Ted S. Warren  /  AP
Diane Masin applies a disinfectant fluid to the leg of Scott Adams, of Renton, Wash., as he is prepared to undergo knee surgery at Overlake Hospital in Bellevue, Wash.
updated 4/27/2004 12:35:35 PM ET 2004-04-27T16:35:35

To prevent Scott Adams’ knee surgery from getting infected, doctors at Overlake Hospital Medical Center didn’t need fancy new medicine or expensive equipment.

Instead, they took simple steps that are proven to prevent infection. They kept Adams warm during surgery, clipped his leg hair instead of shaving it, and administered antibiotics at the right time.

Easy, cheap and effective — but many hospitals fail to take these steps. Although fewer than 3 percent of the 30 million U.S. surgeries each year result in infection, the cost of treating it raises the cost of hospital care and insurance.

And the stakes are even higher: getting a surgical infection doubles a patient’s chance of dying.

Reducing risk
A national survey of 39,000 operations in 2002 found that nearly half the patients didn’t get antibiotics at the correct time, which is one of the best ways to prevent infection.

Health care leaders are trying to reduce infection risk. By concentrating on simple preventive measures, 56 hospitals that took part in a government-sponsored project last year succeeded in cutting their overall surgical infection rate by 27 percent.

The results were even more dramatic at Overlake Hospital, a 337-bed community hospital in suburban Seattle. Overlake recently took part in a 13-month surgical infection prevention program run by Qualis Health, a Seattle-based health care quality improvement organization. The hospital cut its number of surgical infections by more than half, from 12 in 2002 to five in 2003. The hospital performs more than 14,000 operations annually.

Adams, a jovial 31-year-old engineer who blew out his knee playing flag football, noticed the emphasis on preventing infection.

“Pretty much anybody who put a needle in me talked about the risk of infection,” he said.

His leg hair was clipped instead of shaved because shaving causes tiny skin abrasions that can let in infection. He got antibiotics exactly 20 minutes before his surgeon made the first cut, the optimum time for getting the most infection-fighting power from the drugs. And doctors and nurses kept him warm, which helped his body fight infection.

Adams particularly enjoyed the “bear hugger,” a comfortable puffy blanket filled with warm air, that he wore during surgery.

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“I’ve got to get one of those for me at home,” Adams said. He was recovering comfortably and infection-free a few days after his anterior cruciate ligament (ACL) reconstruction surgery.

“I’ll be back playing football again next year,” he predicted.

Timing is crucial
About 780,000 surgeries lead to infections in the United States each year, about 2.6 percent of the total.

A 1992 analysis published in the medical journal “Hospital Infections” found that a surgical infection adds an average of $3,152 to the infected patient’s hospital bill.

Other studies estimate that 40 percent to 60 percent of surgical infections are preventable. The most powerful preventive medicine is antibiotics, given within an hour of incision. Give the drugs too early or too late, and they’ll either wear off or won’t get into the bloodstream fast enough to work.

This isn’t new information. Studies dating back to 1957 have told doctors about the need for well-timed antibiotics. So what’s the holdup?

“There are problems translating good research into actual practice,” said Dr. Dale Bratzler, principle clinical coordinator for the Oklahoma Foundation on Medical Quality and a leader of the national Surgical Infection Prevention Project. He’s working with the authors of major antibiotic studies to set consistent national guidelines.

With 10,000 studies published every year, “there is no physician that can keep up with all the publications,” Bratzler said. “We need to make it more systematic.”

He said the best thing patients can do to protect themselves is to ask their surgeons about antibiotic treatment and make sure to explain any drug allergies. Also, general good nutrition and health will help, he said. The healthier a patient is going into surgery, the smaller the chance of infection.

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