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When a Surgical Site Infection Sends a Friend Through Hell

Cheryl Clark, for HealthLeaders Media, February 16, 2012

"Unfortunately yes. And so yes, if I've done all that I know to do to prevent that—and this is a national discussion—how do we address that? I understand that for the individual, this is 100% and it's awful and it's expensive."

Martha Jefferson does monitor infection rates within its specialties, although it does not yet publicly report them, he continued. That day is coming. The hospital's relatively small surgical caseload means it doesn't have a good risk adjustment tool, although its recent merger with Sentara Healthcare may help integrate electronic data.

In recent years before and since the new building, Ashby said, Martha Jefferson has reduced rates of MRSA. It conducts root cause analyses when infections occur, and uses black lights and secret shoppers to screen for cleaning and handwashing protocols. And, he said, patients are asked to wash their skin with a Hibiclens kit, a chlorhexadine solution prior to surgery.

A nurse works part time in infection control to oversee procedures.

Muncie and Jaffe say much more can be done. They want tougher state and federal laws requiring infection disclosure, so the public can compare surgical infection rates for orthopedic procedures before they choose a hospital.  Martha Jefferson's central line infections are not listed on the federal Hospital Compare, which shows that the hospital has too few cases.

It's clear hospitals have a lot of work to do. According to a Centers for Disease Control and Prevention paper last month, hospitals reporting to the National Healthcare Safety Network had a 1.9% surgical site infection rate in 2006-2008 across 849,659 operative procedures.

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5 comments on "When a Surgical Site Infection Sends a Friend Through Hell"


jody jaffe (2/21/2012 at 2:23 PM)
According to the CDC, 70% of hospital acquired infections (HAIs) can be prevented. No one is saying all HAIs can be prevented, but 70%? That is shameful. So I have to disagree with Dr. Hirsch's premise that hospitals shouldn't be responsible for the costs of these HAIs until it can be proven they are all preventable. The bottom line is hospitals can do more, it just costs money. For example, Martha Jefferson Hospital, where my husband was infected and treated for THREE HAIs, defunded its two infectious disease nurses and refused to pay for an infectious disease doctor to be on its Infection Committee. According to Dr. Dan Sawyer, the infectious disease doctor at Martha Jefferson, infection rates went down when he was in the Operating Rooms, observing and gathering data. And the rates went back up when he stopped. Don't tell me Sentara, Martha Jefferson's parent company, can't afford to fund these positions. It posts net revenues of $3.5 BILLION and paid its CEO, David Bernd, $3.5 million in 2008.

Ray McEachern (2/20/2012 at 1:58 PM)
Rather than citing stats and making excuses, medical professionals must learn to take responsibility for possible mistakes that were the direct or likely cause of this type of infection. There should be a root cause analysis of this specific infection with the intention of finding how it could have happened. Unless there are documented procedures in this patient's record that establish beyond a reasonable doubt that all infection control procedures were followed during his entire stay, the hospital should take responsibilty. Just as airlines have black boxes to help determine cause when things go wrong, hospitals must have checklists and other records to prove their best practices were followed.

AHNguyen (2/17/2012 at 1:08 PM)
Physicians, nurses, and hospitals are not in the business of causing harm to patients. They do not celebrate complications/infections because they are getting paid extra for these events. This premise is idiotic. It is well known in the scientific community that a zero percent infection rate is an impossibility. There are myriad variables contributing to this process, most of which we do not have a complete understanding or comprehension in terms of identification, prevention, or intervention. We have identified the disparate variables contributing to SSIs. These include appropriate hair removal, skin decontamination, prophylactic antibiotics, body temperature, glucose control, and so forth. Adherence to proposed guidelines could reduce the incidence of SSIs significantly, but this rate is not ZERO. With regards to the author's claim of efficacy with preop washing, the current scientific data is "despite repeated demonstrations of a reduction in surface bacteria at the operative site using a CHG shower, meta analyses have shown only a NONsignificant reduction in wound infections in large number of patients." We all feel bad and horrible when someone has a bad outcome. However, without further information from this article, it is imprudent to assign accountability and culpability.