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Digital Issues

Why Don't Antibiotics Always Prevent Joint SSIs?

Why are surgical site infections still prevalent after joint replacement surgery, despite the widespread use of prophylactic antibiotics? The answer might be found in a patient's joint fluid, where a study suggests that bacteria can survive and grow.

Researchers at Thomas Jefferson University in Philadelphia and the National Institutes of Health recently studied samples of synovial fluid from patients undergoing joint surgery to determine whether the concentration of pre-operative antibiotics in each was sufficient to prevent bacterial infections.

They found high concentrations of cefazolin, but when they introduced Staphylococcus aureus to the samples, they also found that the bacteria was able to survive, and more importantly, grow and form clumps in the fluid despite the antibiotics.

Previous research has shown that these clumps, formed when the bacteria embed themselves in a protective mesh of proteins that resist antibiotic penetration, are a source of difficult-to-cure joint infections.

"The next step is to see how we can disperse these mega-clusters of buried bacteria," says Sana Dastgheyb, PhD, lead author of the study. "If we can provide a window for antibiotics to carry out their intended function, we can move towards a clinical model and ultimately cure joint infection."

Kendal Gapinski

Study: If Patients Fear Pain, They'll Feel Pain

Attitude and genetics may influence the perceived intensity of post-surgical pain as much as, or more than, the size or intensity of the operation, a recent study finds.

Researchers at the University of Florida Health tested 150 patients having shoulder surgery, first exploring their attitudes about pain, and then checking for the presence of genes that have been linked to sensitivity and inflammation. They then asked patients to rate their pain on a 0-to-10 scale 1 week before surgery; then 3, 6 and 12 months after surgery. Patients who were especially fearful of pain and who had a high pain sensitivity variant of the COMT gene were more than 40% likely to say they were still in pain 12 months after surgery, compared with 20% of patients who didn't have those factors.

The pain sensitivity questionnaire measured fear of various kinds of pain, such as paper cuts and slamming a hand in a car door, as well as pain catastrophizing — the fear that pain will worsen or that nothing can be done to prevent it.

The goal of the research is to help tailor appropriate pain treatments, says lead investigator Steven George, PT, PhD, adding that there's no reason to believe that the findings wouldn't apply to other parts of the body, too.

Jim Burger

Where Anesthesia Takes Effect

The identification of a protein that drives the effectiveness of inhalational anesthesia could lead to lower-concentration agents with fewer unwanted consequences, say Johns Hopkins researchers.

The researchers, who published their findings in the journal Anesthesiology, focused on a scaffolding protein called postsynaptic density protein-95 (PSD95) which, when blocked, prevents some forms of chronic pain and reduces the levels of anesthesia needed to have an effect on patients. According to the study, inhalational anesthesia's molecules bind on PSD95 to prevent excitatory neurons from transmitting signals.

PSD95 is also involved in making proper connections between neurons in the developing brain, a process that could be impacted when general anesthesia is administered to infants or young children, according to the researchers. They say those concerns have prompted recommendations that, if possible, surgery be postponed in pediatric patients in order to avoid potential neurotoxicity and long-term cognitive impairment.

"The current findings could help to design new and more specific anesthetics or allow us to lower the anesthetic concentration needed for anesthesia, as anesthetics at higher concentrations can have dangerous side effects," says study senior author Roger Johns, MD, MHS, a professor in the department of anesthesiology and critical care medicine at the Johns Hopkins School of Medicine in Baltimore, Md.

Daniel Cook

InstaPoll: Do You Wear Scrubs in Public?

Do you leave your facility in your scrubs? Tell us in this week's InstaPoll.

More than half (56%) of the 177 respondents to last week's poll report that their staff balk at wearing protective eyewear in the operating room, most often because the PPE distorts their vision. The results:

Is it difficult to get staff to comply with eyewear PPE?

  • Yes, they complain of distortion. 34%
  • Yes, they complain of feeling too hot. 22%
  • No, it is not a problem. 44%

Dan O'Connor

News & Notes

  • Lawmakers propose ASC parity The Ambulatory Surgical Center Quality and Access Act of 2015, introduced in the U.S. House of Representatives last week, would require CMS to derive ASC reimbursements from the Hospital Market Basket rate instead of the Consumer Price Index for urban consumer; include an ASC industry leader to its Advisory Panel on Hospital Outpatient Payment; explain why certain procedures are not on its ASC payment list; and publicly disclose its ASC and hospital quality reporting results.
  • Florida considering 23-hour ASC rule Florida may soon become the 34th state to enact legislation allowing patients to stay in ASCs for up to 23 hours. A bipartisan proposal would eliminate current restrictions, which require surgery center patients to either be discharged by close of business or admitted to a hospital. "Increasing recovery times would further enhance our ability to provide safe, clinically sophisticated and cost-effective care," says Brian Rye, administrator for the Melbourne (Fla.) Surgery Center, in a release from a group called Floridians for Better Community Care. "Allowing for a patient to fully recover makes more sense than the inconvenience, greater infection risks and increased costs resulting from hospitalization."
  • Safer labels keep patients safer Redesigning the labels of IV medication bags to include more visual contrast could help to improve drug identification and prevent delivery errors, according to a study appearing in the Journal of Patient Safety. For the study, researchers subjected anesthesia trainees to realistic but simulated surgical emergencies and directed them to choose the correct medication from an improperly stocked cart.

February 10th E-WEEKLY