from shedding S. aureus for 4 hours.
• Alcohol-based antiseptic. Total joint patients who arrive at Saint
Francis Hospital are given a single-use ampule, which they use to swab
nasal sanitizer around each nostril — 6 times in counterclockwise and
clockwise directions — an hour before they're wheeled into the OR.
The ethanol antiseptic, which reduces bacterial colonization and lasts
for several hours, is largely pleasant for patients for use.
Ms. Epstein says a nurse explains to the patient how to use the
ethanol-based swab and why nasal decolonization is important, and
watches the patient swab to make sure it's done correctly.
"There's no doubt that decolonizing the nose before surgery lowers the
risk of infection," says Dr. Sporer, "but there's not yet clear evidence to
suggest one method is superior to another."
3. Pre-op precautions
Ask patients to wash their bodies with a chlorhexidine gluconate solu-
tion once a day for 5 days leading up to surgery. Patients should also
shower with CHG the night before surgery. On the day of surgery, use
CHG wipes in pre-op to decontaminate the area around the site. On a
knee replacement patient, for example, you'd wipe from mid-thigh to
mid-calf, covering the entire circumference of the leg.
Some surgeons administer intravenous tranexamic acid (TXA) in pre-
op to limit intraoperative and post-op bleeding, says Dr. Deirmengian.
TXA prevents the body from breaking down blood clots that have
formed, which results in less perioperative and post-op bleeding. That, in
turn, prevents large hematomas — which are breeding grounds for bac-
teria — from forming underneath tissue around the joint.
"Decreasing blood loss also significantly reduces the need for blood
transfusions, which are linked to higher infection rates," adds Dr.
Sporer.
7 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9
