EXPERT ADVISORY: Minimizing Surgical-Site Infections
New England Journal of Medicine editorial authored by VCU expert
Sathya Achia Abraham
VCU Communications and Public Relations
(804) 827-0890
sbachia@vcu.edu
1/7/2010
Almost half of all surgical-site infections that occur post-operatively can be prevented, according to an editorial by a Virginia Commonwealth University physician published in the Jan. 7 issue of the New England Journal of Medicine.
In the editorial, Richard P. Wenzel, M.D., professor and former chair of the Department of Internal Medicine in the VCU School of Medicine, examined two large multi-institutional studies published in the same issue of the journal and analyzed their combined impact for controlling surgical-site infections.
One study showed an approximately 40 percent reduction of all surgical-site infections in a group of patients who received a preoperative skin scrub with chlorhexidine-alcohol, compared to the standard povidone-iodine scrub. The second study focused on reducing infections caused by Staphylococcus aureus by eliminating nasal and skin carriage of the organism in surgical patients before the operations.
According to Wenzel, approximately 20 percent to 30 percent of surgical-site infections are caused by S. aureus, and more than half of these infections arise from endogenous, or naturally occurring, bacteria that already exist in a person.
Wenzel, who is also an epidemiologist, suggested that the infection prevention rate could be increased by an additional 7.5 percentage points if the S. aureus interventions were added to the new scrub interventions. With a combined approach, a total of 47.5 percent of surgical-site infections might be prevented, which translates to between 150,000 to 250,000 infections that could be prevented in the U.S. in a year, he said.
Wenzel called the first approach a “horizontal program” since infections caused by all organisms were reduced, including half of the S. aureus infections. The second approach he called a “vertical program” which focused on a single microbe - S. aureus.
“The weight of evidence suggests that chlorhexidine-alcohol should replace povidone-iodine as the standard for preoperative surgical scrubs,” summarized Wenzel.
“The approach of removing S. aureus among patients who are carriers could be reserved for high-risk procedures such as heart surgery, implant surgery or surgery in patients with defective immune systems,” he said.
- About VCU and the VCU Medical Center
Virginia Commonwealth University is a major, urban public research university with national and international rankings in sponsored research. Located on two downtown campuses in Richmond, VCU enrolls more than 32,000 students in 211 certificate and degree programs in the arts, sciences and humanities. Sixty-nine of the programs are unique in Virginia, many of them crossing the disciplines of VCU’s 13 schools and one college. MCV Hospitals and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the nation’s leading academic medical centers. For more, see www.vcu.edu.
