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OU Leader Contributes to New National Guidelines on Surgical Infections

An OU Medicine physician leader is among the primary authors of a new study about prevention of surgical site infections.

Oklahoma City (August 2, 2017) – Surgical site infections are the most common and expensive form of hospital-acquired infections, and they occur in 2 percent to 5 percent of all operations in the United States. However, at least 50 percent of such infections are preventable. An OU Medicine physician leader is among the primary authors of a new study about prevention of surgical site infections. The results of that study led to new guidelines issued by the Centers for Disease Control.

Dale Bratzler, D.O, M.P.H., is chief quality officer for the OU Physicians clinical practice and a professor in the OU Colleges of Medicine and Public Health. He also is a national expert on surgical site infections and evidence-based methods of their prevention.

“Surgical site infections are still common, and their severity will vary based on the location of the infection and the complexity of the operation,” Bratzler said. “For example, if patients get an infection while undergoing cardiac bypass surgery or having a hip replacement, the results can be devastating. Surgical site infections dramatically increase the cost of care, cause disability for patients and may require several operations to address the problem, in addition to treatment with antibiotics.”

Bratzler was a lead author for the study, which was published in JAMA Surgery and officially adopted as a CDC guideline. As part of their work, the authors queried community hospitals and surgeons about what questions they wanted answered concerning surgical site infections. The group then reviewed thousands of articles on randomized controlled trials concerning prevention of surgical infection.

Following are some of the major recommendations:

  • For any type of surgery, outpatient or inpatient, the new recommendation is to stop giving all antibiotics once the incision is closed. Doctors have often continued to give antibiotics to the patient after they close the wound. However, studies consistently show no benefit to continuing to give antibiotics. In addition, continuing antibiotics leads to a 60 percent increased risk that, if the patient is infected, it would be from an organism that is resistant to antibiotics. “Most surgical infections start in the operating room when the wound is open – that’s when the wound can become contaminated with bacteria,” Bratzler said. “When the surgeon closes the wound, the bacteria stays in the closed space, which doesn’t have much blood flow because the blood vessels have been cauterized. Giving additional antibiotics after the surgery is over isn’t going to make a difference and can be harmful.”
  • To reduce the chance of a mother getting an infection during a Caesarean section, doctors should give antibiotics before the incision is made. Previously, doctors would wait until the baby’s umbilical cord was clamped before giving the mother antibiotics. However, studies consistently show that antibiotics provide better protection when given before the incision, and doing so does not adversely affect the baby.
  • Keeping patients warm in the operating room reduces the risk of surgical infections.
  • Supplemental oxygen during major operations – both in the operating room and after surgery – has been shown to reduce infections.
  • Controlling a patient’s blood sugar after surgery reduces the risk of infection. High blood sugars impair the body’s ability to fight off infection.
  • Use an alcohol-based skin antiseptic to clean the skin before an incision is made. Alcohol rapidly kills bacteria.

“The most important thing to remember is that half of the surgical site infections that occur are potentially preventable if we implement these evidence-based guidelines,” Bratzler said. “Our recommendations are based on what the evidence shows will reduce the risk of developing a surgical infection.”