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Running head: CHLORHEXIDINE GLUCONATE PREOPERATIVE SHOWER

Chlorhexidine Gluconate Preoperative Shower
Christine Elizabeth Costlow

Annapolis Hospital

POHA / PACU

September 30, 2012

Chlorhexidine Gluconate Preoperative Shower
“Each year, more than 18 million surgical procedures are preformed in US hospitals. The Center for Disease Control and Prevention (CDC) estimates that 2.7% of these are complicated by surgical-site infections (SSIs), accounting for at least 486,000 nonsocomial infections each year” (Kirkland et al, 1999, p. 725). According to Scott each infection burdons the health care system with expenses ranging from “$10,443 to$ 25,546” (2009, p. 5). In addition to the increased cost associated with treating the SSI Berrios (2009) sites in the Surgical Site Infection (SSI) Toolkit that each individual with a SSI has an increased rate of mortality. Among all patients diagnosed with a SSI, there is a 3% mortality rate, which is 2-11 times higher risk of death than the average surgical patient. Berrios continues by stating, “75% of deaths among patients with SSI are directly attributable to SSI” (2009, p. 2). At this time there is not an agreed upon method to preventing SSIs. There have been many studies and discussions over the best practice to avoid infection; however, to date it is the responsibility of each individual surgical center to determine the method that will be used to achieve the desired outcome of zero surgical site infections among their surgical patients. The following paper will outline the current state of Annapolis’ pre-operative practice in regards to SSI prevention. Research which supports a change in practice will be examined. The outline of the implementation plan for the use of Chlorhexidine Gluconate Preoperative Shower will be detailed. Staff compliance and Annapolis’ most recent post surgical site infection data will be evaluated. In conclusion, the plans going forward for SSI prevention at Annapolis will be discussed. Current State of Practice

The changes in healthcare reporting and payment have made it essential for the healthcare industry to examine current practices and adapt to strive for both better patient outcomes and increased revenue. Annapolis’ current preoperative processes revolve around the Surgical Care Improvement Project (SCIP) initiatives. SCIP includes eight guidleines that were developed and implemented to improve surgical patient’s outcomes. SCIP 1 and SCIP 2 recommendations are used in the preoperative and intraoperative area to assist in the prevention of post-surgical infections. The Joint Commission describes SCIP 1 as “Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision” (2012, p. SCIP-Inf-1-1). SCIP 1 initiative is futher detailed as follows; “Surgical patients with prophylactic antibiotics initiated within one hour prior to surgical incision. Patients who received vancomycin or a fluoroquinolone for prophylactic antibiotics should have the antibiotics initiated within two hours prior to surgical incision. Due to the longer infusion time required for vancomycin or a fluoroquinolone, it is acceptable to start these antibiotics within two hours prior to incision time” (Joint Commission, 2012, p. SCIP-Inf-1-1). Annapolis management and unit council has set in place a process, which ensures that each patient receives the ordered antibiotic within the time set forth by the guidelines. This is carried out by the preassessment or preoperative nurse obtaining an order for the correct antibiotic. Once the surgical patient is in the pre-operative department, the nurse obtains the antibiotic and places it at the bedside for anesthesia to initiate prior to transporting the patient to the operating suite. This process ensures that the antibiotic is started no more that 60 minutes prior to incision time. SCIP 2 compliance is maintained by closely working with the surgeons to ensure...
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