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WASHINGTON, D.C. -- The Centers for Disease Control and Prevention (CDC) has introduced an educational campaign for helping surgeons prevent antimicrobial resistance in their patients. The CDC made the announcement at the American College of Surgeons conference in Chicago, which wraps up this week. The surgeons' campaign is a component of CDC's Campaign to Prevent Antimicrobial Resistance in Healthcare Settings.
The campaign for surgeons focuses on four key strategies for preventing antimicrobial resistance in healthcare settings: 1) preventing infection, 2) diagnosing and treating infection effectively, 3) using antimicrobials wisely, and 4) preventing transmission of drug-resistant pathogens. The strategies include 12 action steps derived from evidenced-based guidelines and recommendations developed by CDC with the support of other medical and public health organizations.
"Surgical patients are at risk for antimicrobial-resistant infections due to surgical incisions and exposure to medical devices like ventilators, central lines, and urinary catheters," said Dr. Denise Cardo, director of CDC's Healthcare Quality Promotion Program. "This campaign, developed in collaboration with surgeons, offers 12 steps that surgeons can take to protect their patients from these ongoing risks."
The action steps for surgeons who provide care for surgical patients include:
Action Step 1: Prevent surgical site infections
Monitor and maintain normal glycemia
Perform proper skin preparation using appropriate antiseptic agent and, when necessary, hair removal techniques
Think outside the wound to stop surgical site infections
Action Step 2: Prevent device-related infections: get the devices out
Use catheters only when essential
Use proper insertion and catheter-care protocols
Use drains appropriately
Remove catheters and drains when they are no longer essential
Action Step 3: Prevent hospital-acquired pneumonia
Wean from the ventilator when appropriate
Elevate head of bed to 30 degrees
Drain circuit/tubing condensate away from patient
Prevent contamination of respiratory therapy equipment, ventilator circuits and respiratory medications
Action Step 4: Target the pathogen
Target empiric antimicrobial therapy to likely pathogens
Obtain appropriate cultures
Target definitive antimicrobial therapy to known pathogens
Optimize timing, regimen, dose, route, and duration of antimicrobial therapy
Practice safe source control (e.g. debridement, or open wound as indicated)
Action Step 5: Access the experts
Consult the appropriate expert for complicated infections:
surgeons, infectious disease experts, clinical pharmacists
Action Step 6: Start prophylactic antimicrobials promptly
Give the initial dose within one hour preceding incision
Use the appropriate antimicrobial and dosing
Repeat the dose during surgery as needed to maintain blood levels
Action Step 7: Stop prophylactic antimicrobials within 24 hours
Discontinue use even with catheters or drains still in place
Action Step 8: Use local data
Know your local antibiogram
Know your formulary
Know your patient population
Action Step 9: Know when to say "no" to vanco
Vancomycin should be used to treat known infections, not for routine prophylaxis
Treat staphylococcal infection, not contaminants or colonization
Consider other antimicrobials in testing methicillin-resistant staphylococcus aureus (MRSA)
Action Step 10: Treat infection, not contamination or colonization
Use proper antisepsis for drawing blood cultures
Get at least one peripheral vein blood culture, if possible
Avoid culturing vascular catheter tips
Treat bacteremia, not the catheter tip
Action Step 11: Contain contaminant and contagion
Follow infection control precautions
Consult infection control teams
Action Step 12: Practice hand hygiene
Set an example
Wash your hands or use an alcohol-based handrub
Do not operate with open sores on hands
Do not operate with artificial nails
Promote good habits for the entire surgical team
"Antibiotic resistance poses a major threat to everyone," said Cardo. "This educational campaign will increase patient safety by preventing these infections. CDC is developing similar programs for clinicians who care for hospitalized children and patients in long-term care facilities."
Antimicrobial-resistant infections in healthcare settings pose a major threat to patient safety. Each year in the United States, an estimated 2 million hospitalized people acquire infections that result in more 90,000 deaths. Bacteria cause more than half of these infections, which are resistant to at least one of the antimicrobials commonly used to treat them, according to CDC. Previous studies have shown that surgical patients who develop drug-resistant infections are at increased risk of illness, longer hospital stays, and death.
The 12 steps for surgeons are endorsed by the American College of Surgeons and the Surgical Infection Society. The campaign was made possible through support from the CDC Foundation. Materials being developed for the campaign include a slide set featuring the 12 action steps and the evidence to support them, posters, and a scratch pad listing the12 action steps. The campaign also features a web site where surgeons may access the 12 action steps as well as information to share with their patients.
For more information on CDC's campaign to prevent antimicrobial resistance in healthcare settings go to www.cdc.gov/drugresistance/healthcare.