José M. Balibrea (Coordinator of the Spanish Surgical Association Surgical Infections Committee)
Hospital Vall d’Hebron (Barcelona, Spain)
Surgical site infections (SSIs) are the most frequent cause of nosocomial infection (38%). Although the overall risk of SSI is low, its estimated prevalence is quite high, taking into account that millions of surgical procedures are performed every year worldwide. Moreover, approximately half of SSIs are preventable through application of evidence-based strategies. In the last year some of the main Health Organizations such as WHO, ACS, SIS and CDC have published several bundles of preventive measures to diminish SSI incidence. In this lecture Dr. Balibrea reviewed the current evidence on two of the main measures concerning surgical field preparation (hair management & skin antisepsis) in the latest European Surgical Infection Society Congress held in Hamburg.
Due to the implementation of specific guidelines/statements, surveillance programs, online surveys and the development of alert systems, SSI can be currently seen as a “hot spot” in surgical education.
Of all the recommended preventive measures, those related to surgical field preparation are crucial as they are one of the surgeon’s last opportunities to reduce SSI risk before surgery starts. However, they are usually not seen as an important issue due to a lack of clear information about some specific aspects such as timing and antiseptic agent selection or application.
When considering hair removal, current guidelines recommend that hair in the surgical site should only be removed if it will interfere with surgery due to the risk of microscopic cuts and abrasions resulting in disruption of the skin’s barrier. Also, clippers should be used rather than razors or depilatory cream. However, there is no consensus on the timing or the location for hair removal.
As for topical antisepsis, it is important to remark that it prevents only those SSIs generated by cutaneous pathogens. Although there is no ideal topical antiseptic agent, unless contraindicated, most scientific societies recommend the use of alcohol-based antiseptics for intraoperative skin preparation. In some recent randomized controlled trials alcohol-based chlorhexidine solutions have proven to be superior when compared to iodine alcohol-based Solutions. Nevertheless, specific risks such as ignition and mucosal, eye, CNS, middle ear damage should be taken into account.
