In heart surgeries and knee and
joint-replacement procedures, up to 85 percent of staph infections
after surgery come from patients’ own bacteria, according to a 2002
study in the New England Journal of Medicine.
Despite the
threat that staph bacteria pose to patients, there is no uniformly
accepted procedure to reduce surgical-site infections in the United
States. Now, a team of researchers led by the University of Iowa is
recommending guidelines that will cut the infection rate by 71 percent
for staph bacteria and 59 percent for a broader class of infectious
agents known as gram-positive bacteria. In a paper published Thursday
(June 13) in the British Medical Journal, the researchers recommend three steps to reduce post-surgical staph infections:
- Swab patients’ noses for two strains of staph (MRSA and MSSA) before surgery
- For the 30 percent of patients who have staph naturally in their noses, apply a anti-bacterial nose ointment in the days before surgery
- At surgery, give an antibiotic specifically for MRSA to patients who have the MRSA strain in their noses; for all others, give a more general antibiotic
Marin Schweizer, an assistant professor in internal
medicine at the UI and the lead author on the BMJ paper, notes the nose
ointment costs around $20 a tube and is usually covered by health
insurance. “We now know we can target staph where it exists naturally in
some patients, which is in the nose,” she says. “That’s the bull's-eye ,
and we can wipe it out. What we are recommending is a really simple,
cheap solution to a big problem.”
The group is now testing the
protocol at 20 community hospitals nationwide, including the UI
Hospitals and Clinics, as well as 10 Veterans Affairs health-care
centers, including the one in Iowa City. The VA is funding the study.
The recommendations come from the team’s review of 39 studies of various surgical-site infection practices employed at hospitals nationwide. Many of the individual studies involved small patient samples, and thus were not statistically significant. By combining studies with similar treatment practices and analyzing the outcomes from other studies with different treatments, the UI-led team found a best approach and a large enough sample to make it statistically significant.
“The
combination matters, and the treatment being in a bundle matters, too,”
says Schweizer, whose primary appointment is in the Carver College of
Medicine. “By putting it all together in one care bundle, that one
checklist, it becomes standard operating procedure for every hospital.”
Three
in ten people in the U.S. unwittingly carry staph in their noses, where
they reside benignly as the alpha bacterium in a warm, moist olfactory
world. While harmless in the nose, staph can wreak major havoc if
introduced within the body, such as a wound healing from surgery. In
fact, the researchers found that 78 percent to 85 percent of
surgical-site infections involving staph come from the patients’ own
bacteria. In those cases, the infecting agents were traced to bacteria
in the patients’ noses by comparing the DNA profile of the bacteria at
the surgical site with those in the patients’ noses. Most likely, people
touched their noses and then touched the wound, freeing the bacteria to
roam.
Those post-surgery staph infections mean pain, personal and
financial, with two studies estimating treatment to cost between 40,000
and $100,000, most of it due to follow-up surgeries.
Despite the
risks and repercussions, the team found that 47 percent of hospitals
reported in a survey that they don’t use the nose ointment for staph
carriers.
Contributing authors from the UI include professors Eli
Perencevich and Loreen Herwaldt. Research assistants Jennifer McDanel,
Jennifer Carson and Michelle Formanek, all from the UI, also contributed
to the work, along with Barbara Braun and Joanne Hafner, from The Joint
Commission in Oakbrook Terrace, Ill.
The U.S. Department of
Health and Human Services funded the study, after Schweizer and her
colleagues responded to the department’s call for proposals to reduce
surgical-site infections.
Source:Newswise