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surgical site infection should focus on interventions where effect has been demonstrated," they wrote in the Cochrane Database of Systematic Reviews in September 2012 (tinyurl.com/nu66dhd).
In a series of studies published last year, however, surgeons from the Rubin Institute for Advanced Orthopedics and the Center for Joint Preservation and Replacement at Baltimore's Sinai Hospital made the case that asking patients to prepare their sites with CHG is not only effective but also economical.
• For a study appearing in the March 2013 issue of the Journal of Arthroplasty, some hip replacement patients were given CHG-impregnated cloths and instructions to wipe down the surgical site on the evening before and the morning of surgery. Others received standard, in-hospital skin prepping. The CHG-wipe group saw a 0.5% SSI rate, as compared to the non-wipe group's 1.7% rate (tinyurl.com/q4y9seq).
• When the study was conducted among knee replacement patients (for the June 2013 issue of the Journal of Knee Surgery), the difference in SSI rates was similarly significant: 0.6% for the patients that used CHG wipes, 2.2% for the patients that didn't (tinyurl.com/kxjwbqw).
• Accounting for surgical site infection rates and the cost of revision surgeries after knee replacement procedures, researchers determined that the pre-operative use of CHG wipes at their facility saved about $2.1 million in healthcare costs per 1,000 patients. They calculated this out to an annual savings of $780 million to $3.18 billion, according to their report in the August 2013 Journal of Arthroplasty (tinyurl.com/n6ps93e).
Hair now, gone tomorrow
The Surgical Care Improvement Project states that clippers or depilatory
creams, not razors, should be used to remove hair at the surgical site, and the Association of periOperative Nurses and other organizations stress that hair removal should take place only when absolutely necessary for access.
Recent evidence-based studies have been sparse, but the November 2011
