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Using a PICO(T) Question To Develop an Evidence-Base Approach

The prevention of surgical site infection (SSI) in surgical patients is a practical challenge that needs to be investigated. Tissue chlorhexidine (CHG) has been shown to reduce the risk of infection at the surgical site when used to prepare the skin before surgery (Chamberlain, 2021). In the operating room and surgical facilities, they are widely used. Microbes and pollutants enter the body through the nasal passages, skin and oral cavity. CHG wipes, povidone-iodine antiseptic nasal swabs, and CHG mouthwash have all recently been released, with preoperative patients in mind.

Is it true that certain elements use less energy than others? Creating PICO(T) design style questions can assist you in deciding on a learning path and selecting the best evidence. Instead of focusing on specific surgical procedures, the PICO(T) question was designed to see if using CHG wipes in combination with an antiseptic cotton swab and CHG mouthwash was more effective than using individual CHG wipes in reducing SSI in postoperative patients (Martin., et al 2020). Instead of focusing on specific surgical procedures, this group was intended for people who had surgery in general (e.g., those lying on the floor in the operating room).

Sources of Evidence

To limit the number of microbes that colonize the patient’s nose and skin, especially Staphylococcus aureus, SSI prophylaxis should be used. Antibiotic nasal clearance with Mupirocin has been shown to limit SSI by up to 50% when used with other therapies (Mehmood., et al 2021). Another study found that a systematic nasal and skin disinfection strategy (Project JOINTS) reduced secondary syphilis incidence from 1.3 to 0.66 percent. On the other hand, Mupirocin requires several days to prepare, making it challenging to stick to the medication. Povidone-iodine cotton are less expensive and, as an antiseptic, do not contribute to antibiotic resistance because they are only used once.

According to PR Newswire, the skin preparations patients receive before preoperative therapy is standardized. The FDA has approved Medline’s Total Preparation System for reducing SSI. It’s found in different concentrations and combinations in various products, including wet wipes and shower solutions (Rodrigues, Rodrigues & Henriques, 2019). We’re not looking for the most advanced technology, specific washes, or specific CHG item combinations. Instead, we seek out the most heinous of practices. The ultimate goal is to see if an assortment of skin supplements, nasal swabs, and mouthwashes is beneficial, and this article demonstrates that there is a market for it.

Findings and Relevance

The posters from the Global Surgery Conference and AORN 2019 are included in this book, highlighting new evidence-based practice and research in general surgery. According to the sign, efforts are being made to enhance the quality of surgical patients at VA hospitals. The baseline experimental protocol included the MRSA test, CHG wipes, and mupirocin nasal ointment (Chamberlain, 2021). “Standardization of antiseptic skin preparations, use of preoperative chlorhexidine showers, warming of patients in pre-anesthesia areas, use of advanced sterile techniques to seal skin and fascia to treat previously unknown gaps in antibiotic prophylaxis” was the title of a study. Maintaining adherence has been difficult in the past, despite chlorhexidine showerheads and mupirocin nasal ointment. When a CHG washcloth, CHG mouthwash, and intranasal povidone-iodine were used together, the number of SSI cases decreased from 11 to 4 years. Over the last seven years, the SSI has dropped by 42%.

This site was chosen because it provides a comprehensive comparison of CHG vs. chlorhexidine-only packages. The use of CHG in surgical skin preparations has been successfully demonstrated in several studies, as previously mentioned. There isn’t much information available to compare the sizes and contents of various packages (Martin., et al 2020). The Houston Medical Center in Virginia implemented new evidence-based best practice recommendations to improve quality, widely publicized and highlighted at international surgical conferences. “We tested the effectiveness of PI-SNA on the morning of surgery to minimize SSI in patients undergoing lower extremity fractures in our current study.”

Social Security Disability (SSI) can be upsetting. PI-SNA nose staining was used to assess trauma patients who underwent orthopedic surgery and received PI-SNA nose staining before surgery. Before and after surgery, patients were bathed with a 2 percent CHG towel or a 4 percent CHG Dynahex solution in the morning (Mehmood., et al 2021). We chose PI-SNA over Mupirocin in addition to CHG because Mupirocin must be given several times daily for up to 5 days before surgery to be effective. Preoperative treatments such as MRSA tests, tissue chlorhexidine, and mupirocin nasal ointment are expected; however, in this protocol, MRSA screening was replaced with povidone-iodine nasal swabs and chlorhexidine mouthwash, but CHG wipes remained. Not only did the SSI rate rise, but so did the cost per patient,a which dropped $83.09 from 4.9 to 3.4 percent.


When developing the research question, the PICO(T) approach was used to see if using a chlorhexidine pack instead of a chlorhexidine towel/shower would reduce the incidence of wound infection in surgical patients. This conclusion is supported by the data gathered (Rodrigues, Rodrigues & Henriques, 2019). Our patients find it humiliating and harmful to them and the healthcare system.


Chamberlain, T. (2021). Preventing the Spread of Infectious Diseases in Radiology. Radiologic Technology92(4), 367-381.

Martin, V. T., Abdi, M. A., Li, J., Li, D., Wang, Z., Zhang, X., … & Yu, B. (2020). Preoperative Intranasal Decolonization with Topical Povidone-Iodine Antiseptic and the Incidence of Surgical Site Infection: A Review. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research26, e927052-1.

Mehmood, Q., Nawaz, A., Chahal, P., & Mukherjee, D. (2021). Postoperative infections: a preventable calamity.

Rodrigues, C. F., Rodrigues, M. E., & Henriques, M. C. (2019). Promising alternative therapeutics for oral candidiasis. Current medicinal chemistry26(14), 2515-2528.


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