Resisting Surgical Infections
By JANICE FITZGERALD, MS, RN, CPHQ
February 1, 2009
ArrayHow the implementation of safeguards will produce staunchly effective outcomesComplications and adverse outcomes can affect 40-50 percent of surgical patients. Across the country, that means perioperative adverse events affect more than 1 million people and result in excess costs of approximately $25 billion. The major adverse outcomes are related to surgery associated infections, but also include venous thromboembolic events (VTE) which incorporate deep vein thrombosis and pulmonary embolus, cardiac events, and respiratory failure.
Data shows that postoperative complications account for 22 percent of preventable deaths in hospitalized patients, involving an additional 2.4 million patient care days. In the past 10 years, national and international organizations have identified evidence-based care strategies that have resulted in a decrease of adverse events. These measures encompass all phases of the perioperative period, including the spheres of the nurse and the physician.
In 2002, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) launched the Surgical Infection Prevention Project (SIPP), meant to decrease postoperative infections in CMS patients.
Supported by a diverse panel of expert organizations, SIPP demonstrated a 27 percent reduction in infections after the initial 15 months. Because of its success in the areas of process and outcomes, as well as the validation that medical literature could be applied in a standard fashion, its scope was expanded in becoming the Surgical Care Improvement Project (SCIP). In this expansion, the structure of the program and rationale for the inclusion of additional measures were spelled out.
Infection PreventionRisk of infection increases when antibiotic prophylaxis is administered incorrectly — this could mean the use of the wrong antibiotic, an antibiotic given too early, too late, or one continued for too long. In a study of 2,847 patients, the lowest infection rate (less than 1 percent) was noted when an antiobiotic was administered within one hour prior to incision, and the risk of infection increased progressively the more time there was between administration and surgery.
Patients who received antibiotics more than two hours prior to incision had an infection rate of 3.8 percent. Likewise, patients who received antibiotics three hours after surgery had an infection rate of 3.3 percent. Furthermore, infection rates increased when patients received the antibiotics at progressively longer periods of time after the incision. Despite the studies discussed, publicly reported progress measures for antibiotic prophylaxis continue to indicate that practitioners are not following these evidence-based recommendations.