Heightened infection-control practices are associated with significantly lower infection rates in office-based Mohs surgery.

Background: Reported infection rates for Mohs micrographic surgery (MMS) range from less than 1% to 3.5%.

Objective: To determine whether lower infection rates are possible for MMS with a consistently applied infection-control regimen.

Methods: A series of 832 consecutive patients with 950 tumors undergoing MMS formed the cohort for a retrospective study of infections before and after a program of heightened infection-control practices at a single-surgeon academic Mohs practice. The sterility upgrade included jewelry restrictions, alcohol hand scrub before stages and reconstruction, sterile gloves and (during reconstruction) sterile gowns for staff, and sterile towels and dressings for patients during Mohs stages.

Results: Infection rate was 2.5% (9 infections/365 tumors) before the sterility upgrade and 0.9% (5 infections/585 tumors) after, a statistically significant difference (p=.04).

Conclusion: MMS already has low rates of infection, but this study shows that rigorous infection-control practices can significantly affect infection rates. The authors have indicated no significant interest with commercial supporters.