Simple Steps to Cut Deadly Infections

Swab nasal passages. Administer antibiotics before incisions. Wear gloves. Wash your hands. Such simple steps could reduce the risk of patients developing deadly infections and the transmission of organisms to healthcare personnel, long an undressed problem in many hospitals worldwide.

Surgical site infections (SSIs) are the second most common cause of nosocomial infections in the world, are deadly and treatment costs billions of dollars annually, said Dr. Andreas Widmer of the division of infectious disease and hospital epidemiology, University Hospital Basel, Switzerland.

"It is a huge problem all over the world," he said. "Patients who develop SSIs are up to 60 percent more likely to spend time in an ICU, five times more likely to be readmitted to the hospital...and two times more likely to die than patients without an SSI."

He cited several established risk factors for SSIs, including ongoing infections other than those at the surgical site, insufficient heating of the patient during surgery, failure to give appropriate oxygen supply and failure to give proper and timely antimicrobial prophylaxis.

To prevent SSIs, Widmer said that prior to surgery both the nose and the throat of the patient should be screened for the presence of methicillin-resistant Staphylococcus aureus (MRSA).

MRSA decolonization can be achieved by applying ointment such as mupirocin in the nose and gargling with the antiseptic chlorhexidine, he said.

"We found substantial agreement between the result of nose and throat swabs," Widmer concluded in one of his studies. "This relationship makes intuitive sense because of the close anatomical connection between the two." [J Clin Microbiol 2007 Nov;45(11):3855]

He also recommended the routine procedure of administering antimicrobial prophylaxis 30 to 60 minutes prior to incision. He noted that prophylaxis should not be done later than 15 minutes before surgery, depending on the pharmacokinetics of the antibiotic used.

Meanwhile, punctured gloves during surgery also lead to higher SSIs, Widmer said. To avoid this, surgical teams must use high-quality gloves with Acceptable Quality Level (AQL) He added that double-gloving should also be observed to reduce risk of punctures especially in orthopedic surgery, and urged that routine changing of gloves every 2 hours be observed.

Widmer, who is also a member of the WHO Task Force on Hand Hygiene, said hand hygiene is important in reducing healthcare-associated infections.

The WHO guideline for surgical hand antisepsis advocates the adoption of alcohol-based hand rub as standard of care and hand-washing with soap and water when hands are visibly dirty.

New drugs have also been develop that might reduce the burden of SSIs by multi-drug resistant pathogens, but many of the fifth-generation cephalosporins are still awaiting approval from the US FDA, such as ceftobiprole and iclaprim.

In some hospital settings, healthcare personnel follow other common infection control practices but these are poorly supported by clinical trials, including laminar air flow for implant surgery, hand antisepsis prior to surgery and disinfection of the surgical site, Widmer said.