title: The Combined Impact of Surgical Team Education and Chlorhexidine 2% Alcohol on the Reduction of Surgical Site Infection following Cardiac Surgery.
abstract: BACKGROUND
  The use of 2% chlorhexidine in 70% alcohol (CHG) has been associated with reduction in catheter-related bloodstream infections and surgical site infection (SSI) in general surgery. Also, improved awareness of best practice from the perspective of the operative team is likely to result in reductions in SSI rates.
  
  
  METHODS
  This is an ambispective cohort study of patients undergoing elective cardiac surgery. Between January 2010 and December 2010, patients underwent surgical preparation using Alcohol Povidone Iodine (API). Between January 2011 and December 2011, the surgical team received education and switched to CHG for surgical preparation. Univariate analysis was performed to identify the impact of known risk factors for SSI. A logistic regression model was then fit to estimate the effect of education and CHG in the reduction of SSI in 2011, controlling for known SSI risk factors.
  
  
  RESULTS
  There was a substantial reduction in overall SSI rate in 2011 following staff education and the introduction of CHG. The overall unadjusted SSI rate was 4.67% versus 2.08% (p<0.05) for 2010 and 2011 respectively. Using a logistic regression model, the combined effect of education and CHG in 2011 was a 63% reduction in SSI in cardiothoracic surgery (OR 0.37, 95% CI: 0.17-0.83, p=0.016), controlling for age, major co-morbidities, and SSI risk factors.
  
  
  CONCLUSIONS
  Using CHG as pre-operative antiseptic in cardiothoracic surgery in a risk-adjusted cohort with education of the surgical team is associated with significantly lower SSI infection rates when compared with API. Emphasis must be placed on the multifactorial approach required to prevent postoperative wound infections.
authors.affiliation: Mater Private Hospital , Dublin, Ireland .
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Hannan
authors.affiliation: Mater Private Hospital , Dublin, Ireland .
authors.forename: Katie E
authors.initials: KE
authors.lastname: O'Sullivan
authors.affiliation: Mater Private Hospital , Dublin, Ireland .
authors.forename: Ann M
authors.initials: AM
authors.lastname: Higgins
authors.affiliation: Mater Private Hospital , Dublin, Ireland .
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Murphy
authors.affiliation: Mater Private Hospital , Dublin, Ireland .
authors.forename: James
authors.initials: J
authors.lastname: McCarthy
authors.affiliation: Mater Private Hospital , Dublin, Ireland .
authors.forename: Edmund
authors.initials: E
authors.lastname: Ryan
authors.affiliation: Mater Private Hospital , Dublin, Ireland .
authors.forename: John P
authors.initials: JP
authors.lastname: Hurley
mesh_terms: D000368:Aged; D000438:Alcohols / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage*; D015331:Cohort Studies; D004202:Disinfectants / Q000008:administration & dosage*; D004203:Disinfection / Q000379:methods; D004501:Education, Medical; D006801:Humans; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D013903:Thoracic Surgery; D016896:Treatment Outcome
chemical_list: D000438:Alcohols; D004202:Disinfectants; D002710:Chlorhexidine