Incidence of surgical site infections in clean, non-contaminated orthopedic cases in patients prepped using a commercially available topical skin antiseptic (Duraprep®), in a single tertiary hospital
Background: Surgical site infections (SSI) are still one of the most frequent causes of morbidity and mortality following any surgical procedure. In 2010, an estimated 16 million operative procedures were performed in acute care hospitals in the United States (1). A recent prevalence study found that SSIs were the most common healthcare-associated infection, accounting for 31% of all nosocomial infections (2). The Center for Disease Control healthcare-association infection (HAI) prevalence survey estimated that 157,500 cases of SSI are associated with in-patient surgeries in 2011 (3). In the era of multi-resistant organisms it is of utmost importance that surgeons have a clear understanding of the techniques used to prevent these dreaded infections. Antiseptic and aseptic techniques play an important part in the elimination if not the reduction of the incidence of post surgical infections. This study aims to determine the incidence of surgical site infections in clean, non-contaminated orthopaedic procedures for patients prepped using commercially available topical skin antiseptic (Duraprep ®). And to provide literature regarding its advantages over other types of skin antiseptics and other methods of surgical skin preparation techniques.
Methods: A chart review of patients admitted at St. Luke’s Medical Center, QC from January to September 2015 was done. Inclusion criteria included patients who underwent orthopaedic surgery classified as clean cases, use of skin antiseptic (Duraprep ®) following the instructions provided by the manufacturer and use of prophylactic antibiotics. Presence of surgical site infection within a thirty (30) day period was reported and using the criteria given by the CDC guidelines.
Results: A total of 74 cases were included in the study classified as 34 general adult cases, 11 trauma cases, 13 joint, 14 hand and 2 spine procedures. None of the cases had any incident of surgical site infection within 30 post-operative days. In terms of cost effectiveness, the conventional skin preparation (P 1029.07) is cheaper compared to using Duraprep ® (P 1435.42) by 406.35 pesos. However, considering the reduced prepping time and ease of use, Duraprep ® may still be beneficial in reducing operative time and probaly operating room fees.
Conclusion: Surgical site infections are still the common causes of healthcare associated infections. Proper asepsis and antiseptic techniques are invaluable methods to prevent these events. DuraPrep® is an effective skin antisepsis against surgical site infection.