Much Cleaner Cuts
Problem: Infection related to surgery Proposal: Better use of antibiotics, don't shave with razor prior to surgery, tighten control of blood sugar Possible lives saved: 8,000
A hospital is a risky place for people who have had surgery. No matter how much antibacterial solution is painted on before the first cut, opening the body invites lurking microbes. Infections at the surgery site complicate an estimated 780,000 operations a year, or more than 1 in every 40 procedures. For abdominal surgery, the likelihood is as high as 1 in 5. And the complications are tough to treat. Infected patients are two to three times more likely to die and are hospitalized an average of seven days longer than uninfected patients who had the same operation.
Even before the 100K campaign got underway, IHI had been working with a group of 56 hospitals on strategies to lower the rate of surgical-site infections. Results of the yearlong effort, published last month in the American Journal of Surgery, showed a reduction in such infections of more than one fourth.
But Berwick didn't need to wait for the study to end. Research published as far back as the early 1960s had laid out an effective arsenal of weapons. The 100K campaign focuses on four.
Time antibiotics better. Surgeons understand that giving an antibiotic in the 60 minutes before surgery lowers the infection rate. But getting it into patients within the 60-minute window happens only about 56 percent of the time, a February study in the Archives of Surgery found. "It's often started in another place, it's done running in 20 to 30 minutes, and then there's a delay," says lead author Dale Bratzler. "Typically the antibiotic loses half its potency in two to three hours, so if there's a several-hour delay, the patient is a candidate for infection by the time he's rolled into the OR." The answer: Don't start the antibiotic until the patient enters the operating room. At Hackensack, just before the scalpel comes down, the surgeon reads a checklist to make sure this is exactly what has happened.
Stopping the antibiotic within 24 hours after surgery is also a 100K stipulation because it may help combat antibiotic-resistant bugs that have become a major headache at hospitals.
Control blood sugar during heart surgery. Many studies focusing on cardiovascular surgery have found that patients whose blood sugar rises by more than a certain amount around the time of surgery are much more likely to die or suffer abnormal heart rhythms or other complications in the following month than are patients whose blood sugar is kept under control.
Rethink the razor. In years past, patients often were shaved the night before surgery. The razor left the skin raw and open to infection. Existing guidelines, noted by IHI, suggest that hair usually doesn't need to be removed at all. If it is, only remove it just before surgery--and use electric clippers, not razors. Hackensack leaves the decision to individual surgeons. McLeod threw out razors years ago.
Keep patients warm. Let a surgery patient get too cold and the risk of postsurgical infection rises. IHI's suggestions include cranking up the temperature in the OR. Hackensack uses an IV warmer, another IHI proposal, to raise the temperature of fluids before infusing them.
This story appears in the July 18, 2005 print edition of U.S. News & World Report.