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Wednesday, September 23, 2015

Hospital-Acquired Post-Surgical Infections

"I expected the number to be high, but not quite that high."
"As a surgeon, infection is your worst complication. It is clear that bacteria are brought into the operating room by the OR personnel and can potentially cause surgical wound infections The best way to monitor traffic is to count door openings."
"[Entry to an OR should be considered] a privilege and not a right. Before entering any OR, OR personnel should ask themselves this question: is my presence really beneficial to the patient?"
"Infection following total joint arthroplasty remains a disastrous complication for both the patient and surgeon."
"Once the bacteria is in contact with metal, it is very difficult, if not impossible to eradicate with antibiotics alone."
Dr Martin Bedard, orthopedic surgeon, Hopital de l'Enfant Jesus de Quebec

"The misery -- because I see a lot of these patients -- is significant."
"We would all like to ask ourselves, how do we get to zero [infection rates]?"
"The staff are gowned and gloved. But the patient is there, giving off their skin cells as we yank and pull and do the surgery ... we all know from the Pigpen theory of infectious diseases, the more people in the room, the greater the risk."
"Does opening and closing a door make a difference? We don't know."
Dr. Dick Zoutman, professor, Queen's University, Kingston
New research suggests it may be best to limit the amount of people coming and going into the OR.
Wayne Cuddington / Postmedia    New research suggests it may be best to limit the amount of people coming and going into the OR. 
A new study points to the rather cavalier disregard of medical personnel to hygiene practises during surgical procedures in operating rooms being responsible for the incidence of surgical infections. The study, published in the Canadian Journal of Surgery, the work of Dr. Bedard and his co-authors, followed orthopedic surgeries in particular, since this is Dr. Bedard's specialty. What pertains to this type of surgery would also hold true for all other type of surgery, unless some, like triple-heart-bypass observe stricter entry/exit rules for the operating theatre, and with good reason.

There is a fallout from the incidence of such infections. The most obvious is the pain and inconvenience caused to the patient who must then struggle to overcome infection with the use of antibiotics or whatever protocol is then called upon to rid him/her of the hospital-acquired infection which can be extremely pervasive. Avoidance is a far more effective tool, obviously. Re-admission to hospital may result, and sometimes additional surgical procedures to correct the inadvertent complicating results of the original surgery.

The estimated additional cost to the health care system in the treatment of an infected prosthetic joint can go up to $60,000. Inherent in the cost may be repeat surgeries and on occasion temporary removal of the prosthesis for the purpose of sterilizing the affected knee. The risk of such infections is about one to two percent: "one percent times thousands of surgeries per year is not insignificant", points out Dr. Zoutman. Humans "slough off" millions of cells from the surface of the human skin. The more people in an operating room, the more likely infection may be to occur.

Efforts are extended to ensure that the operating room is as sterile as possible. Medical personnel don gowns, masks and gloves. But those who exit the room during the intense procedure, then return, have a greater opportunity to spread infection. There are obviously sound reasons for people leaving or entering the operating room; from retrieval of an instrument to fetching a component of the joint. On the other hand, other people leave to "chat with a friend" in the corridor outside, to ask questions unrelated to the operation, or to pick up personal items.

Bacterial count is directly proportional to the number of people in the room; the greater the number in the room, the more frequently traffic flows in and out. And frequent door openings are capable of disturbing the positive pressure airflow system in the OR "possibly introducing more bacteria into the OR and potentially contributing to contamination of the wound", the study concludes. Over 200,000 Canadians become infected in a health-care institution annually. Surgical site infections are  responsible for one-third of all such hospital-acquired infections.

Hip and knee replacements, as the most frequently performed surgeries in Canada, account for up to 105,000 surgeries combined between 2012 and 2013, according to the Canadian Institute for Health Information. A total of 7,110 door openings were recorded for the study, relating to 100 surgeries. On average, a dozen people and up to 19 were present in the operating room for each operation performed and examined for the purposes of the study.

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