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Surgical Prep

Each year, nearly 2 million patients in U.S. hospitals get infections following surgery or other medical procedures, and about 90,000 die.

But amidst all the news and concern surrounding hospital infection rates comes a new study that shows two commonly held practices to prevent infections in surgical patients simply don’t make a dent.

Making patients scrub with antibacterial cleansers and shaving them doesn’t appear to be effective.

What is effective, is a lot more simple.

“They haven’t done anything yet, but of course I got up and took my normal shower today.” Mary Beth Sullivan is waiting for her hip replacement surgery. But she didn’t do anything special to get ready…to clean the surgical area before hand. “I am not worried about it, I am not a nervous Nelly type of person. Hospitals have all sorts of infections racing around them but they know how to deal with them best.”

Well, maybe they’re overdoing it on things that don’t matter, and not doing things well that do. New research shows two common preoperative practices, washing or showering with an antiseptic before going to surgery, and body hair removal, do not reduce surgical site infections.

Plain soap does just fine to remove normal bacteria that resides on the skin prior to going to the O.R.

Likewise, the value of shaving the area before surgery has not been demonstrated conclusively to be effective. The authors say, if it’s necessary, just clip some hairs to expose the area.

In fact, that’s better.

“The concern is that this would have a potential for some minor trauma to the skin that could be a portable of entry for infection where as clipping the hair the body hair to the shortest possible length is less traumatic to the skin and I thin that this is the trend in most places,” says Dr. Bruce Polsky, Chief of Infectious Diseases at St. Luke’s-Roosevelt Hospital.

But guess what does work: when healthcare workers clean their hands properly. And sadly, this is not well done in all institutions, and has been cited as a risk for in-hospital infections.

The other big ticket thing that works: reliably giving preoperative antibiotics; and, of course, caring for the wound after surgery.

Still, Dr. Polsky argues, erring on the side of caution, and scrubbing with betadine, say, may not be such a bad thing. “I don’t think they are a waste of time and money, today in the era where infections are occurring in hospitals have obtained a high level of visibility with the public as they should, we have an obligation to do everything we can to protect our patients, and to not only treat infections when they occur but to particularly to prevent infection and we would like to see this get down to zero.”

Research has shown that compared to similar risk patients undergoing the same surgery, a patient who gets a surgical site infection is twice as likely to die, 5 to 6 times more likely to require re-admission, and likely to stay in the hospital twice as long.

Treating hospital infections costs about $30 billion a year.

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