How Effective Are On-Time Antibiotics?

The Surgical Care Improvement Project (SCIP) requires that patients receive prophylactic antibiotics within 1 hour prior to incision, but research recently published online by JAMA Surgery suggests that timing isn't everything.

A team of researchers led by Mary T. Hawn, MD, MPH, of the University of Alabama at Birmingham — who has previously questioned how effective SCIP measures are in preventing infections — examined data from 112 Veterans Affairs hospitals nationwide pertaining to this quality reporting metric.

Out of 32,459 procedures between 2005 and 2009, including hip and knee arthroplasties, colorectal surgeries, hysterectomies and arterial vascular cases, 1,497 (4.6%) resulted in surgical site infections. The study's authors found that the orthopedic surgery patients tended to suffer more SSIs when vancomycin was administered, and that the colorectal patients saw fewer SSIs on cefazolin and quinolone. But they did not see a significant correlation between compliance with the antibiotic timing measure and lower SSI rates.

"The SSI risk varies by patient and procedure factors as well as antibiotic properties but is not significantly associated with prophylactic antibiotic timing," they write. "While adherence to the timely prophylactic antibiotic measure is not bad care, there is little evidence to suggest that it is better care."

David Bernard

Minimally Invasive Surgery Lowers Costs, Reduces "Sick Days"

Minimally invasive surgical procedures reduce health plan spending and decrease workplace absenteeism when compared to standard versions of the procedures, according to a study published in JAMA Surgery.

Researchers cross-matched national health insurance claims data with employee attendance data between Jan. 1, 2000, and Dec. 31, 2009. They then looked at adults with employer-sponsored health insurance who underwent either the standard or minimally invasive version of 6 procedures: coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization or aortic aneurysm repair.

After adjusting for variables, the researchers found that health plan spending was lower for minimally invasive versions of coronary revascularization, uterine fibroid resection and peripheral revascularization; costs were lower with the standard approach in prostatectomy and carotid revascularization. Overall, MIS was associated with significantly fewer missed days of work for coronary revascularization, uterine fibroid resection, prostatectomy and peripheral revascularization.

Stephanie Wasek

APIC Updates C. Diff Guidelines

The Association for Professionals in Infection Control and Epidemiology has released a new guide aimed at stemming the tide of Clostridium difficile infections, as a stronger germ strain of the superbug continues to wreak havoc in healthcare facilities nationwide.

According to the guide, C. diff infections (CDI) are more frequent and severe due to the emergence of a hypervirulent epidemic strain that's resistant to antibiotics and causing more complications and mortality (patient deaths linked to CDI increased 400% between 2000 and 2007, reports the CDC).

C. diff can be spread by direct and indirect contact with infected patients and their environments, explains the guide, which heightens the importance of proper hand hygiene, barrier protection and surface disinfection. "Adherence to the components of contact precautions will help break the chain of infection," says the guide.

APIC says the new directives offer practical, evidence-based strategies — both routine and heightened — for surveillance and elimination of CDI, access to online tools and resources based on the latest research and regulatory requirements, and a primer for infection preventionists on antimicrobial practices most effective in limiting CDI risks.

As reported here last week, APIC has released results of a member survey showing that ramped up efforts against C. diff haven't been fully effective and that greater effort and monitoring are needed to address the superbug's growing threat.

Daniel Cook

InstaPoll: Which Never Event Do You Fear the Most?

More than 4,000 so-called "never events," including wrong-site surgery and leaving foreign objects inside patients' bodies, occur in U.S. operating rooms each year. Tell us in this week's InstaPoll which never event you fear the most.

Surgeon's initials are most often used to mark the surgical site, according to last week's poll of 460 readers. The results:

  • arrow pointing to the site: 5%
  • "yes" with the surgeon's initials: 31%
  • "x" with the surgeon's initials: 13%
  • surgeon's initials: 50%
  • smiley face: 1%

Dan O'Connor

News & Notes
  • Adults affect kids' recoveries Pediatric patients are less likely to become distressed in PACU when adult caregivers or parents convey empathy, use distraction or coping techniques and talk in assuring tones, according to a study published in the April issue of the journal Anesthesiology. The researchers note, however, that already distressed children are more likely to remain so if adults use empathy or reassurance, leading the study's authors to suggest reassurance should be avoided when a child is already out of sorts.
  • Propofol abuse examined A study appearing in the April issue of the Journal of Addiction Medicine takes a look at the issue of propofol abuse among healthcare employees, which it says is on the increase. Propofol abuse is most frequent among physician and nurse anesthesia providers, who have the greatest access to the drug, the study says, and more likely to be seen among women than men. While the drug is first abused as a sleep aid, its use and potential debilitating consequences rapidly escalate, write the authors.
  • Pre-op diet influences outcomes Even short-term changes in pre-operative nutrition can profoundly affect such surgical outcomes as ischemia and re-perfusion injury, according to research published in the journal Surgery. In animal trials, researchers found that high-fat diets before surgery resulted in poorer outcomes for mice than when those mice had been on restricted pre-op diets. The researchers suggest that humans may also benefit from dietary restrictions in the days leading up to their procedures.