Studies suggest ways to prevent post-surgical infections in hospitals

“This is going to be a huge help to the infection-control crowd”

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Two new studies are suggesting relatively simple ways in which hospitals can prevent many post-surgical infections by killing bacteria the patients themselves bring in, according to Monday's New York Times. Screening, scrubbing or pretreating the patient in ways that are not currently being employed all were shown to contribute to this favorable outcome. “This is going to be a huge help to the infection-control crowd,” said Marcia Patrick, a nurse and board member of the Association for Professionals in Infection Control and Epidemiology, who was not involved with either study.

Both of the studies' findings appeared in the New England Journal of Medicine. One tested patients for the presence of the very common staphylococcus aureus bacterium, which is normally not harmful, and treated about 500 of those who tested positive with antibiotic ointment on their noses over five days plus showers using a soap containing the antiseptic chlorhexidine. These patients were 60 percent less likely to develop infections.

Although this study was of limited use because all of the patients had surgery serious enough to require a hospital stay of at least five days, the other study could have more general implications. This study showed that using a chlorhexidine-alcohol disinfectant in place of the usual povidone-iodine solution reduced total infections by 40% and staph A infections by half. Dr. Richard P. Wenzel, an infectious disease specialist at Virginia Commonwealth University, editorialized about the studies and recommended that this second procedure be adopted across the board while reserving the more comprehensive approach for serious operations like heart surgery.

EXPERTS: ExpertSource can offer several highly qualified experts to comment on this story:

Ms. Gina Pugliese, RN, MS, Premier healthcare alliance

Gina Pugliese is vice president of the Premier Safety Institute, editor of its Safety Share online newsletter, and is responsible for the overall content of the Safety Institute's Web site. She is an associate faculty member of Rush University College of Nursing and a member of the adjunct faculty of the University of Illinois School of Public Health, Division of Epidemiology and Biostatistics, in Chicago. In addition, she is the senior associate editor of Infection Control and Hospital Epidemiology and serves on the editorial board of the Joint Commission Journal on Quality Improvement and Safety. She served as co-chair for 16 years and is currently on the faculty of the international Healthcare Epidemiology Training Program that is co-sponsored by the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention (CDC). For eight years, Pugliese was the director of safety of the American Hospital Association (AHA). For more than 25 years, she has served in clinical, teaching, and administrative positions in nursing, hospital administration, safety, and infection control. She is the author of more than 130 publications and has developed and/or served as faculty in over 400 national and international educational conferences in fourteen countries and 25 national videotapes and teleconferences. Pugliese has served on a number of national committees for JCAHO, CDC, FDA, Centers for Medicare and Medicaid Services (CMS), and the Occupational Safety and Health Administration (OSHA), Agency for Healthcare Research and Quality (AHRQ) and the National Quality Forum (NQF) to assist in guideline-setting and regulatory processes related to patient safety and infection prevention and control. Pugliese is currently a member of a technical advisory panel for the CMS National Surgical Care Improvement Project (SCIP) and the NQF Voluntary Consensus Standards for the Reporting of Healthcare-associated Infection Data. Pugliese has received numerous honors for her work in healthcare epidemiology, patient safety and infection prevention, including a special recognition award from the U.S. Department of Labor in 1991, the AHA Employee of the Year in 1992 and APIC's Carol DeMille Outstanding Achievement Award in 2001. In 2005, the Gina Pugliese Scholarship was established by SHEA for a clinician to attend each of the bi-annual SHEA/CDC international Healthcare Epidemiology Training Courses.

Russell N. Olmsted, MPH, CIC, St. Joseph Mercy Health System AND President-Elect, Association for Professionals in Infection Control and Epidemiology (APIC)

An infection preventionist for more than 28 years, Olmsted is epidemiologist in Infection Prevention and Control Services for St. Joseph Mercy Health System (SJMHS) in Ann Arbor, Michigan; a member of a national Catholic healthcare network, Trinity Health, headquartered in Novi, MI.

Since November of 2006, Olmsted has been a member of the Centers for Disease Control and Prevention’s (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC). He also chaired the 2008 External Peer Review Panel of the National Healthcare Safety Network (NHSN), and is a member of the NHSN Steering Work Group. With backgrounds in biology/microbiology and healthcare epidemiology, he has developed interest in the impact of environment of care on health care-associated infections (HAIs). As such Olmsted served as liaison from APIC to the Facility Guidelines Institute’s (FGI’s) Health Guidelines Revision Committee (HGRC) recently published Design and Construction Guidelines for Health Care Facilities, 2010 edition. He is continuing his role with FGI as a member of the HGRC Steering Committee for the 2014 edition.

Olmsted was elected President-Elect of APIC, a position he will hold until January 2011 at which time he will become APIC President. As a long-time APIC member and leader, Olmsted served as a board member, editor of the 1996 APIC Text and is currently associate editor and member of the editorial board of the American Journal for Infection Control (AJIC). He served as editor of the APIC News, became a member of APIC’s Continuous Quality Improvement Task Force and was the first chairperson of the APIC Information Technology Committee.

Olmsted is past president of the Michigan Society for Infection Prevention & Control and led a state-wide task force to conduct a peer review of data mining technology on behalf of the Michigan Health and Safety Coalition. Currently, he collaborates with other infection preventionists to develop tools and present information to the Michigan Health & Hospital Association’s (MHA) Keystone Center for Patient Safety & Quality to reduce blood stream infections and ventilator-associated pneumonia to zero. He continues these efforts with a current Keystone initiative focusing on hand hygiene and enhancing appropriate use of urinary catheters. He also serves as affiliated faculty for the University of Michigan’s Patient Safety Enhancement Program that is studying adoption of evidence-based practices to prevent HAIs in U.S. and VA hospitals.

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