The rates of post-operative bloodstream and catheter-associated urinary tract infections rose in 2009, prompting federal health officials to label healthcare-associated infections "one of the most serious patient safety concerns" in the National Healthcare Quality Report.

"Very little progress has been made on eliminating healthcare-associated infections (HAIs), according to a new section in the 2009 quality report," the U.S. Agency for Healthcare Research and Quality announced last week.

Three of the 5 HAIs tracked were on the rise in 2009: The rate of post-operative sepsis rose 8%; catheter-associated UTIs rose 3.6%; and rates of "selected infections due to medical care" rose 1.6%. The only HAI outcome measure that registered improvement was post-operative pneumonia, which declined 11.6%. The report found no change in the rate of central venous catheter-related bloodstream infections.

While AHRQ raises an alarm over the lack of improvement in HAI reduction, researchers note that the increasing infection rates "may, in part, reflect improving detection of HAIs."

And the report does have some bright spots, as it shows improvements in antibiotic prophylaxis administered to adult surgical patients. The rate of patients who received antibiotics within 1 hour of surgical incision rose 26.4%, and the rate of patients who had antibiotics discontinued within 24 hours after surgery rose 32.9%. Further demographic breakdowns revealed that white patients were more likely to receive timely pre-surgical antibiotics than blacks, Hispanics, Asians and American Indians.

"Despite promising improvements in a few areas of health care, we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access," concludes AHRQ Director Carolyn M. Clancy, MD.

Irene Tsikitas

Robotic prostatectomy leads to decreased surgical and recovery times as well as less blood loss and shorter hospital stays when compared to traditional open techniques, reports David B. Samadi, MD, of the Mount Sinai School of Medicine in New York City.

After performing robotic prostatectomy on 575 patients and open procedures on 106 more, Dr. Samadi noted anesthesia and surgical times dropped by 45% and 51%, respectively, estimated blood loss was reduced by 96% and hospital stays were 67% shorter.

Dr. Samadi, who will release his findings later this month in the online edition of the Journal of the Society of Laparoendoscopic Surgeons, reports no intraoperative complications following the robotic surgery, including blood transfusions, intraoperative red cell salvaging or rectal perforations which, he says, is a common complication following prostate surgery.

The findings come soon after a study appearing in the March issue of the British Journal of Urology International noted that robotic prostatectomy outcomes are not adversely affected by a surgeon's lack of tactile feedback. Researchers reviewed pathology results following 1,340 robot-assisted prostatectomies for positive surgical volumes, which indicate the surgeon may have missed some cancer cells while removing the prostate gland, says Ashutosh Tewari, MD, the study's lead author and a professor of urology, urologic oncology and public health at New York City's Weill Cornell Medical College.

Positive margins began at 2.1% and declined to 1% in the last 100 patients, compared to positive margins found in up to 9% of patients undergoing traditional prostatectomy, according to the study. The researchers say surgeons operating with a robotic system can use visual cues and anatomical landmarks to improve surgical outcomes, including tissue color, vein and nerve locations and signs of tissue inflammation.

Daniel Cook

Knee replacements performed with computer assistance offer more precise alignment and, in turn, less risk of joint failure and post-op infections than conventional joint surgeries do, according to a New York hospital's study.

Physicians at Mercy Medical Center in Rockville Centre, N.Y., studied the outcomes of 1,000 consecutive computer-assisted total knee arthroplasty cases performed at the facility between February 2005 and January 2010.

According to the study, presented at the American Academy of Orthopedic Surgeons' annual meeting last month, the computer-assisted, robotic surgeries aligned patients' hips and the knee implants to within 3 degrees of the ankle - the acknowledged measure of precise placement - 100% of the time. Conventional surgeries only meet that mark 50% to 80% of the time.

Additionally, the study saw no joint failures or revision surgeries among its 1,000 patients in the first 5 years of the study, as compared to a 3% to 8% failure rate among conventionally treated patients, who see half of joint failures within 2 post-surgical years due to imprecisely aligned implants, unstable joints and aseptic complications. And only 2 of the 1,000 patients (0.2%) suffered post-op infections, as compared to the 1% to 5% expected among conventional surgeries.

David Bernard

The "little pinch" of the IV needle is a big deal for a lot of patients. Some would say that patients' anxiety levels are often higher for their IV starts than for their surgeries. This week we want to know your opinion on the best place to find a suitable vein for IV therapy - the hand, the wrist, the forearm or the crease of the elbow? Cast your vote in this week's poll question. We'll report the results in this space next week.

Sixty-one percent of the 132 facility managers who anwered last week's poll say their facilities employ certified nursing assistants. Here's the breakdown: