Results of an Audit on Preoperative Skin Preparation in 41,188 Patients in France

Background: Background: surgical site infections (ssi) are a major target of the french nosocomial infection (ni) prevention program. the national prevalence survey conducted in 2006 showed that ssi represents 14.2% of all ni. during the period 1999-2006, 964,128 surgical procedures were monitored by the national ssi surveillance network (raisin) which revealed an ssi incidence of 1.54%. based on these data, the five ni coordination centers proposed an audit to french health facilities on preoperative patient skin preparation, which represents a major risk factor for ssi.

Objective: Objective: this study was designed to determine the differences between preoperative patient skin preparation practices according to the criteria of the “société française d’hygiène hospitalière” (sfhh) consensus conference and observed practices particularly concerning patient information, preoperative showering, preoperative hair removal , surgical site disinfection and the traceability of these procedures.

Methods: Methods: this audit was completed prospectively by a pair of previously trained auditors. all patients were eligible apart from minors and patients unable to give their consent to participate in this study. this questionnaire-based audit was conducted by interviews of patients and staff and by observation of professional practices in the operating room. the chi-square test and wilcoxon nonparametric test were used for statistical analysis.

Results: Results: 609 (50.8%) health facilities took part in the audit including 41,188 patients from all surgical specialties. information given to patients about preoperative showering was observed in 88% of cases.70% of patients complied with the preoperative showering process including hair-washing with an antiseptic skin wash solution. better compliance was observed when thorough instructions had been given to the patient (76% vs. 35%). the cleansing and surgical site disinfection steps complied with sfhh criteria in 81% and 62% of cases, respectively.compatible products were used for operative site showering, cleansing and disinfection for 87% of patients. this compliance was lower in ophthalmology (29.9%) and stomatology (44.6%). traceability of the information given to the patient, preoperative surgical hygiene and preoperative site disinfection was found in 36%, 82% and 72% of cases, respectively.

Conclusions: Conclusions: the results of this audit indicate that the main content of the sfhh consensus conference has been understood in all specialties including interventional radiology. this study identified 3 directions for further improvement: a reminder of existing guidelines, accuracy of guidelines for certain types of surgery and improvement of the organization of surgical care in certain health facilities. this audit demonstrates the need to conduct further studies, particularly in specialties such as ophthalmology, ent, stomatology and obstetrics.