EFFECTS OF PREOPERATIVE CHLORHEXIDINE USE ON RATES OF SURGICAL SITE INFECTIONS College of Health and Human Services- School of Nursing, Northern Kentucky University DNP 816: Analysis & Application of Health Data for ANP

EFFECTS OF PREOPERATIVE CHLORHEXIDINE USE ON RATES OF SURGICAL SITE INFECTIONS 

PICOT QUESTION • In adult surgery patients (P), what is the effect of preoperative chlorhexidine use (I), when compared with no preoperative chlorhexidine use (C), on rates of surgical site infections (SSI)(O), within 30 days postoperatively? • SSI’s are one of the most common nosocomial infections and greatly impact patient quality of life and healthcare costs. SSI’s affect approximately 1%-10% of surgical patients (Tsai et. al., 2021). (Monlnlycke, 2020)

MAJOR FINDINGS • Article #1: The experimental group (chlorhexidine wipes) had significant reductions in staphylococcus aureus (p=.032) and staphylococci (p=.000). There were significant increases in bacterial load in the control group (hair shaving). There were no SSI’s reported in either group of percutaneous coronary intervention patients (Tsai et. al., 2021). • Article #2: Chlorhexidine showers were associated with a higher risk of SSI (odds ratio 1.49) and surgical site occurrence (SSO) (odds ratio 1.34) in ventral hernia repair patients (Prabhu et. al., 2016). • Article #3: There was no significant difference in periprosthetic joint infection (PJI) between the chlorhexidine shower group and routine soap and water group (p=.588) in total hip arthroplasty (THA) patients (Su et. al., 2021). • Article #4: The non-fusion spinal surgery subgroup analysis showed a significant reduction in SSI rates (p=.02) and the spinal fusion subgroup did not show a significant reduction in SSI rates after the protocol was initiated SSI rates (p=.21) in spinal surgery patients using chlorhexidine wipes (Chan et. al., 2018). • Article #5: There was a significant decrease in SSI risk in high-risk and moderate-risk total knee arthroplasty (TKA) patients in the chlorhexidine wipe group and a significant increase risk of SSI in high-risk and moderate-risk TKA patients in the control group (Kapadia et. al., 2016). • Four articles were retrospective case control studies and one article was a randomized controlled trial. • Two studies found no significant difference in SSI rates • Two studies found a significant decrease in SSI rates • One study found a significant increase in SSI rates (Polit & Beck, 2017) This study source was downloaded by 100000898494836 from CourseHero.com on 06-18-2025 05:09:12 GMT -05:00 GAPS IN LITERATURE • Lack of generalizability to entire population of surgical patients • Patient compliance was not addressed • Patient characteristics were not addressed: • Level of education • Social support • Attitude toward treatment • Socioeconomic status • Comorbidities • Other pre-operative, intra-operative, and post-operative factors were not addressed: • Cleanliness of departments • Competence of perioperative staff This study source was downloaded by 100000898494836 from CourseHero.com on 06-18-2025 05:09:12 GMT -05:00 FUTURE RESEARCH • Prospective studies, quasi-experimental studies, randomized controlled trials • Increase generalizability • Address patient compliance • Include patient characteristics • Include pre-operative, intra-operative, and post-operative factors This study source was downloaded by 100000898494836 from CourseHero.com on 06-18-2025 05:09:12 GMT -05:00 RESEARCH NEEDS AND NEXT STEPS • The CDC recommends a full body shower at least the night prior to surgery using either an antimicrobial or nonantimicrobial soap or antiseptic agent (Berrios-Torres et. al., 2017). • The AORN guidelines focus on patient and employee education regarding preoperative decolonization (AORN, 2021). • Change the focus from specific preoperative skin antisepsis to patient knowledge of the importance of decolonization and attitude toward treatment. This study source was downloaded by 100000898494836 from CourseHero.com on 06-18-2025 05:09:12 GMT -05:00 UPDATED PICOT QUESTION • In adult surgery patients (P), how does a patient’s knowledge of preoperative decolonization and attitude toward treatment (I), when compared to a lack of knowledge of preoperative decolonization and poor attitude toward treatment (C), affect rates of surgical site infections (O), within 30 days postoperatively (T)? (McCabe et. al., 2018) This study source was downloaded by 100000898494836 from CourseHero.com on 06-18-2025 05:09:12 GMT -05:00 REFERENCES Association of Perioperative Registered Nurses. (2021). Guideline Essentials: Skin Antisepsis. https://www.aorn.org/essentials/skin-antisepsis Berrios-Torres, S., Umscheid, C., & Bratzler, D. (2017, August). Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery, 152(8), 784-791. https://doi.org/10.1001/jamasurg.2017.0904 Chan, A., Ammanuel, S., Chan, A., Oh, T., Shrehot, H., Edwards, C., Kondap