December 13, 2000

By Lara Pullen, Ph.D.

Jason Stout

f you've ever had surgery, you know that the operation was intended to make you feel better, not worse. In light of recent publicity on medical errors, however, many hospitals are scrambling to reduce what is generally believed to be an unacceptably high level of post-surgery infections. These infections that are specifically associated with being treated in a hospital are known as nosocomial infections. Unfortunately, depending on the patient type and surgery, as many as 30 percent of individuals who undergo surgery experience post-surgery infection. For 18 percent of these people, the infection persists for six months or longer.

While these statistics sound alarming, Dr. James McCoy, Vice President of Clinical Integration at Advocate Health Care in Illinois, is reassuring when he states that at any reputable hospital, the rates of post-surgery infection tend to be quite low and that most consumers would be "unlikely to distinguish between hospitals." He emphasizes that every hospital is required by the accreditation committee to track and report the rates of nosocomial infections.

Nonetheless, when averaged across the country, approximately 2-10 percent of hospitalized patients develop nosocomial infections. The tremendous cost of treating these infections -- between $32 and $825 million annually -- ensures that these infections are not only a concern for patients but also for the business-minded folks at the hospital.

When averaged across the country, approximately 2-10 percent of hospitalized patients develop nosocomial infections -- and these infections account for between $32 and $825 million excess costs annually.

On many levels, then, the reduction of nosocomial infections is a national priority. Thus far, strategies include the enforcement of stringent sanitation standards and a new use for a common antibiotic ointment.

Stealth bacteria

Researchers have determined that the two organisms most likely to cause post-surgery infections are Escherichia coli and Staphylococcus aureus. E. coli, which has gained some fame in recent years as a contaminant in uncooked hamburger meat, most commonly causes gastrointestinal disorders. S. aureus causes what are known as staph infections, or skin infections. Generally, E. coli and staph infections are most dangerous for the elderly, children, and those with a compromised immune system.

While patients undergoing hospitalization may not be technically immunocompromised, they are more vulnerable than are healthy individuals going about their daily routine. One of the largest contributions to this vulnerability is the fact that they have a point of entry for the bacteria: the surgical wound.

Prevention

In many ways, the prevention of nosocomial infection is similar to the everyday strategies that we all use to protect ourselves from disease. Hospitals routinely perform procedures such as handwashing, identification of potentially infected patients, isolation of individuals known to be infected, and cleaning the environment.

Because the stakes in the battle against infection are higher in the hospital setting than they are at home, hospitals have a few more tools at their disposal. Dr. Trish M. Perl of Johns Hopkins University, Baltimore, Maryland, is an infectious disease specialist who studies nosocomial infection rates and tests strategies designed to reduce those rates. This summer she presented the results of her recent research on the ability of mupirocin, an antibiotic, to prevent post-surgery infection.

Ointment to the rescue

Mupirocin (trade name Bactroban) is specifically designed to prevent the spread of S. aureus in the hospital setting. Unlike the antibiotics that are commonly prescribed and taken orally, mupirocin is applied in the nose with a special applicator. To be effective, the physician must prescribe mupirocin during the pre-operative appointment. The patient then applies the ointment twice daily beginning five days prior to surgery.

Patients that receive at least six doses of the ointment have a 90 percent reduction in the S. aureus nosocomial infection rate. This rate can translate into better health for the patient and, consequently, a better financial bottom line for the hospital. And according to Dr. Perl, mupirocin is "a pretty benign drug," with occasional side effects such as headache, sneezing, and runny nose.

While mupirocin is occasionally used as part of a strategy to prevent nosocomial infections, it is more commonly used in patients who are especially susceptible to infections, such as individuals with diabetes or those who are HIV-positive. Mupirocin may become more common in the future if the results from the upcoming follow-up clinical trial continue to support its efficacy.

So, if you or a loved one have a surgery planned in your near future, don't be surprised if your doctor gives you an ointment to wipe in your nose. That ointment just might make your stay in the hospitals days, or months, shorter.

Related link:

• Rx.magazine feature story: A New Plan to Report Doctors' Errors

Send feedback on this article.

Jason Stout

December 13, 2000

f you've ever had surgery, you know that the operation was intended to make you feel better, not worse. In light of recent publicity on medical errors, however, many hospitals are scrambling to reduce what is generally believed to be an unacceptably high level of post-surgery infections. These infections that are specifically associated with being treated in a hospital are known as nosocomial infections. Unfortunately, depending on the patient type and surgery, as many as 30 percent of individuals who undergo surgery experience post-surgery infection. For 18 percent of these people, the infection persists for six months or longer.

While these statistics sound alarming, Dr. James McCoy, Vice President of Clinical Integration at Advocate Health Care in Illinois, is reassuring when he states that at any reputable hospital, the rates of post-surgery infection tend to be quite low and that most consumers would be "unlikely to distinguish between hospitals." He emphasizes that every hospital is required by the accreditation committee to track and report the rates of nosocomial infections.

Nonetheless, when averaged across the country, approximately 2-10 percent of hospitalized patients develop nosocomial infections. The tremendous cost of treating these infections -- between $32 and $825 million annually -- ensures that these infections are not only a concern for patients but also for the business-minded folks at the hospital.

When averaged across the country, approximately 2-10 percent of hospitalized patients develop nosocomial infections -- and these infections account for between $32 and $825 million excess costs annually.

On many levels, then, the reduction of nosocomial infections is a national priority. Thus far, strategies include the enforcement of stringent sanitation standards and a new use for a common antibiotic ointment.

Stealth bacteria

Researchers have determined that the two organisms most likely to cause post-surgery infections are Escherichia coli and Staphylococcus aureus. E. coli, which has gained some fame in recent years as a contaminant in uncooked hamburger meat, most commonly causes gastrointestinal disorders. S. aureus causes what are known as staph infections, or skin infections. Generally, E. coli and staph infections are most dangerous for the elderly, children, and those with a compromised immune system.

While patients undergoing hospitalization may not be technically immunocompromised, they are more vulnerable than are healthy individuals going about their daily routine. One of the largest contributions to this vulnerability is the fact that they have a point of entry for the bacteria: the surgical wound.

Prevention

In many ways, the prevention of nosocomial infection is similar to the everyday strategies that we all use to protect ourselves from disease. Hospitals routinely perform procedures such as handwashing, identification of potentially infected patients, isolation of individuals known to be infected, and cleaning the environment.

Because the stakes in the battle against infection are higher in the hospital setting than they are at home, hospitals have a few more tools at their disposal. Dr. Trish M. Perl of Johns Hopkins University, Baltimore, Maryland, is an infectious disease specialist who studies nosocomial infection rates and tests strategies designed to reduce those rates. This summer she presented the results of her recent research on the ability of mupirocin, an antibiotic, to prevent post-surgery infection.

Ointment to the rescue

Mupirocin (trade name Bactroban) is specifically designed to prevent the spread of S. aureus in the hospital setting. Unlike the antibiotics that are commonly prescribed and taken orally, mupirocin is applied in the nose with a special applicator. To be effective, the physician must prescribe mupirocin during the pre-operative appointment. The patient then applies the ointment twice daily beginning five days prior to surgery.

Patients that receive at least six doses of the ointment have a 90 percent reduction in the S. aureus nosocomial infection rate. This rate can translate into better health for the patient and, consequently, a better financial bottom line for the hospital. And according to Dr. Perl, mupirocin is "a pretty benign drug," with occasional side effects such as headache, sneezing, and runny nose.

While mupirocin is occasionally used as part of a strategy to prevent nosocomial infections, it is more commonly used in patients who are especially susceptible to infections, such as individuals with diabetes or those who are HIV-positive. Mupirocin may become more common in the future if the results from the upcoming follow-up clinical trial continue to support its efficacy.

So, if you or a loved one have a surgery planned in your near future, don't be surprised if your doctor gives you an ointment to wipe in your nose. That ointment just might make your stay in the hospitals days, or months, shorter.

Related link:

• Rx.magazine feature story: A New Plan to Report Doctors' Errors

Send feedback on this article.