title: Incidence of infection after Mohs micrographic and dermatologic surgery before and after implementation of new sterilization guidelines.
abstract: BACKGROUND
  Clinical guidelines regarding surgical instrument sterilization established by accrediting organizations should be based on peer-reviewed scientific literature. Few data exist in the scientific literature to support the changes in sterilization protocols imposed by accrediting organizations.
  
  
  OBJECTIVE
  We sought to determine whether recently established guidelines for the sterilization of surgical instruments have had any clinical impact on postsurgical infection rates.
  
  
  METHODS
  Infections rates after excisional and Mohs micrographic surgery before and after implementation of new Joint Commission on the Accreditation of Healthcare Organizations sterilization guidelines were examined retrospectively. All surgeries were performed at an academic outpatient office.
  
  
  RESULTS
  In all, 1415 patients underwent a total of 1688 surgeries. No significant differences were observed in mean patient age (P = .113), mean number of Mohs micrographic surgical levels (P = .067), final defect size (P = .305), patient gender (P = .072), repair type (P = .691), or infection rate (P = .453). No major differences in predisposing factors were identified in patients who developed postsurgical infections.
  
  
  CONCLUSIONS
  This was a retrospective study conducted at a single academic institution.
  
  
  CONCLUSIONS
  In our practice, recent changes in surgical instrument sterilization protocols have had no impact on postsurgical infection rates. The implementation of such guidelines places an additional burden on the health care system without providing any improvement in patient outcomes.
authors.affiliation: Division of Dermatology, Cooper University Hospital Medical Center, Marlton, New Jersey.
authors.forename: Austin
authors.initials: A
authors.lastname: Liu
authors.affiliation: Division of Dermatology, Cooper University Hospital Medical Center, Marlton, New Jersey. Electronic address: lawrence-naomi@cooperhealth.edu.
authors.forename: Naomi
authors.initials: N
authors.lastname: Lawrence
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D015580:Mohs Surgery / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery; D013242:Sterilization / Q000379:methods / Q000592:standards*; D013525:Surgical Instruments / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Mohs micrographic surgery infection rate; dermatologic surgery infection rate; sterilization protocols; surgical instrument sterilization