Surgical Skin Disinfection - Guidelines

Introduction

Surgical site infection can result in significant health risks in individuals who are undergoing surgery. Disinfection of the skin and surgical site is a crucial step in mitigating the complications associated with surgical site infections. Increased hospitalization period and healthcare costs are the consequences associated with postoperative surgical infections. The appropriate guidelines and protocols followed for surgical site disinfection aid in the reduction of overall healthcare-associated infections (nosocomial infections). This article focuses on health risks associated with SSIs and the recommended guidelines for surgical skin disinfection.

What Is the Prevalence of Surgical Site Infections?

The prevalence of infection after the surgical procedure varies from 0.5 to 3 percent of the patients undergoing surgery.

What Is Surgical Skin Disinfection?

The preparation of the surgical site by thoroughly cleaning and sanitizing the surgical site (the site where surgery is planned) is referred to as surgical skin disinfection. Sanitizing and cleaning are usually performed using different antimicrobial agents and disinfectant solutions. The preoperative preparation (preparation of surgical site before operation) of the surgical site is one of the crucial steps that helps to prevent infections after the surgery and also improves the clinical outcomes of the procedures.

What Are the Different Skin Disinfectants Used During Surgical Site Preparation?

There are different types of skin disinfectants available in the market. The chosen disinfectant for surgical site preparation should be soap-free, non-allergenic, non-toxic, and customized to individual patients' skin types. Different examples of disinfectant are:

• Chlorhexidine gluconate.

• Povidone iodine.

• Alcohol.

• A combination of different antiseptics.

What Are the Guidelines for the Selection of Appropriate Disinfectant?

According to the guidelines, the appropriate disinfectants should be selected if they have the following properties:

• It should be non-toxic and non-irritating.

• It should be non - allergenic and should not contain any allergens or irritants that can cause allergic reactions on the skin.

• It should be selected based on the patient skin type.

• It should be effective against a broad spectrum of microbes including bacteria, viral, and fungi.

• It should be effective in reducing microorganisms on intact skin.

• The effectiveness of disinfectant should be persistent.

• The duration of action of the disinfectant should be quick.

• It should be compatible with other products used during the surgical procedure. The disinfectant should not interact and cause adverse reactions when combined with other agents.

• The disinfectant should be skin-friendly.

• The selection of products, along with their concentrations, should be made after careful consideration of various factors unique to both the patient and the facility.

• It should have a longer duration of action.

What Are the Recommended Protocols for Surgical Site Disinfection?

According to various published guidelines and studies, effective surgical site disinfection comprises of,

• Assessment and Evaluation of Patient Undergoing Surgery: A detailed medical history, along with history of previous surgeries, allergy history, and ongoing medications if any, should be recorded by the healthcare professionals. Patients under high risk, such as diabetic patients and immunocompromised individuals, might require special attention and special consideration during and after surgery.

• Selection of Appropriate Disinfectant: The selection of disinfectants should be cautiously made by the healthcare professional, keeping in mind the allergic ingredients and compatibility of the individual patient skin type. A disinfectant that works against a broad spectrum of microbes, such as viruses, fungi, and bacteria, should be the optimal choice of disinfectant during the surgical procedure. PVP-I (Povidone iodine) is mostly preferred and in use as a disinfectant in current practices.

• Surgical Site Preparation: The access to the surgical site should be proper, and the patient should be comfortably positioned. The preparation of the surgical site involves removing hairs from the surgical site using clippers to avoid any microtrauma from the blade of the shaving razor. After the complete removal of hair, a thorough cleaning of the surgical site is done using an appropriate disinfectant.

• Application of Disinfectant: The application of disinfectant should be done using proper techniques and a broad-spectrum disinfectant. A complete manufacturer's instructions given on the box, including contact time and coverage area, should be read and followed completely. The application of disinfectant should be done in a systematic manner, starting from the center of the surgical site and moving toward the outer surface in concentric circles. A sufficient amount of time should be allowed for the disinfectant to dry before draping the patient by surgical drapes. The contact time of application of disinfectant

• Consideration During Specific Procedures: The disinfection procedure should be customized according to the type of surgery performed, site of incision, and duration of surgery. For surgical procedures involving mucosal membranes, disinfectants should be used cautiously.

• Following Persistent Aseptic Techniques: A proper aseptic technique should be strictly followed during the surgical procedure to avoid contamination of the surgical site and sepsis. A complete sterilization protocol should be followed by the entire surgical team before and during the procedure. Operation theater should be disinfected and fumigated before the surgical procedure.

• Post-operative Care: It is advised to monitor the surgical site for any red flag signs such as redness, swelling, suppuration (pus discharge or drainage), and infections. Regular change of the surgical dressing at the surgical site is advised to prevent the risk of surgical site infection.

Conclusion

Surgical site disinfection is a vital practice in ensuring patient safety during surgical procedures. By effectively cleaning and sanitizing the skin before surgery, healthcare professionals can significantly reduce the risk of infections and associated complications. Adhering to evidence-based guidelines, selecting appropriate disinfectants, and maintaining strict adherence to aseptic techniques are essential for achieving optimal outcomes. The process of selecting appropriate products and concentrations for surgical site disinfection is a critical aspect of ensuring patient safety and reducing the risk of infections. By carefully evaluating these factors, doctors can make informed decisions regarding the selection of disinfectants and their concentrations. Continuous education and updates in protocols are necessary to stay abreast of evolving best practices in surgical site disinfection