A multi-center study led by infection control experts at the University of Iowa finds that implementing a series of simple interventions before surgery can reduce the rate of surgical-site infections (SSIs) by up to 40 percent.
Dr. Loreen Herwaldt of the UI departments of internal medicine and epidemiology and director of hospital epidemiology at UI Hospitals and Clinics is senior author on the study. Other researchers on the study affiliated with the UI College of Public Health include Dr. Marin Schweizer, assistant professor of internal medicine and epidemiology, and Dr. Joseph Cavanaugh, professor and interim head of biostatistics.
The study, published in the June 2 issue of JAMA, tested the effectiveness of a “bundle” of evidence-based interventions for lowering SSIs caused by Staphylococcus aureus (staph) bacteria in patients undergoing heart surgery or hip or knee replacement procedures.
The interventions included screening patients for the presence of staph bacteria in their noses; having patients who tested positive apply an antibiotic ointment in their noses and bathe with an antimicrobial wash for up to five days before the surgery; and giving all patients appropriately targeted antibiotics just before surgery — patients who tested positive for methicillin-resistant S. aureus (MRSA) received vancomycin and cefazolin or cefuroxime, while all other patients received cefazolin or cefuroxime only.
Approximately one in three people have staph bacteria inside their noses. This colonization is generally harmless, but if these bacteria get into a surgical incision they can cause a severe infection, which can have serious health and financial consequences. In addition to causing potentially life-threatening health complications, an SSI can add between $13,000 to $100,000 to the cost of health care.
Twenty hospitals in nine U.S. states participated in the study and rates of SSIs were collected for a median of 39 months during the pre-intervention period and a median of 21 months during the intervention period.
Overall, 101 complex staph SSIs occurred after 28,218 operations during the pre-intervention period and 29 occurred after 14,316 operations during the intervention period. The rates of complex staph SSIs decreased for hip or knee replacement by 17 for every 10,000 operations, and by six for every 10,000 heart operations.
“Patients undergoing total hip or knee replacements and cardiac operations should be tested to see if they carry the staph bacteria in their noses. If they do carry the staph bacteria, the protocol we describe in the paper can lower their risk of a serious staph infection by about 40 percent,” says Dr. Herwaldt.”
This project was funded by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. It also received support from VA Health Services Research and Development.