Ritualistic Practices
Do Not Prevent
Surgical Site Infections
Sarah Judkins, MD
University of Colorado
Surgical Grand Rounds
OBJECTIVES
• Historical Perspective
• Scrubbing
• Masks
• Skin Prep
• Conclusions
SURGICAL SITE
INFECTIONS
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Obesity
Age
Diabetes
Nicotine
Steroids
Malnutrition
Blood Tx
OR time
Why do we care?
• major cause of morbidity and mortality
2-5% of clean surgeries
up to 20% of intra-abdominal surgeries
• increase length of stay 7 days
• results in > $3000 additional charges
• Five times more likely to be readmitted
• Two times more likely to die
SCRUBBING
Hingst, et al. J Hosp Infect 1992
5mins3mins
Deshmukh, et al. Mil Med 1998
5mins1mins+foam
Wheelock, et al. AORN 1997
3mins2mins
O’Farrell, et al. J Hosp Infect 1994
10mins5mins
SCRUBBING
• hand scrubbing VS. hand rubbing
• 4387 consecutive patients
SSI rates
2.48% (scrubbing) VS. 2.44% (rubbing)
compliance and tolerance improved in
hand rubbing protocol
Pariente, JJ. JAMA 2002
MASKS
Dr. Johannes von Mikulicz-Radecki
‘mundbinde’ (1897)
MASKS
Dr. Arthur E. Hertzler
The Horse and Buggy Doctor (1938)
Orr, N. Ann R Coll Surg, 1981
• 1049 elective general surgery cases
•
6 months with, then without masks
50% reduction in wound
infections in UNMASKED group
MASKS
3088 consecutive surgeries
1537 operations with masks
SSI 4.7%
1551 operations without masks
SSI 3.5%
Tunevall, TG. World Journal Surg, 1991
SKIN PREP
scrub+paint (115) vs. paint alone (119)
groups well-matched (p>0.09)
SSI rate
10% scrub+paint vs. 10% paint alone
Ellenhorn, et al. J Am Coll Surg 2005
THE FUTURE
• Minimize risk factors
• Redose antibiotics
• More laparoscopy
• Improved OR air flow systems
• Improved infection control in hospitals
REFERENCES
Pariente, JJ, et al. Hand-Rubbing With an Aqueous Alcoholic Solution vs Traditional
Surgical Hand-Scrubbing and 30-Day Surgical Site Infection Rates. JAMA
2002;288:722-727.
Hingst, V, et al. Evaluation of the efficacy of surgical hand disinfection following a
reduced application time of 3 instead of 5 min. J Hosp Infect 1992;20:79–86.
Wheelock, SM, et al. Effect of surgical hand scrub time on subsequent bacterial growth.
AORN 1997;65:1087-92.
Deshmukh, N, et al. A comparison of 5-minute povidone-iodine scrub and 1-minute
povidone-iodine scrub followed by alcohol foam. Mil Med 1998;163:145-7.
O’Farrell, DA, et al. Evaluation of the optimal hand-scrub duration prior to total hip
arthroplasty. J Hosp Infect 1994;26:93-8.
Orr, N. Is a mask necessary in the operating theater? Ann R Coll Surg Engl
1981;63:390-2.
Tunevall, TG. Post operative wound infections and surgical face masks: A controlled
study. World Journal of Surgery 1991;15:383-7.
Beck, WC. The Surgical Mask: Another sacred cow? AORN 1992;55:955-7.
Ellenhorn, JD, et al. Paint-only is Equivalent to Scrub-and-Paint in preoperative
preparation of abdominal surgery sites. J Am Coll Surg 2005;201:737-41.