What patients can do to prevent surgical site infections

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Story highlights

  • The World Health Organization presents new guidelines for the prevention of surgical site infections
  • Guidelines include bathing before surgery but not shaving the site

(CNN)Preparing to have surgery, many people wonder whether they are helpless to prevent a potentially deadly hospital-associated infection. A new report published Thursday by the World Health Organization, "The Global Guidelines for the Prevention of Surgical Site Infection," addresses these concerns.

Though the report targets surgical teams as its audience, patients might also benefit from reading these guidelines, written by a panel of 20 leading experts. Collected from dozens of scientific studies, the recommendations include 13 guidelines for preventing infections before surgery and 16 for during and after surgery.
    "They address many of the things that have been addressed in previous guidelines, with some additions as well," said Linda Greene, president-elect of the Association for Professionals in Infection Control and Epidemiology.

    New recommendations

    Hospital- or health care-associated infections include blood, urinary tract, skin or surgical site infections that a person picks up while receiving treatment in a medical facility. A surgical site infection means any infection that occurs when bacteria enter a patient's body through an incision made during an operation.
    To avoid surgical site infections (PDF), the WHO panel recommend that patients always have a bath or shower before surgery -- but not be shaved. "Shaving is strongly discouraged at all times, whether preoperatively or in the operating room," the authors note.
    According to Dr. Ed Kelley, director of the WHO's Department of Service Delivery and Safety, shaving "is something, actually, that has long been assumed was necessary in order to facilitate skin exposure."
    "However, as we talk about in the guidelines, hair removal can increase the risk of causing microscopic cuts or traumas to the skin, and evidence tells us there's clear benefit to not removing the hair or simply clipping if it absolutely needs to be done," Kelley said Wednesday.
    The WHO panel also focuses on difficult-to-treat infections that are resistant to common antibiotics. For example, one of the guidelines specifies that antibiotics be used before and during surgery, not afterward, as the best method to halt the spread of superbugs.
    This "key piece of advice" focuses on using antibiotics when they will have the most impact for the patient without driving drug resistance, noted Dr. Sally Davies, chief medical officer for the United Kingdom.
    "Antibiotics should be used before an operation, close to that operation, so the maximal level is in the blood at the time of that incision and can kill any bugs that can come in," Davies said.
    The panel also recommends enhanced nutritional support for underweight patients undergoing major surgical operations and the administration of "multiple nutrient-enhanced nutritional formulas" to help prevent surgical site infections among these patients.

    Use your voice

    Davies says patients need to be aware of the guidelines and advocate that health care providers follow them. "The public can ask, 'Are you following the proper guidelines? Are you doing what we need?' "
    Her thoughts are echoed by Greene, who suggests that patients directly question their surgeons and health care providers. "Tell me what you're doing to prevent infections," she said. Other questions she suggests: How's your hand hygiene rate; do you track it? Do you have a process in place that encourages patients to speak up?
    In this "age of transparency and patient safety," Greene said it is important for us to ask questions of our health care providers and to consider going to another provider or facility if you feel uncomfortable with the answers.
    "Quite honestly, consumers are being much more proactive. I've been doing this infection prevention for, probably, 30 years, and in the last five years, I've had more inquiries, because consumers want to know," Greene said.
    Another suggestion: Patients can search online for hospital-acquired infection data. "Hospital Compare" on the Medicare website contains information about hospitals. Many states, usually through their departments of health, track health care-associated infection data as well. (Here are New York State rates, and here are Kansas rates.)
    "You can go and look and see what the patterns and trends are in certain hospitals," Greene said, adding that you can then ask your surgeon about these rates.

    Millions of surgeries, millions of infections

    "Every year, over 240 million surgical procedures are performed globally," Kelley said. Although no global registry exists to track surgical site infections, health authorities estimate that each year, millions of patients around the world acquire infections during surgery.
    In the United States, an estimated 722,000 health care-associated infections occurred in acute care hospitals during 2011, and about 75,000 patients died from such infections, according to the Centers for Disease Control and Prevention. One to three of every 100 patients will develop a surgical site infection, the CDC estimates.
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    The figures in other parts of the world are even more discouraging. In low- and middle-income countries, more than one out of every 10 patients becomes infected during surgery. In some countries, the estimate ranges as high as one-third of all patients, said Kelley. In Africa, 20% of cesarean sections lead to infections, which can endanger the lives of mothers and impact the lives of their babies and families.
    Yet, Kelley stressed, a surgical site or hospital-acquired infection can happen anywhere, despite the quality and reputation of a health care system.
    Currently, his own father is dealing with a chronic infection after surgery.
    "My own mother contracted a surgical site infection after a liver transplant in one of the best New York hospitals," Kelley said. "She died from basically what was a preventable infection."