The National Healthcare Safety Network (NHSN) divides the types of surgical site infection (SSI) into three categories, based on the depth of the infection. A superficial incisional SSI is an infection that occurs within 30 days of an operative procedure, involves only the skin and subcutaneous tissues of the incision, and has at
least one of the following:

1. “Purulent drainage with or without laboratory confirmation, from the superficial incision.

2. Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.

3. At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat and superficial incision is deliberately opened by surgeon, unless incision is culture negative.

4. Diagnosis of superficial incisional SSI made by a surgeon or attending physician.” [1]

The other two types of infection defined by the NHSN are deep incisional SSI and organ/space SSI.[1] The definition of deep incisional SSI adds a period of up to 90 days after the procedure and includes purulent wound drainage or spontaneous dehiscence or required intentional opening of the wound, constitutional symptoms or positive imaging (e.g. abscess) or diagnosis by other testing or diagnosis by the surgeon or attending physician.[1] Organ/space SSI includes all of the above signs and/or symptoms for deep incisional infection, but includes infection of any tissue manipulated during surgery.[1] Despite improved practices in infection control, SSIs still cause morbidity, increased length of hospitalization, and mortality.[2] With a goal of containing rising medical care costs, the Centers for Medicare & Medicaid Services selected conditions that are reasonably preventable and are costly to manage. These conditions are not reimbursed by Medicare and include SSI following certain orthopedic procedures as well as other surgical procedures.[3]


SSIs are among the most common healthcare-associated infections (HAIs), accounting for up to 21.8% of HAIs according to a study by Magill et al.[4] SSIs not only cause increased morbidity and mortality for patients, but also increase the cost of delivery of care, due to hospital readmissions, increased length of stay,[5,6] and operative revisions, such as removal of hardware in orthopedic surgery infections.[7] Up to 60% of SSIs are preventable and are penalized in the Value-Based Purchasing and Hospital-Acquired Condition Reduction Programs.[8]

Multiple factors contribute to a patient’s risk of contracting HAIs.[11] Infection is also common with percutaneous devices, such as orthopedic pins, wires, external fixators, and thoracostomy tube placement.[12] Pin infection can lead to osteomyelitis, failure of fixation and healing in the bone, and systemic infection. A Cochrane Review reported that up to 80% of pin tracts developed superficial infections.[13] Skin infections can also occur at the insertion site of thoracostomy tubes and can require removal of the thoracostomy tube.[14] Empyema occurs in 2% to 25% of patients with thoracostomy, depending on the characteristics of the study and the study population.[15-19]

Although the Institute for Healthcare Improvement, The Joint Commission, and others have made recommendations leading to successful interventions to improve patient outcomes and reduce infection risk,[11,20] the prevalence and high cost of infectious complications warrant continuing effort to prevent hospital-acquired wound infections in surgical wounds and wounds caused by device insertion.

Preoperative skin antisepsis is recommended to reduce the risk of infection, but the skin’s endogenous flora – the primary pathogen source for SSI – quickly regenerate.[21] The use of antiseptic dressings can help reduce regrowth of bacteria on the skin.22 Postoperative dressings ideally help protect the wound against infection,[23] and newer types of dressings have incorporated antimicrobial agents in pursuit of this goal. Although Staphylococcus is thought to be the major pathogen in SSIs, other pathogens are also frequently found in wounds, suggesting that an antimicrobial choice should include coverage for both gram-positive and gram-negative bacteria.[24] Two commonly used antimicrobial agents used in antiseptic dressings are silver-based products and CHG.

Silver is reported to be effective against bacteria, fungi, and viruses and has bactericidal and bacteriostatic effects.[24] Despite studies finding that an antiseptic dressing containing silver is effective, data from other studies are conflicting. Connery and colleagues[25] found no difference between the use of a silvercontaining dressing and gauze. Cavanagh et al[26] found that of six silver-containing dressings, only one produced bactericidal effects against S. aureus.

CHG has been shown in multiple studies to be an effective antiseptic. CHG molecules have a positive charge, binding strongly with negative charges in the cell walls, causing cell death. The broad-spectrum activity of CHG includes an antiseptic effect against bacteria and yeast.[27] In vitro time-kill studies have shown effectiveness against a spectrum of bacteria commonly found on the skin, including Acinetobacter baumannii and
methicillin-resistant S. aureus (MRSA).[28] In a literature review, Karki and Cheng found that skin cleansing with CHG reduced the risk of SSI and colonization with vancomycin-resistant Enterococcus (VRE) or MRSA.[29] Hannan and colleagues[30] found that CHG as a preoperative antiseptic reduced SSI rates compared with alcohol povidone iodine (API). CHG has also been found to be effective as part of a prevention bundle. Schweizer et al[31] found that the use of CHG bathing, intranasal mupirocin for patients found to be carriers of MRSA or MSSA, and antibiotic prophylaxis prior to surgery (vancomycin and cefazolin or cefuroxime for MRSA carriers, cefazolin or cefuroxime for non-carriers) led to a decrease in complex S. aureus wound infections.

The effects of CHG on microbial growth under dressings has also been studied. In an in vitro study, Bashir and colleagues22 found that CHG was effective in suppressing bacterial growth under occlusive dressings.

ReliaTect® Post-Op Dressing with CHG

The ReliaTect® Post-Op Dressing with CHG was designed to provide many of the components of the ideal postoperative dressing, as described by Dumville et al[32] in a Cochrane Review. These attributes include the ability to absorb and contain exudate without leakage, impermeability to water and bacteria, suitability of use with different types of wound closures, avoidance of wound trauma during dressing changes, and lower
frequency of required dressing changes.[23,33,34] In addition to these dressing characteristics, the ReliaTect® Post-Op Dressing with CHG prevents external contamination of the wound through the functions of two different layers: the outer film layer and the adhesive layer. The outer film layer serves as a barrier that is impermeable to external contaminants, including fluids (waterproof ), bacteria, viruses, and yeast.35 The inner adhesive layer contains CHG.

In vitro tests have demonstrated that ReliaTect® Post-Op Dressing with CHG inhibits microbial colonization within the dressing.[35]

This antimicrobial effect lasts throughout the 7-day recommended wear time and provides a minimum of 4-log reduction against a wide variety of clinically relevant microorganisms for up to 7 days. The antimicrobial action is also rapid; ReliaTect® Post-Op Dressing with CHG reduces 99.99% of clinically relevant bacteria within 1 day.[35]

In addition to its antimicrobial benefits, the acrylic adhesive is absorptive. The dressing can absorb light to moderate amounts of blood, perspiration, and exudates, but is not designed for large amounts of fluid absorption.

ReliaTect® Post-Op Dressing with CHG is transparent, providing visualization of the surgical wound site for inspection and assessment; this feature may reduce the need for dressing changes and associated costs. Transparency helps facilitate daily, direct observation of the surgical site, which is the “gold standard” for SSI detection.[36] The dressing is breathable, allowing for oxygen and moisture vapor exchange, yet is impermeable to external contaminants. The vapor transmission rate is greater than the
absorption rate, and this dynamic moisture management can help the dressing to remain securely adhered in the presence of exudate and other fluids.[35]

ReliaTect® Post-Op Dressing with CHG has a wear time of up to 7 days, minimizing the need for dressing changes.35 It is noncytotoxic, non-irritating to the skin, and the material is flexible, providing skin-friendly contact that conforms to bodily contours.

ReliaTect® Post-Op Dressing with CHG is offered in two sizes to accommodate different surgical wound sizes: 8 cm x 15 cm (3.2 in x 5.9 in) and 10 cm x 25 cm (3.9 in x 9.8 in).

Interested in seeing if ReliaTect® Post Op Dressing with CHG is a good fit for your facility?

National Healthcare Safety Network. (2013). Surgical Site Infection Surveillance (SSI). Available at:
2. Centers for Disease Control and Prevention. (2017). Procedure-Associated Module SSI. Available at:
3. Centers for Medicare & Medicaid Services. (2015). Hospital-Acquired Conditions. Available at:
4. Magill, S. S., Edwards, J. R., Bamberg, W., et al. (2014) Emerging Infections Program Healthcare-Associated Infections and Antimicrobial
Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med, 370(13), 1198-1208. doi:
5. Kirkland, K. B., Briggs, J. P., Trivette, S. L., Wilkinson, W. E., & Sexton, D. J. (1999). The impact of surgical-site infections in the 1990s: attributable
mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol, 20(11), 725-730. doi:10.1086/501572
6. Digiovine, B., Chenoweth, C., Watts, C., & Higgins, M. (1999). The attributable mortality and costs of primary nosocomial bloodstream infections
in the intensive care unit. Am J Respir Crit Care Med, 160(3), 976-981. doi:10.1164/ajrccm.160.3.9808145
7. Cai, J., Karam, J. A., Parvizi, J., Smith, E. B., & Sharkey, P. F. (2014). Aquacel surgical dressing reduces the rate of acute PJI following total joint
arthroplasty: a case-control study. J Arthroplasty, 29(6), 1098-1100. doi:10.1016/j.arth.2013.11.012
8. Ban, K. A., Minei, J. P., Laronga, C., et al. (2017). American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016
Update. J Am Coll Surg, 224(1), 59-74. doi:10.1016/j.jamcollsurg.2016.10.029
9. Hospital Value-Based Purchasing. Department of Health and Human Services, Centers for Medicare & Medicaid Services.
Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf. Published
April 18, 2016. Accessed January 16, 2017.
10. FY 2017 HACRP Key Dates Matrix. Hospital-Acquired Condition Reduction Program (HACRP). Centers for Medicare & Medicaid Services. https://www. Accessed January 16, 2017.
11. Office of Disease Prevention and Health Promotion. Health care quality and patient safety overview. Available at:
12. Green, S. A., & Ripley, M. J. (1984). Chronic osteomyelitis in pin tracks. J Bone Joint Surg Am, 66(7), 1092-1098.
13. Lethaby, A., Temple, J., & Santy-Tomlinson, J. (2013). Pin site care for preventing infections associated with external bone fixators and pins.
Cochrane Database Syst Rev, 12, CD004551. doi:10.1002/14651858.CD004551.pub3
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4(2), 143-155. doi:10.4103/2229-5151.134182
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18. Coselli, J.S., Mattox K.L., Beall, Jr., A.C. (1984). Reevaluation of early evacuation of clotted hemothorax. Am J Surg, 148(6), 786-790.
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22 Bashir, M. H., Olson, L. K., & Walters, S. A. (2012). Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied
to chlorhexidine gluconate-prepped skin. Am J Infect Control, 40(4), 344-348. doi:10.1016/j.ajic.2011.03.030
23. National Collaborating Centre for Women’s and Children’s Health. (2008). Surgical Site Infection: Prevention and Treatment of Surgical Site Infection.
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infection: review of current experience and recommendation for future studies. Burns, 40 Suppl 1, S30-S39. doi:10.1016/j.burns.2014.09.011
25. Connery, S. A., Downes, K. L., & Young, C. (2012). A retrospective study evaluating silver-impregnated dressings on cesarean wound healing.
Adv Skin Wound Care, 25(9), 414-419. doi:10.1097/01.ASW.0000419407.37323.e8
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Wound J, 7(5), 394-405. doi:10.1111/j.1742-481X.2010.00705.x
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infections and colonization with multi-resistant organisms: a systematic review. J Hosp Infect, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005
30. Hannan, M. M., O’Sullivan, K. E., Higgins, A. M., Murphy, A. M., McCarthy, J., Ryan, E., & Hurley, J. P. (2015). The combined impact of surgical team
education and chlorhexidine 2% alcohol on the reduction of surgical site Infection following cardiac surgery. Surg Infect (Larchmt), 16(6),
799-805. doi:10.1089/sur.2015.033
31. Schweizer, M. L., Chiang, H. Y., Septimus, E., et al. (2015). Association of a bundled intervention with surgical site infections among patients undergoing
cardiac, hip, or knee surgery. JAMA, 313(21), 2162-2171. doi:10.1001/jama.2015.5387
32. Dumville, J. C., Gray, T. A., Walter, C. J., et al. (2016). Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev, 12, CD003091.
doi: doi:10.1002/14651858.CD003091.pub4.
33. British Medical Association and Royal Pharmaceutical Society of Great Britain. (2011). British National Formulary (BNF): Appendix 8: wound
management products and elasticated garments. Available at:
34. Goldman, M.P., Fronek, A. (1992). Consensus Paper on Venous Leg Ulcer. The Journal of Dermatologic Surgery and Oncology, 18(7), 592-602.
35. Eloquest Healthcare. (2016). ReliaTect® Post-Op Dressing with CHG Instructions for Use. Data on file.
36. Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., et al. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update.
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