Pre-operative Planner: Pre-surgical Baths in the Battle Against SSIs

The best defense for battling surgical site infections is a good offense. And part of a good offensive game plan is to make sure your OR nurses understand the importance of the chlorhexidine gluconate (CHG) bath in fighting SSIs.

Pre-surgical baths using an antibacterial product have proven to decrease SSIs. We have a protocol that patients have a CHG bath the night before surgery, then again on the morning of surgery. When we see our outpatients in a pre-surgery clinic, we educate them on how to perform the CHG bath at home. While we’re proud of our low infection rates, we continue to prioritize inpatient baths, as well as the accurate and consistent documentation of those baths.

To do that, we conducted a study to find out if educating our nurses and techs on pre-surgical baths impacted compliance with completion and proper documentation of a CHG bath for inpatients.

Experienced med-surg nurses who transitioned to the operative environment noted CHG bathing was sometimes less of a focus in their prior practice. These nurses believed that educating their peers could increase CHG bathing rates.

To initiate the process, the first thing we did was chart reviews. This let us measure our compliance for the documentation of the pre-surgical baths. We also wanted to ensure the nurses understood the importance of performing and documenting the pre-surgical bath.

Educating your nurses is always key, and in this instance, we were able to emphasize why we have the patients go through a pre-surgical bath and how that impacts SSIs. We did that through their staff meetings and a PowerPoint presentation. Also, we conducted a pre-education survey and a post-education survey that asked the nurses 6 questions:

1. Rank the following task in order of priority for you as a caregiver: medication administration, patient safety, pre-surgical bathing and linen changes and assessment.

2. How often do you perform pre-surgical CHG baths and linen changes on pre-surgical patients? (always, sometimes, not often, never)

3. How often do you document pre-surgical CHG baths and linen changes on pre-surgical patients? (always, sometimes, not often, never)

4. Who is responsible for ensuring the patient has a surgical bath? (pre-op, RN, nurse tech, other)

5.. Have pre-surgical baths and linen changes been shown to decrease SSIs? (yes, no)

6. Would you change your practice if you knew pre-surgical baths and linen changes helped decrease SSIs? (yes, no)

Those surveys revealed that the nurses had an increase in knowledge. We attributed that increase to our educational efforts.

The most effective means of training was peer-to-peer education. By tasking veteran nurses with this initiative, the training was well received by peers. That peer-to-peer education was important. We appreciate that we have a good surgical site infection rate and that this additional education was something that we could do to enhance the comfort level of the nurses, giving them additional confidence to provide the best care they can for their patients.

While a good portion of that was a re-emphasis on knowledge, it’s equally important that nurses know how to check the correct box on the chart, indicating that the pre-surgical bath was done.

Patients use a CHG product that they can get over the counter. Instruct your outpatients to take a shower with that product the night before, put it on the area where the procedure is being performed and don’t rinse off that area. Because CHG works with a layering effect, leave it and just blot it. That’s also why we instruct patients to repeat the bath on the morning of surgery. Repeat rinses get CHG going down into the layers of the skin. That’s how it gets its efficacy.

For your inpatients, help them with the bath the night before and the morning of the surgery to assure that they’ve done it properly and are getting the layering effect of the CHG. For those patients who can’t easily get to the shower, instruct them to use a CHG wipe on the surgical site.

We conducted post-education chart audits that showed that CHG bathing rates improved by more than 20%. The project was expanded to the pre-surgical area where nurses used CHG cloths to clean the surgical site the day of surgery. We gave the same education to this unit, which encouraged a renewed focus on the importance of CHG bathing. As a result, CHG cloths were introduced in the unit for use with non-ambulatory patients.

You want to keep those SSIs under control? Look at your current rates of recorded baths being given to inpatients by doing a chart review; provide education to those nurses on the floor to improve compliance; and conduct another chart review afterwards to see if your rates improved. OSM