Erin Kyle, DNP, RN, CNOR, NEA-BC
Editor in Chief, Guidelines for Perioperative Practice for AORN
Erin Kyle, DNP, RN, CNOR, NEA-BC, Editor in Chief, Guidelines for Perioperative Practice for AORN, describes some key recommendations that are new to the Guideline for Preoperative Patient Skin Antisepsis.
Surgical site infection (SSI) is the costliest healthcare-acquired infection, with an estimated annual cost of $3.3 billion. According to the Centers for Disease Control, it is associated with nearly 1 million additional inpatient days annually. To support implementing practices that reduce the patient’s risk of developing an SSI, the Association of perioperative Registered Nurses (AORN) has revised its Guideline for Preoperative Patient Skin Antisepsis to reduce the patient’s risk of developing an SSI – before they even enter the OR or procedure room.
Preoperative decolonization program
SSIs can be caused by the patient’s own flora, an endogenous infection. Adding decolonization programs for patient skin antisepsis is supported by a large body of evidence and allows the perioperative nurse to implement measures that can reduce patient risk factors associated with being a carrier of Staphylococcus aureus, including methicillin-resistant and susceptible S. aureus. The evidence on decolonization programs includes:
- Universal programs: treating all patients regardless of colonization status,
- Targeted programs: treating only those patients identified as colonized, and
- Blended programs: combining both universal and targeted strategies.
“The guideline recommends that interdisciplinary teams use the evidence that is presented in the guideline and determine the type of decolonization program that is right for their patients and organization,” said Kyle.
Just as with preoperative decolonization, the evidence about the effectiveness of preoperative bathing to reduce the patient’s own flora is presented in the guideline; the guideline recommends that preoperative bathing be implemented using a standardized protocol and clear patient instructions.
This guideline includes a discussion of evidence that evaluated implementation of patient skin antisepsis elements, such as preoperative decolonization and preoperative bathing as part of SSI prevention bundles. The evidence in this guideline suggests that these bundled approaches can be effective in reducing rates of SSI.
The revised guideline also provides recommendations for patient skin pigmentation and skin antiseptic solutions, safety considerations for using alcohol-based skin antiseptics, and information about using sterile solutions and sequential antiseptic applications.