Study Looks at How to Stop Operating Room Infections

Paying close attention to the area around the wound and frequent measurement made a difference.

The arrival of quality control measures makes halting operating room (OR) infections more important than ever, and researchers from the University of Texas have zeroed on 2 items that make a difference:

· Mandating sterile operating conditions at or close to the wound,

· Tracking in-hospital outcomes on surgical-site infections.

Their findings, based on a study of Texas hospitals, will be published in the Journal of the American College of Surgeons (ACS), based on a presentation made at the ACS Quality and Safety Conference in July.

“Every institution wants to lower complication rates and, in particular, wound infection rates," lead study author Thomas A. Aloia, MD, FACS, of the University of Texas MD Anderson Cancer Center, department of surgical oncology, said in a statement. "However, we have limited resources to carry out quality assessment and quality improvement.”

“What's important about this study is that it brings feasibility to hospitals that may be considering 80 possible variables to intervene on. To get off to a strong start, they can begin by looking at conditions right at the wound and their reporting practices. A focus on these elements should produce the biggest impact for quality improvement initiatives.”

Surgical site infections (SSIs) add costs to the system; studies estimate that costs for a patient who develops an infection are twice that of patients who have uneventful operations. SSIs account for 1 in 6 of all hospital-based infections, lead to longer stays, and cause higher death rates. Gastrointestinal surgery is a special area of concern, as infections here increase stays by an average of 10 days and raise costs an average of $20,000, according to an earlier study in the American Journal of Infection Control.

For the study, the University of Texas researchers surveyed leading surgeons at 20 hospitals affiliated with the Texas Alliance for Surgical Quality (TASQ), a collaborative of the American College of Surgeons National Surgical Quality Improvement Program. They asked respondents to rank how well the 3 key surgical disciplines—surgery, anesthesia, and nursing—meet 38 infection control practices in 6 areas:

· attire

· preoperative preparation

· during-surgery protocols

· antibiotics

· postoperative care

· outcomes reporting.

"The best performing hospitals were vigilant about skin prep, using a clean closure and giving antibiotics appropriately—all those things that happened right at the level of the wound," Aloia said. "In addition, the hospitals that reported out their data on a formal basis--monthly or quarterly--to their surgeons, departments, and institutions also had the highest performance."

The findings were consistent were recently studies and infection site guidelines from CDC, as well as those from the ACS Surgical Infection Society, the authors noted. By contrast, regulations on undershirts, nail polish, shoes and shoe coverings, restrictions on jewelry, and coverage requirements for head and facial hair seem to lack data to back them up.

The study authors plan to revisit the participating programs in a year to see how lower-performing programs have changed infection control practices and if they have improved SSI rates as a result.