2019 Research Forum

Surgical Site Infections in Emergency Department Patients and the Effects of Handwashing with Chlorhexidine

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

Kern Medical, Department of Emergency Medicine; Kern Medical, Medical Student, Clinical Rotations

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 (SSI) 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. Multiple studies have demonstrated 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. Introduction

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. Methods

Conclusions After reviewing the medical records of all recruited patients, it appears they were without signs of SSI after having undergone 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. 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 on 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. 1. Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002; 51(No. RR-16): [1-56] 2. Evans HL, Dellit TH, Chan J, Nathens AB, Maier RV, Cuschieri J. Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients. Arch Surg. 2010; 145(3): 240-246 3. Edmiston CE, Okoli O, Graham MB, Sinski S, Seabrook GR. Evidence for Using Chlorhexidine Gluconate Preoperative Cleansing to Reduce the Risk of Surgical Site Infection. AORN Journal. 2010; 92(5):509-518. 4. WHO Guideline on Hand Hygiene in Health Care First Global Patient Safety Challenge Clean Care is Safer Care. Geneva, Switzerland: WHO Press; 2009. 5. Healthcare-Associated Infections Report 2016, Kern Medical Center (Bakersfield). https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20L ibrary/Kern_KernMedicalCenter_2016.11.22.17.pdf. Accessed 02/21/2018 Acknowledgements We would like to acknowledge Phillip Aguiniga, Max Lesaca, Madison Garrett, Anna Park and the rest of the members from the Kern Medical Research Assistant program, for their time and effort in assisting us with this research. References

Results

Five patients are currently enrolled in the study. The patients were initially admitted for non-emergent surgeries that included three patients requiring cholecystectomy, one patient requiring incision and drainage of an abscess and one patient requiring lithotripsy of a ureteral stone. Their hands were washed with a 2% Chlorhexidine solution under the guidance of patient recruiters prior to leaving the ED. On admission patient’s vital signs, anion gap and serum bicarbonate were all within normal limits. All of their surgeries and post-operative care were without event. Three of the five patients also followed up in the Kern Medical Surgery clinic for post-operative evaluation and were all found to be afebrile and without clinical signs of infection.

Objectives

In this study, we aim to determine the effects of handwashing by Emergency Department (ED) patients admitted to the hospital for non- emergency surgical procedures and SSI in an attempt to discover additional methods of reducing HAI.

Patient Data

120

100.3

98.6

98.4

100

98.3

98.2

97.5

80

Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Standard

60

40

32

29

29

28

25

23

20

15.1

14

12.9

11

9.8

9.6

9

8.8

7

7

6

3

0

Temperature

CBC

AnionGap

Bicarbonate

27