An estimated 400,000 surgical site infections (SSIs) occur each year in the United States, leading to nearly 10,000 deaths, significant morbidity, and excess healthcare resource utilization. Preadmission antiseptic showers with chlorhexidine gluconate (CHG) have been shown to effectively inhibit or kill microbial florae on the surface of the skin, thereby reducing the risk for SSIs. However, research has suggested that patient compliance with preadmission showering protocols appears to be lower than expected.
Testing Electronic Reminders
A preadmission shower product organization recently built an electronic alert, web-based system that provides reminders for patients to take their preadmission shower with CHG via text message, email, or voice mail. For a study published in the Journal of the American College of Surgeons, Charles E. Edmiston, Jr., PhD, and colleagues analyzed the benefits of using the electronic alert system for enhancing compliance with a preadmission showering protocol. Participants were instructed to take preadmission showers and then randomized to receive either electronic reminders or no reminders. Compliance was measured by assessing skin surface concentrations of CHG.
“Patients who received the electronic alerts had significantly higher skin surface concentrations of CHG than those who didn’t get the reminders,” says Dr. Edmiston. Patients who were not alerted had 65% lower average concentrations of CHG on their skin surface when compared with those who received electronic reminders. “Our findings suggest that patients can be empowered to be an intimate part of the process using electronic alerts,” adds Dr. Edmiston. “We found that 85% of participants—both young and old—wanted to receive texts rather than emails (10%) or voicemail messages (5%). It appears that texting is an important mechanism to communicate with patients.”
Dr. Edmiston notes that the electronic alerts helped ensure that patients had CHG concentrations on their skin that were high enough to reduce or kill any microbial populations that could be perceived as a possible postoperative pathogen. This included Staphylococcus, a type of bacteria that often plays a significant role in the development of postoperative SSIs.
It is of critical importance for clinicians to emphasize the overall benefits of preadmission showers to patients, says Dr. Edmiston. “Instructions should be provided on the amount of CHG needed to maximize skin surface concentrations, the importance of waiting about 1 minute before rinsing it off, and the need to avoid using lotions, creams, or perfume following the shower,” he says. “One of the most important components of ensuring preadmission shower adherence is for surgeons to directly provide patients with the CHG rather than rely on sending them to a retail pharmacy. We can also use this opportunity to explain to patients why they need to use the product.”
Readings & Resources (click to view)
Edmiston C, Krepel C, Edmiston S, et al. Empowering the surgical patient: a randomized, prospective analysis of an innovative strategy for improving patient compliance with preadmission showering protocol. J Am Coll Surg. 2014;219:256-264. Available at www.journalacs.org/article/S1072-7515(14)00303-2/abstract.
Jakobsson, J, Perlkvist A, Wann-Hansson C. Searching for evidence regarding using preoperative disinfection showers to prevent surgical site infections: a systematic review. Worldviews Evid Based Nurs. 2011;8:143-152.
Edmiston C, Krepel C, Seabrook G, et al. Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission. J Am Coll Surg. 2008;207:233-239.
Lipke V, Hyott A. Reducing surgical site infections by bundling multiple risk reduction strategies and active surveillance. AORN J. 2010;92:288-296.