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Simple Steps Can Stave Off Infection

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Simple Steps Can Stave Off Infection

April 26, 2004

BELLEVUE, Wash. (AP) - To prevent Scott Adams' knee surgery from getting infected, doctors at Overlake Hospital Medical Center didn't need fancy new medicine or expensive equipment.

Instead, they took simple steps that are proven to prevent infection. They kept Adams warm during surgery, clipped his leg hair instead of shaving it, and administered antibiotics at the right time.

Easy, cheap and effective - but many hospitals fail to take these steps.

A national survey of 39,000 operations in 2002 found that nearly half of patients didn't get antibiotics at the correct time, which is one of the best ways to prevent infection. And the stakes are high: getting a surgical infection doubles a patient's chance of dying.

Health care leaders are trying to reduce that risk. Fifty-six hospitals participated in a national collaborative last year, co-sponsored by the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention. By concentrating on those simple preventive measures, the hospitals succeeded in decreasing their overall surgical infection rate by 27 percent.

The results were even more dramatic at Overlake Hospital, a 337-bed community hospital in suburban Seattle. The hospital recently participated in a 13-month surgical infection prevention program run by Qualis Health, a Seattle-based health care quality improvement organization. The hospital cut its number of surgical infections by more than half, from 12 in 2002 to five in 2003. The hospital performs more than 14,000 operations annually.

Adams, a jovial 31-year-old engineer who blew out his knee playing flag football, noticed the emphasis on preventing infection.

"Pretty much anybody who put a needle in me talked about the risk of infection," he said.

His leg hair was clipped instead of shaved because shaving causes tiny skin abrasions that can let in infection. He got antibiotics exactly 20 minutes before his surgeon made the first cut, the optimum time for getting the most infection-fighting power from the drugs. And doctors and nurses kept him warm, which helped his body fight infection.

Adams particularly enjoyed the "bear hugger," a comfortable puffy blanket filled with warm air, that he wore during surgery.

"I've got to get one of those for me at home," Adams said. He was recovering comfortably and infection-free a few days after his anterior cruciate ligament, or ACL, reconstruction surgery.

"I'll be back playing football again next year," he predicted.

About 780,000 surgeries lead to infections in the United States each year, which is 2.6 percent of the nearly 30 million operations performed. On top of the health risk, surgical infections cost a lot. A 1992 analysis published in the medical journal "Hospital Infections" found that surgical infections added an average of $3,152 to hospital bills for patients with the infections.

Other studies estimate that 40 to 60 percent of surgical infections are preventable. The most powerful preventive medicine is antibiotics, administered within one hour of incision. Give the drugs too early or too late, and they'll either wear off or won't get into the bloodstream fast enough to work.

This isn't new information. Studies dating back to 1957 have told doctors about the need for well-timed antibiotics. So what's the holdup?

"There are problems translating good research into actual practice," said Dr. Dale Bratzler, principle clinical coordinator for the Oklahoma Foundation on Medical Quality and a leader of the national Surgical Infection Prevention Project. He's working with the authors of major antibiotic studies to create a set of consistent national guidelines.

"There are 10,000 randomized trials published every year. There is no physician that can keep up with all the publications," Bratzler said. "We need to make it more systematic."

He said the best thing patients can do to protect themselves is to talk with their surgeons - ask about antibiotic treatment, and make sure to tell doctors in detail about any drug allergies. Also, general good nutrition and health will help, he said. The healthier a patient is going into surgery, the smaller the chance of infection.

At Overlake, surgical director Mahin Wright used a combination of charm and reason to get surgeons to embrace the infection prevention measures.

"It was really hard to get everyone on board. The surgical arena has strong individuals who are highly opinionated. I did a lot of hallway talking," she said. "You just romance them, keep massaging them and telling them how great it is for patients. If you focus on patients, they respond very quickly."

She made the operating rooms warmer and gave surgeons cooling vests so they wouldn't get too hot. She asked doctors to stop giving patients antibiotics after surgery - there's no evidence it helps, and overuse of antibiotics can breed drug-resistant "superbugs" that are a huge problem in hospitals.

The Overlake project started with knee and hip surgeries but soon spread to the rest of the operating rooms.

A midwife-turned-hospital administrator, Wright said she wasn't surprised that simple steps yielded strong results. Technology is great, she said, but often the simplest lifesaving measures work the best.

"A lot of the time it's the basics," Wright said. "We need to pay attention to common sense."

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On the Net:

National Surgical Infection Prevention Project: http://www.medqic.org/sip


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