Study: Conduct, Not OR Attire, Is What Reduces SSIs

LOW PRIORITY Regulations regarding surgical caps and other OR attire appeared to have no effect on SSIs.

What providers do is a lot more important than what they wear when it comes to preventing surgical site infections, a recent study suggests. Researchers who surveyed 20 hospitals in Texas found that the lowest infection rates occurred at hospitals that were vigilant about skin prep, that focused on sterile conditions at or near the wound and that tracked and shared SSI data.

But "policies regulating the attire of OR personnel had no measurable impact on infection rates," says lead author Thomas A. Aloia, MD, FACS, a surgical oncologist at the University of Texas MD Anderson Cancer Center in Houston, who presented the study at the American College of Surgeons Quality and Safety Conference in July.

The survey asked surgeon leaders to rank on a 4-point scale how well surgeons, anesthesia providers and nurses at their hospitals adhered to 38 infection-control practices in 6 categories: attire; pre-op preparation; during-surgery protocols; antibiotics; post-operative care; and outcomes reporting.

Nearly all hospitals reported maximal adherence to the practices of removing hair with clippers and to best-practice prophylactic antibiotic metrics. But adherence regarding several other best practices varied, and the hospitals with the lowest SSI rates were those that were most compliant in regard to pre-operative showers for patients; skin preparation techniques; using clean instruments, gowns, and gloves for wound closure and dressing changes; and reporting SSI data on a formal basis to surgeons and other departments.

On the other hand, OR attire restrictions, especially those away from the surgical field — including those regarding surgical caps, undershirts, shoes, shoe coverings, jewelry, nail polish, and coverings for forearms, head and face — didn't affect SSI rates, the study found.

Jim Burger

D.C. Hospital Denies Report of Sewage-Soaked ORs

STRONG DENIAL John Sullivan, the hospital's president, says the allegations are based on "inaccuracies and misused data."

MedStar Washington Hospital Center, where politicos and power brokers often seek care while in the nation's capital, is denying a report that claims its ORs are filled with sewage, a porta-potty-like stench and buzzing flies.

The stunning accusations were detailed in a recent article published in the USA Today, which interviewed hospital insiders and reviewed public records to paint a disturbing scene within the surgical department. Here are some of the troubling charges:

  • Sewage leaks in ORs that are located beneath bathrooms, including the OR where Louisiana Rep. Steve Scalise had his last surgery after being shot during a congressional baseball team practice in June.
  • Surgical team members walking between "sewage soaked" ORs and instrument storage areas.
  • Buckets being used to catch water leaks during surgeries.
  • Portable fans blowing in ORs to rid the rooms of "porta potty" odors.
  • Flies constantly buzzing around ORs and, in some cases, landing in open wounds.
  • Four incidences of retained objects over a 12-month period.

Lisa McGiffert, director of Consumer Reports' Safe Patient Project, described the alarming scenes as a "hospital that is out of control" and says anyone would be "horrified and disgusted" that the problems would be allowed to persist for so long.

Some former members of the medical staff wonder if budget cuts and significant staffing layoffs — 400 nurses left their jobs last year — the hospital made to manage a $16 million deficit last fiscal year contributed to the lapses in infection control and safe patient care, according to the report.

John Sullivan, the hospital's president, lashed out at the paper in an open letter penned to defend his facility's reputation. Mr. Sullivan, who admitted a "minor plumbing leak" at the hospital, writes, "Despite our best effort to provide USA Today with accurate information about us, the story is riddled with inaccuracies and misused data."

Mr. Sullivan claims the hospital is "financially strong" and has invested in programs to improve quality and safety. He also pointed out that the Joint Commission and D.C. Department of Health rigorously inspect every inch of the hospital, which he says in fully accredited.

Daniel Cook

Does Underwater Colonoscopy Amplify Polyp Detection?

CLEAR PATHWAYS MDs who practice hydrocolonoscopy report better views and better detection of lesions.

Hydrocolonoscopy continues to yield positive reports from gastroenterologists. What sets it apart from more traditional methods is the use of water instead of air to expand the colon before an exam, and according to research from the University of California at Irvine, the practice is more efficient for docs and more comfortable for patients.

Presenting his findings to Digestive Disease Week 2017, UCI's Anish Patel, MD, reported that 'underwater' colonoscopy achieves higher rates of polyp detection (PDR) and adenoma detection (ADR). Noting this result, Dr. Patel attributed the increase to the floating effect of the water. When the colon is suffused with water, polyps lining the wall become more buoyant, magnified, and visible to the eyes of examiners, and the jet stream clears away any lingering debris and mucus. Traditional air insufflation, however, can leave lesions flattened and hard to see. As for navigating with colonoscopes, water weighs the entire colon down, rounding out the organ's sharp turns for easy navigation. Air insufflation tends to blow these corners up.

Dr. Patel's results predict more satisfaction with the water method among MDs. Patients, however, are also happier by his accounts, finding less discomfort than they do with air insufflation, less cramping and gas, and less call for pain relief and sedation. Though U.S. MDs tend to favor sedation in colonoscopy, some have pointed out that the water-based method grants options to patients who can't or won't be sedated. Plus, for European MDs who prefer an unsedated colonoscopy, using water means a more comfortable, successful exam.

Though hydrocolonoscopy has been practiced for 30+ years, only recently has it grown among American gastroenterologists. Its future expansion seems to hinge on more positive findings and studies like Dr. Patel's at UC Irvine. For now, though, it brings further possibility to colonoscopy and how to treat patients.

Joe Madsen

InstaPoll: Do You Let Families in the PACU?

Family visitation in the PACU is a hotly debated issue. Some feel it's disruptive, while others allow visitors at the nurse's discretion — usually reserved for pediatrics, special needs or patients held longer than 2 hours. Tell us in this week's InstaPoll if you allow family in the recovery room.

ORs and waiting rooms are most in need of a remodeling, according to the 218 respondents to last week's InstaPoll. The results:

Which area of your facility is most in need of renovation?

  • Waiting room 25%
  • Pre-op 17%
  • ORs 30%
  • PACU 15%
  • Business office 13%

Dan O'Connor

News & Notes

  • Handoff communication In a recent report, Sentinel Event Alert focuses on the mishaps of patient care during handoffs between providers. The main issue, they say, is poor communication, and their report outlines 8 effective tips for improving this problem.
  • Virtual reality may reduce need for sedation Researchers in Australia say it's worth exploring whether immersive virtual reality has the potential to reduce the amount of anesthesia needed during surgery. A pilot study with patients having joint replacement surgery under regional anesthesia found that patients who were equipped with a virtual reality device during surgery required less propofol than those who weren't, with no significant difference in post-op satisfaction.
  • Surgery and teen opioid abuse Teenagers and young adults who are prescribed opioids after surgery — particularly gallbladder removal and colon procedures — are more likely to become persistent post-op users of the painkillers, according to research presented this week at annual meeting of the American Academy of Pediatrics. Study author Calista Harbaugh, MD, a general surgery resident at the University of Michigan Medical School, says the findings highlight the importance of limiting the use of opioids while still effectively treating surgical pain in younger patients.