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Thomas Jefferson University Hospital cuts Whipple procedure wound infections in half with new measures

e common than in other procedures. Infections can be painful and require reopening the incision, which can ultimately leave scarring. Also, if an infection is not identified quickly, it can spread and patients can become very ill.

Two standout measures, Dr. Lavu says, are the gown and glove change prior to skin closure and intraoperative wound edge protection, which separates edges of the incision from contact with visceral contents, instruments and gloves during the procedure. And, like past studies have shown, using chlorhexidine-alcohol for skin preparation, instead of iodine, helps lower the risk of wound infections.

"The preoperative and post operative briefings alone, which are now being instituted in many American hospitals, reduce complications simply by improving communication among members of the health care team," Dr. Lavu says.

While some procedures at certain hospitals include a similar surgical bundle care, Jefferson's is the first one, to the author's knowledge, that has been implemented for pancreatic surgery.

"Now it is the standard of care here, and we are trying to move the surgical care bundle as it applies to other kinds of surgery, even in other departments at Jefferson," Dr. Lavu says.

The 12 measures that were implemented at Jefferson in 2008 and include:

  • Absence of remote infection
  • Preoperative smoking cessation
  • Pre-admission chlorhexidine-alcohol skin preparation
  • Preoperative clipper hair removal
  • Preoperative chlorhexidine-alcohol skin preparation
  • Preoperative antibiotic administration
  • Intraoperative would edge protection
  • Intraoperative glycemic control
  • Intraoperative temperature control
  • Gown and glove change prior to skin closure
  • Deep venous thrombosis prophylaxis and beta-blocker administration
  • Pre and post-operative briefings


Contact: Steve Graff
Thomas Jefferson University

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