Healthcare-related infections are an ongoing battle within the healthcare industry around the world. Preventive hygiene routines for personnel and patients are a critical element, and hygiene is a top-priority issue in most hospitals. The Swedish model, which involves a whole body wash by patients with bactericidal soap prior to surgery, is attracting increasing attention in other countries.
Efforts to prevent healthcare-related infections are one of the highest priorities within quality and patient safety in the Swedish healthcare sector.1 The number of reported MRSA cases is low compared to that in other countries, and this is mainly due to the good hygiene routines, combined with a restrictive use of antibiotics. However, there is still much room for improvement. Healthcare-related infections are estimated to cost Sweden about Û400 million per year, according to the Swedish Institute for Infectious Disease Control (Smittskyddsinstitutet). This money could be used in a more constructive manner. The spread of infection is either exogenous, when bacteria is transmitted from outside, or endogenous when it comes from the patient’s own skin flora.2 In hospitals, the greatest risk of infection is from personnel carrying the infection from one patient to another in the wards, primarily on the hands. These infection pathways must be stopped; first and foremost by scrupulous hand hygiene. One other obvious risk is that of surgical wounds becoming infected with bacteria from the patient’s own normal, or resident, skin flora. The risk for this type of infection can be reduced radically through a preoperative whole body wash with chlorhexidine soap.
Swedish recommendations
The Swedish National Board of Health and Welfare recommends a whole body wash with chlorhexidine for all patients undergoing vascular, orthopaedic, cardiac or other surgery in which the patient’s own skin flora could cause serious infections.2 Normally, these bacteria have a protective function but, if they come in contact with a surgical wound, they can cause major problems. There are no European standards for products that are used as preoperative body washes. However, in Swedish hospitals, a whole body wash with a soap solution, containing 4% chlorhexidine, is the accepted numberone method within critical, high infection risk surgery.4,5 If you shower with ordinary soap, the bacteria-bearing skin flakes released to the surroundings increase during the first hour. But when chlorhexidine soap is used instead of ordinary soap, the number of bacteria on the skin drops significantly, resulting in lower amounts of bacteriabearing skin flakes. After repeated washing with chlorhexidine soap, the effect is amplified. Even though scientific evidence is not yet available supporting the efficacy of a preoperative whole body wash regarding normal infection risk surgery, the general consensus at Sahlgrenska University Hospital is that all patients who undergo a surgical intervention should prepare themselves in the same way as for high infection risk surgery. Recommended for whole body washing by healthcare professionals prior to going into hospital,6 4% chlorhexidine gluconate is more effective than PVPI or soap7 and can be used as part of a care bundle to help reduce surgical site infections. In a recent study, whole body washing with HiBiSCRUB, in conjunction with a nasal antibiotic reduced the risk of hospital associated Staphylococcus aureus infections by nearly 60%.8 • HiBiSCRUB® is an antimicrobial skin cleanser containing 4% w/v chlorhexidine gluconate.
References
1 Sveriges kommuner och Landsting. Ren vård är säkrare vård II. Erfarenheter från andra omgången av genombrottsprojektet VRISS (Vårdrelaterade infektioner ska stoppas), 2007. (Sweden’s municipalities and county councils. Clean care is safer care II. Experiences from the second phase of the breakthrough project VRISS (Healthcare-related infections must be stopped), 2007). 2 Socialstyrelsen. Att förebygga vårdrelaterade infektioner. Ett kunskapsunderlag, 2006. (The Swedish National Board of Heath and Welfare. Preventing healthcare-related infections. A knowledge base, 2006). 3 Denton GW. Chlorhexidine. In: Block SS, editor. Disinfection, sterilization and preservation. Fifth ed. Philadelphia: Lippincott Williams & Wilkins; 2001:321–336. 4 PM preoperativ helkroppsdesinfektion från Sahlgrenska universitetssjukhuset, Västra Götalandsregionen, 2008. (PM Preoperative whole body wash disinfection from Sahlgrenska University Hospital, West Götaland region, 2008). 5 PM preoperativa hudförberedelser från Akademiska sjukhuset, Landstinget i Uppsala län, 2009. (PM preoperative skin preparations from the Academic Hospital, County Council in Uppsala county, 2009). 6 University College London Hospital, Information for patients and relatives on Testing positive for MRSA, dated Jan 2007. 7 Garibaldi RA et al; 1988. Journal of Hosp Infection. Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. Vol 11; 5-9. 8 Bode LGM et al; 2010. NEJM. Preventing Surgical-Site infections in nasal carriers of Staphylococcus aureus. Vol 362; 9-17.
For more information contact:
Mölnlycke Health Care The Arenson Centre, Arenson Way, Dunstable, Bedfordshire LU5 5UL
Tel: 0870 6060766
Email: surgical.admin@molnlycke.com
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