Surgical Morbidity and Mortality Should Decrease With New Infection Prevention Guidelines, Says Industry Workgroup

IRVING, Texas -- Surgical site infections, the

second-most common cause of hospital-acquired infections, can be prevented if

hospitals administer the right antibiotics, at the right time and in the right

dosage. Representatives from leading national medical organizations,

physicians and hospitals in the United States formed a workgroup to address

this issue and have now developed consensus guidelines for preventive use of

antibiotics to help reduce surgical infections. The guidelines were published

in the June 15, 2004 issue of the journal Clinical Infectious Diseases.

"If we consistently use the appropriate antibiotics an hour before surgery

and halt antibiotic administration when it is no long necessary, we can

dramatically improve morbidity and mortality associated with surgical

infections," said John Hitt, MD, vice president of clinical improvement for

VHA Inc., and one of the members of the workgroup that developed the consensus

guidelines. "Furthermore, this will result in significant financial savings

to hospitals."

The Centers for Disease Control and Prevention (CDC) estimates that

500,000 surgical site infections occur annually in the United States. Each

infection is estimated to increase a hospital stay by an average of seven days

and add more than $3,000 in costs. Patients who develop surgical site

infections are up to 60 percent more likely to spend time in the intensive

care unit, where care is more costly for the patient and the hospital. They

also are five times more likely to be readmitted to the hospital. The causes

of surgical site infection are inconsistent use of antibiotics, using the

wrong antibiotics, inconsistent timing of antibiotic administration, or

complete failure to use antibiotics prior to surgery.

The workgroup examined the best practices for antibiotic administration

for five common surgical procedures: cardiothoracic surgery, vascular surgery,

colon surgery, hip or knee replacement, and vaginal or abdominal hysterectomy.

National performance data reveals that 25 percent of patients undergoing colon

surgery do not receive the correct antibiotic to prevent infection; between

3 percent and 10 percent of other patients do not receive the correct

antibiotic for surgery.

The most important recommendation by the panel was that antibiotics should

be given one hour before surgery (on average, only 55 percent of surgical

patients receive antibiotics within an hour of surgery) and should not be used

for more than 24 hours after the end of the operation. Nationally,

antibiotics are currently continued for an average of 40 hours following a

surgical procedure. The panel validated that timely administration of

antibiotics results in effective infection prevention and that a shorter

duration of antibiotics is less likely to produce antibiotic-resistant

bacteria.

"For some surgical procedures, hospitals are administering antibiotics as

long as 96 hours following surgery, so a real savings opportunity exists for

hospitals that adhere to the guidelines," said Hitt. "Granted, the

antibiotics used to prevent surgical infections are not the most expensive

brands, but the savings are real. VHA is endorsing and encouraging a change

of behavior among its member hospitals."

Hitt said appropriate use of antibiotics will reduce:

-- gastrointestinal side effects of some antibiotics

-- related laboratory monitoring costs

-- risk of allergic reactions for certain patients

The paper, "Antimicrobial Prophylaxis for Surgery: An Advisory Statement

from the National Surgical Infection Prevention Project," was the result of a

yearlong effort by leading national medical organizations to identify best

practices for preventing surgical site infections. The statement has been

accepted by more than 20 medical societies and national health care

organizations, including the American College of Surgeons, the American

Academy of Orthopaedic Surgeons, and the Society of Thoracic Surgeons. The

quality improvement project is co-sponsored by the Centers for Medicare &

Medicaid Services and the Centers for Disease Control and Prevention, and is

conducted through the CMS Health Care Quality Improvement Program. Its goal

is to reduce the occurrence of post-operative infection by improving the

selection and timing of preventative antibiotic administration.

Participating organizations were the American Academy of Orthopaedic

Surgeons, American College of Obstetricians and Gynecologists, American

College of Surgeons, American Geriatrics Society, American Society of Health-

System Pharmacists, Infectious Diseases Society of America, The Medical

Letter, Society of Thoracic Surgeons, Surgical Infection Society, Society for

Healthcare Epidemiology of America, and VHA Inc.

Source: VHA Inc.