2019 Research Forum

Applicant: Shelah Hayes MD R1 Principal Investigator & Faculty Sponsor: Daniel Quesada MD Surgical Site Infections in Emergency Department Patients and the Effects of Handwashing with Chlorhexidine

Shelah Hayes MD R1, Daniel Quesada MD, Rachel Mendez O’Donnell MD, Adam Johnson MD R3, Matthew Stapleton MD R4, Doan Nguyen MS IV

INTRODUCTION Hospital acquired infections (HAI) have caused concern for many years as they continue to be a source of increasing patient morbidity and mortality as well as increasing hospital cost. In particular surgical site infections have been extensively studied and several organizations including the CDC and the WHO have implemented several protocols to reduce these types of infections. Many of these protocols involve handwashing by healthcare workers, due to multiple studies demonstrating a significant impact in decreasing the transmission of microorganisms through handwashing. However, no study has researched the impact of patient hand hygiene and its effect on SSI. PURPOSE In this study, we aim to determine the effects of handwashing Emergency Department (ED) patients admitted to the hospital for non-emergent surgical procedures and SSI in an attempt to discover additional methods of reducing HAI. METHOD All ED patients admitted to the hospital for non-emergent surgeries will wash their hands using a 2% Chlorhexidine solution while in the ED. A proper standardized technique will be ensured by using set protocols that are observed or performed by research assistants and other patient recruiters. Medical records of all enrolled patients for a span of approximately 6 months will be reviewed and assessed for possible signs of infection that include but are not limited to fever and positive blood cultures as well as elevated WBC, lactic acid and procalcitonin. This data will then be compared with all non- enrolled patients who were admitted from the ED for non-emergent surgery during this same time period. In addition, patients will be recruited during various days and times to increase randomization. RESULTS Two patients are currently enrolled in the study. The patients were initially admitted for cholecystitis requiring non-emergent cholecystectomy and their hands were washed with a 2% Chlorhexidine solution prior to leaving the ED. On admission both of the patients vital signs, CBC with differential, anion gap and serum bicarbonate were all within normal limits. Both of their surgeries and post-operative care were without event. The patients also followed up in the Kern Medical Surgery clinic for post-operative evaluation and were both found to be afebrile and without clinical signs of infection. DISCUSSION After reviewing the medical records of both patients, it appears they were without signs of SSI after having non-emergent surgery. As a result of this data, it can be suggested that handwashing with Chlorhexidine seems to prevent SSI. Further significant conclusions cannot be drawn at this time due to limited data. CONCLUSIONS Further enrollment of patients in the future will allow for more statistical analysis and as a result will further clarify the effect of handwashing with Chlorhexidine and SSI. The outcome of this research will greatly impact the current management of non-emergent surgical patients admitted from the ED and will lead to further conclusions about HAI and SSI rates.

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