INF ECTIO N CO NTRO L
Updated Skin Antisepsis Guidelines Aim to Reduce Surgical Site Infections By BOB KRONEMYER
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ince its introduction in the 19th century, skin antisepsis has helped to reduce the incidence of health care–associated infections. Updated guidelines from the Association of periOperative Registered Nurses (AORN) now offer new evidence to help interdisciplinary teams make decisions and standardize preoperative skin antisepsis protocols. “Standardization eliminates variability, resulting in less waste, fewer errors and improved quality outcome,” said lead author Karen deKay, MSN, RN, CNOR, CIC, a perioperative practice specialist at AORN, in Denver. “Skin antisepsis is a broad term that includes several interventions to reduce the microbial load on the patient’s skin and inhibit rapid rebound growth of microorganisms from the skin where the incision will be made.” Skin antisepsis is important because the removal of soil and transient microorganisms, as well as the reduction of resident microorganisms, minimize the number of bacteria on the skin near the surgical site, according to Ms. deKay. “The intervention most perioperative personnel are familiar with is surgical site preparation. When an incision is made, it compromises our body’s coat of armor and increases the likelihood of introducing microorganisms internally,” she said. “Hence, reducing the number of microorganisms near the incision site decreases the chance of skin microorganisms entering the surgical site through the incision, thereby decreasing the chance for a surgical site infection [SSI].”
Clinical practice guidethe risk of death, hospitallines for SSI prevenization, prolonged recovtion from various health ery and even long-term agencies and professional complications. By reducing societies recommend decolcomplications, the guideonization, alcohol-based skin line promotes patient safety.” antiseptics and bundles to Dr. Camins said the curdecrease the incidence of SSIs. rent and previous versions “Most clinicians are of the AORN guidelines Skin antisepsis is aware of the benefit of “provide clinicians the important because decolonization in reductools necessary to reduce ing SSIs,” Ms. deKay said. the bioburden found on the the removal of “However, they may not be skin to avoid contaminasoil and transient aware that decolonization is tion of the surgical wound. microorganisms, not indicated for all surgical Skin antisepsis is one of the patients and that commumost important measures as well as the nity, hospital and proceto prevent infections durreduction of resident ing surgery.” dure risk factors need to be microorganisms, evaluated by an interdisciFollowing the recomplinary team to determine minimize the number mendations of the guidewhich surgical population lines and the manufacturer’s of bacteria on the skin instructions for using antiwould benefit the most near the surgical site. septic solution carefully from decolonization.” Likewise, clinicians are “will result in a lower risk mindful of the need to decolonize for colo- for the development of SSIs,” he said. nization by methicillin-resistant StaphyloHowever, one potential obstacle in coccus aureus (MRSA). “However, they may implementing the guidelines is the time not be cognizant of the need to also decol- and resources required to form an interonize for methicillin-susceptible Staphylo- disciplinary team or using a facility’s curcoccus aureus colonization,” Ms. deKay said. rent SSI prevention task force “to take a “Patients with both methicillin-susceptible closer look at how preoperative patient and methicillin-resistant S. aureus in their skin antisepsis elements can contribnares or on their skin are more likely to ute to a reduction in the facility’s SSIs,” develop Staphylococcus aureus SSIs.” Ms. deKay said. If these elements are Bernard Camins, MD, the medical already part of a facility’s SSI bundle, director of infection prevention for the “you need to provide the resources necMount Sinai Health System, in New York essary to establish a process that will City, and a member of the AORN Guide- closely monitor adherence to these praclines Advisory Board, noted the guidelines tices, as regular observation of processwill decrease the risk for developing infec- es can identify inconsistencies and areas ■ tions after surgery, “therefore decreasing for improvement.”
Artificial Intelligence continued from page 6
“It is clear that health care is digitizing rapidly and that AI will permeate it increasingly and in profound ways,” Dr. MeltonMeaux, a professor of surgery and Core Faculty of the Institute for Health Informatics at the University of Minnesota, in 8
OR Management News • Volume 16 • September 2021
Minneapolis, said during her ACS talk. Despite these trends, Dr. Callcut cautioned that “we’re still in the hype cycle of AI—a lot of excitement, but the applications have not been scaled yet.” Dr. Ross agreed, highlighting other limitations and challenges of AI. “AI is also not going to do robotic surgeries for us. That vision of AI is far off, especially given the technology we have now.” ■
