Antimicrobial Dressing Intervention Associated with Decreased Vascular Patientsʹ Surgical Site Infections

ISSUE: Vascular patients are at high risk for surgical site infections (SSI) and infections add to health care costs. The vascular patients experience third space edema at the incision resulting in separation of the wound margins. This separation was hypothesized to facilitate bacteria invasion into the wound, which would promote wound infections. To address this issue, we implemented antimicrobial dressings on the surgical incision to act as a barrier in preventing bacterial colonization and migration into the edematous, separating wound. PROJECT: In 2000, our hospital expereinced the highest vascular, risk-adjusted index #1(CDCʹs risk index #1; i.e., patients had one of the following risks: ASA score > 2, wound class > 2, or surgical procedure time > 3 hours) SSI rate of 4.6 (CDCʹs benchmark average rate was 1.79). Intervention: surgical team applied antimicrobial dressings (binding 0.2% Polyhexamethylene Biguanide [PHMB] super sponges and kerlix roll, A.M.D., Tyco Company) after incisional skin closure on all vascular patients. Nurses reinforced or removed/replaced wound dressing with same product until dressings discontinued or discharged. RESULTS: Progressively decreasing SSI vascular, risk index #1 infection rates over five year timeframe were noted: pre-intervention rate in 2000 of 4.6 (#18 infections/#323 cases) to 2005 YTD rate of 0.9 (#3/#328 cases). Estimated cost savings of $890,000 over five year timeframe. LESSONS LEARNED: Changing the type of surgical dressings took a multidisciplinary team approach to implement. Successful implementation required “buy-in,” timely coordinated education and a passion to problem-solve barriers quickly. Barriers included: (1) “surprise” dressing storage areas, (2) vascular patients admitted post-operatively to non-surgical clinical floors due to hospitalʹs high patient census/bed availability, (3) pre-packaged vascular surgical instrument sets with old gauze dressings and (4) education of casual position employees. Due to the success of the intervention, the dressings are now used on all surgical patients.