Among all tracked hospital-associated infections, the one that seems to have the lowest rates are surgical site infections. While this relative strength varies by region, the overall low rate of surgical site infections is due in part to so many of the opportunities for infection being eliminated by interventions. However, surgical site infections still occur and data seems to point at the contamination of the patient environment, including surfaces, playing a significant role. In today's post, we will look at all the opportunities for infection after a surgical procedure, and highlight which vulnerabilities still remain.
It was so very long ago that surgery was a cure worse than the disease: The 1800s and early 1900s were a terrifying time for anyone requiring a surgical procedure! Not only was the medical technique still in its early years, there was spotty pain management and inconsistent (or absent) hygiene of the physician, the patient, and the environment. We've come a very long way since these gruesome times, thanks to many medical innovations as well as government regulation and reporting.
These days, the risk of acquiring a hospital-related surgical site infection hovers around 3-4% (for certain surgeries, the rates go up as high as 20%), with 3% of those infected dying as a result. Surgical site infections are considered one of the most preventable complications after surgery - up to 60% can be prevented - as so many threats can be avoided. Let's consider how this is accomplished:
Before Surgery Preventing infection starts before the surgery even takes place. If at all possible, any current infections should be treated before the procedure, and any identified colonization (presence of pathogens without infection) should be eradicated. Anticipating the possibility of an infection, surgical protocols call for antimicrobial prophylaxis for some surgeries. That is administering an antimicrobial agent or antibiotic that kills the type of bacteria most associated with the surgery area (different pathogens are associated with different surgeries). Right before surgery, introduction of pathogens into the surgical site is reduced by not removing hair unnecessarily and not using razors, as well as patient bathing with an antiseptic soap. Of course, the cleanliness of the operating room and equipment and all individuals present is assured through disinfection, sterilization, and use of PPE.
During the Surgery Advances in disinfection and sterilization have also assured the cleanliness of the equipment and healthcare workers during the operation itself, from sterile equipment trays to circulated air. Other controls have been put in place to limit operating room traffic, creating buffer areas and reducing inefficient movement to prevent bringing pathogens into the room. These controls extend to monitoring blood glucose levels during surgery, which have been shown to be correlated with development of a surgical site infection. Research shows that maintaining body temperature within normal ranges also helps prevent infection. Surprisingly, the research does not strongly support or oppose irrigation of the surgical site with antimicrobial agents, and actually recommends against applying antimicrobial agents directly on the surgical site. Use of antimicrobial sutures, however, is recommended.
After the Surgery The hospital is responsible for keeping the patient environment clean, including setting up barriers against transmission of pathogens. Proper wound care involves keeping the surgical site clean and properly dressed, and educating the patient on how to continue this process after discharge. To prevent pathogens from reaching the wound, the hospital is also responsible for keeping the patient area as free from contamination as possible by providing regular and thorough disinfection of surfaces, regularly changing linens, and reducing unnecessary traffic through the patient area.
There have been so many advances in preventing surgical site infections, and the prevalence is so relatively low, that it may seem that no further progress is needed in this area. However, there is still so much that could be done to prevent these dangerous infections, which, even if they do not result in death, can result in disability - even to the point of amputation - and impact quality of life.
What more can be done? A patient cannot become infected with a pathogen if that pathogen never reaches him/her. Hand hygiene and proper use of PPE does a great deal to prevent the transmission of pathogens to a vulnerable patient. Eliminating the source of these pathogens picked up by hands, gloves, ties, sleeves, file folders, stethoscopes, cuffs, and every other item that comes into contact with the patient starts with eliminating the pathogens that fall on horizontal surfaces such as bed rails, overbed tables, and work stations in the first place. Because these surfaces cannot be wiped down every hour, the best investment a facility can make is the installation of biocidal, self-sanitizing materials around the patient, surfaces that actively and continuously kill bacteria, hour after hour. To date, the only materials that can make this claim are raw copper alloys and copper-infused EOSCU. These materials destroy the bacteria before they can be picked up and transmitted to a patient, between cleanings, and best of all, without adding additional or ongoing work on the part of hospital staff. These surfaces represent the next step in reaching zero surgical site infections.
We should celebrate the progress infection preventionists have made in bringing down the rate of surgical site infections. Today, people considering elective surgery or facing emergency surgery have very little to fear in the form of a hospital-associated infection. However, these infections still occur, resulting in substantial costs to the patient in pain and suffering, possible disfigurement, lost work days and lost quality of life and mobility. To a facility, these infections impact reputation, budget, staff usage, ICU bed usage, patient turnover, and ultimately, the bottom line. We should celebrate successes while looking ahead to the next goal, total eradication of surgical site infections. Copper can help us reach this goal.