Updated Skin Antisepsis Guidelines Aim to Reduce Surgical Site Infections

Since its introduction in the 19th century, skin antisepsis has helped to reduce the incidence of health care–associated infections.

Updated guidelines from the Association of periOperative Registered Nurses (AORN) now offer new evidence to help interdisciplinary teams make decisions and standardize preoperative skin antisepsis protocols.

“Standardization eliminates variability, resulting in less waste, fewer errors and improved quality outcome,” said lead author Karen deKay, MSN, RN, CNOR, CIC, a perioperative practice specialist at AORN, in Denver. “Skin antisepsis is a broad term that includes several interventions to reduce the microbial load on the patient’s skin and inhibit rapid rebound growth of microorganisms from the skin where the incision will be made.”

Skin antisepsis is important because the removal of soil and transient microorganisms, as well as the reduction of resident microorganisms, minimize the number of bacteria on the skin near the surgical site, according to Ms. deKay.

“The intervention most perioperative personnel are familiar with is surgical site preparation. When an incision is made, it compromises our body’s coat of armor and increases the likelihood of introducing microorganisms internally,” she said. “Hence, reducing the number of microorganisms near the incision site decreases the chance of skin microorganisms entering the surgical site through the incision, thereby decreasing the change for a surgical site infection [ssI].”

Clinical practice guidelines for ssI prevention from various health agencies and professional societies recommend decolonization, alcohol-based skin antiseptics and bundles to decrease the incidence of ssIs.

“Most clinicians are aware of the benefit of decolonization in reducing ssIs,” Ms. deKay said. “However, they may not be aware that decolonization is not indicated for all surgical patients and that community, hospital and procedure risk factors need to be evaluated by an interdisciplinary team to determine which surgical population would benefit the most from decolonization.”

Likewise, clinicians are mindful of the need to decolonize for colonization of methicillin-resistant Staphylococcus aureus (MRSA). “However, they may not be cognizant of the need to also decolonize for methicillin-susceptible Staphylococcus aureus colonization,” Ms. deKay said. “Patients with both methicillin-susceptible and methicillin-resistant S. aureus in their nares or on their skin are more likely to develop Staphylococcus aureus ssIs.”

Bernard Camins, MD, the medical director of infection prevention for the Mount Sinai Health System, in New York City, and a member of the AORN Guidelines Advisory Board, noted the guidelines will decrease the risk for developing infections after surgery, “therefore decreasing the risk of death, hospitalization, prolonged recovery and even long-term complications. By reducing complications, the guideline promotes patient safety.”

Dr. Camins said the current and previous versions of the AORN guidelines “provide clinicians the tools necessary to reduce the bioburden found on the skin to avoid contamination of the surgical wound. Skin antisepsis is one of the most important measures to prevent infections during surgery.”

Following the recommendations of the guidelines and the manufacturer’s instructions for using antiseptic solution carefully “will result in a lower risk for the development of ssIs,” he said.

However, one potential obstacle in implementing the guidelines is the time and resources required to form an interdisciplinary team or using a facility’s current ssI prevention task force “to take a closer look at how preoperative patient skin antisepsis elements can contribute to a reduction in the facility’s ssIs,” Ms. deKay said. And if these elements are already part of a facility’s ssI bundle, “you need to provide the resources necessary to establish a process that will closely monitor adherence to these practices, as regular observation of processes can identify inconsistencies and areas for improvement.”

This article is from the September 2021 print issue.