Postoperative Wound Infections in Vascular Surgery: Effect of Preoperative Whole Body Disinfection by Shower-bath with Chlorhexidine Soap

Brandberg, A; Holm, Jan; Hammarsten, Jan; Scherstén, T

doi:10.1007/978-1-4612-5868-1_13

Cited by 12 publications

(10 citation statements)

References 4 publications

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“…A reduction in infection rates of groin wounds from 17.5% to 8% was obtained in patients undergoing vascular surgery; the patients showered three to eight times with chlorhexidine detergent before the operation. 25 However, a recent study in two hospitals in Birmingham showed no difference in infection rates of clean wounds (Table 2) following pre-operative bathing with either chlorhexidine detergent or non-medicated soap. 26 It was only possible for patients in this study to have one pre-operative bath and it may be that chlorhexidine would have shown a greater effect after repeated bathing or showering.…”

Section: Pre-operative Bathingmentioning

confidence: 93%

Surgical Scrub and Skin Disinfection

Ayliffe

1984

Infect. Control

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The role of pre-operative disinfection of the surgeon's hands and the skin of the operative site in the prevention of wound infection remains uncertain. The normal resident skin flora, consisting mainly of coagulase-negative staphylococci and aerobic and anaerobic diphtheroids, is an uncommon cause of infection except in prosthetic operations. Staphylococcus aureus is rarely a resident on normal skin other than the perineum, and is mostly present on the hands as a transient acquired from the nose. Nevertheless, it seems rational to kill or remove all transients on the hands of the surgeon and reduce residents to low levels.Surgical skin disinfection is usually assessed by measuring the reduction in organisms on the hands immediately after disinfection, after repeated applications of the disinfectant and after wearing gloves for two to three hours. The hands are commonly sampled in a bowl or plastic bag containing Ringer's or a similar solution and relevant neutralizers, or by the use of glove washings. A standardized technique is necessary to provide a statistical comparison between agents. Antiseptic detergents, chlorhexidine or povidone iodine show immediate reductions in bacterial counts of 70% to 80%, increasing to 99% after repeated application. Hexachloraphene and triclosan detergents show a lower immediate reduction but a good residual effect. Seventy percent ethyl or 60% propyl alcohol, with or without an antiseptic, show an immediate reduction of over 95%, and in excess of 99% on repeated application. Residual levels of organisms tend to be lower after repeated alcohol treatment than following the use of antiseptic detergents. A two to three-minute application of the antiseptic to the hands, without a scrubbing brush, is commonly recommended in the UK, but possibly in routine surgery an application time of 30 seconds is sufficient, killing or removing transients and superficial residents.

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Section: Pre-operative Bathingmentioning

confidence: 93%

Surgical Scrub and Skin Disinfection

Ayliffe

1984

Infect. Control

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“…However, improvements in disinfection in certain types of surgery, eg, insertion of cardiac prosthesis, might still be worthwhile but further evidence is required. 22 Host factors play a predominant role and assessment of risk and appropriate prophylaxis will probably have the greatest impact on infection rates in this type of surgery in the future, io.ii. 23 Since most surgical wounds seal within 24 to 48 hours, ward procedures have a small effect on the incidence of wound infection.…”

Section: %mentioning

confidence: 99%

Nosocomial Infection—The Irreducible Minimum

Ayliffe

1986

Infect. Control Hosp. Epidemiol.

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Prevalence surveys in different countries have shown that about 1 in 10 hospitalized patients at any one time have acquired an infection and the incidence of infection is usually about 3% to 5%. Can this infection rate be significantly reduced and is there an irreducible minimum below which further reduction cannot be obtained? Cross-infection could probably be almost eliminated by the use of plastic isolators or life islands, and endogenous infections reduced by the wider and more rational prophylactic use of topical and systemic antimicrobial agents, and possibly a range of vaccines. However, the use of these techniques on all patients would clearly be impractical and too expensive for use in the foreseeable future. Excessive isolation techniques would have a detrimental psychological effect on many patients. In addition, failure to eradicate the organisms of the normal flora might be associated with more infections caused by antibiotic-resistant bacteria, fungi and viruses which would be more difficult to treat. Even if organisms could be eradicated, morbidity and mortality might not be correspondingly reduced. Priorities must therefore be set on the most effective use of staff and finances. These not only involve a consideration of infection, but all areas of clinical practice, eg, costs of cardiac transplants and provision of geriatric facilities. It therefore seems likely that little additional finance will be available for control of infection, other than possibly for transmissible infections with high mortality such as AIDS.

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“…Brandberg et al. (1980) indicated that a full cholorohexidine bath in the preoperative period could reduce the postoperative wound infection, declaring that the infection rate among 341 elective vascular surgical patients was found to be 17·5% where CG had been cleaned with soap, a rate that decreased to 8% in SG patients that had been bathed three to eight times in cholorohexidine.…”

Section: Discussionmentioning

confidence: 99%

“…Baskan (2000) indicated that the occurrence rate of SSI among patients whose surgical site were shaved was 5AE6%; who used hair removers or nothing was 0AE6%; who were shaved right before the surgery was 3AE1%; 24 hours before the surgery was 7AE1% and more than 24 hours before the surgery was 20%. Brandberg et al (1980) indicated that a full cholorohexidine bath in the preoperative period could reduce the postoperative wound infection, declaring that the infection rate among 341 elective vascular surgical patients was found to be 17AE5% where CG had been cleaned with soap, a rate that decreased to 8% in SG patients that had been bathed three to eight times in cholorohexidine. Hayek and Emmerson (1988) performed a similar study on 250 patients and found SSI rates to be 12AE8% (cleaning with soap) and 11AE7% (cleaning with cholorohexidine) respectively and claimed that the difference between these groups was statistically significant.…”

Section: Clinical Issuesmentioning

confidence: 99%