gov/myncbi/collections/56047643/
If are an Emory Healthcare employee and do not have access to an article you need, send the citation(s) to Ask a Librarian.

Encouraging patients to ask about hand hygiene

Here is how to access 13 articles on encouraging patients to ask about hand hygiene (AKA the “it’s okay to ask” campaign).
a. Go to the Woodruff Health Sciences Center Library homepage: http://health.library.emory.edu
b. Click on PubMed.
c. Then paste this links into your browser:
https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/52594031/public/