Primaris Press Release
| For immediate release: March 10, 2005 |
Contact: Matt Heger Primaris Communications Department (800) 735-6776, Ext. 136 |
Study: Half of Major Surgery Patients Dont Receive Antibiotics According to Guidelines
Group Says Missouri Hospitals Are Making Progress in Preventing Serious Infections
Columbia , Mo. A group of health care quality improvement experts today said that Missouri hospitals are making historic progress in preventing serious surgical infections, but admitted that more work needs to be done to keep patients safe.
Primaris, a non-profit health care consulting firm and Medicare Quality Improvement Organization, said it would intensify its work with local hospitals to redesign processes and procedures so that more patients are given antibiotics within 60 minutes before surgery begins the timeframe most effective for preventing infection.
The announcement comes on the heels of a new study published Tuesday in the Archives of Surgery that suggests nearly half of major surgery patients do not receive an antibiotic in the timeframe that best prevents serious infections. The researchers also found that 10 percent of patients received their first dose more than four hours after the surgery started, when little if any benefit would be expected.
Surgical site infections (SSIs) increase patient death rates by up to 300 percent, require an average of seven additional days in the hospital and add more than $3,000 to the surgery's final cost. A 1999 study found that SSIs are responsible for 20,000 annual in-hospital deaths and cost hospitals more than $3 billion each year.
These research findings are important, said Richard A. Royer, Chief Executive Officer for Primaris. They show that significant opportunities exist to improve the quality of care given to surgical patients. Primaris looks forward to helping Missouri hospitals build upon an already impressive and accomplished foundation.
Under its contract with the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services, Primaris helps physicians, hospitals and other caregivers improve care by measuring quality and encouraging the adoption of proven best clinical practices.
Patients Can Help Prevent Infections
The single most important way patients can help prevent infections and errors is to be active members of their health care team, said Gregg Laiben, MD and Medical Director for Primaris. Ask questions, follow instructions and stay informed.
In particular, Dr. Laiben suggested that patients:
- Take a bath or shower the night before and the morning of surgery.
- Do not shave the area where the surgery will be done, unless the doctor tells them to shave.
- Make sure they, their doctor and their surgeon agree and are clear on exactly what will occur during the surgery.
- Ask how the hospital works to prevent surgical infections.
- Call their doctor if, after the surgery, they have a fever of over 101 degrees, their wound opens up and/or becomes hot, red and tender, or if they notice increased, cloudy or colored drainage from the wound.
- Keep their wound clear and dry when they return home to recover.
Four Missouri Infection Prevention Success Stories
One of the nation's largest Catholic hospitals, St. John's Mercy Medical Center a 979-bed, Level I trauma center in west St. Louis County, Missouri is improving surgical outcomes by redesigning how it cares for patients. Working with Primaris, and later with the Institute for Healthcare Improvement (IHI), this hospital standardized processes and better designated infection prevention accountability among caregivers. Hospital management clearly communicated goals and expectations to employees, and an infection prevention committee helped staff stay focused. Peer evaluation gave the entire prevention program credibility.
Today, St. John's Mercy Medical Center delivers pre-surgery antibiotics in line with published guidelines almost 90 percent of the time, and expects to approach 100 percent compliance in the near future. The hospital is also successfully encouraging surgeons to use clippers, instead of razors, when removing hair at the surgical site. Shaving before surgery causes trauma to the skin from the edge of the razor. Using electric clippers causes less skin trauma and lowers the risk of surgical site infections.
Christian Hospital a 678-bed, two-division facility in north St. Louis County, Missouri is using a zero tolerance philosophy to reduce infections in heart surgery (coronary bypass) patients. A new checklist system ensures that all of the appropriate steps in the infection prevention process are completed, and mandatory education classes keep surgical staff members up-to-date with current guidelines for care.
Christian Hospital 's strategy is working well. A team of quality improvement experts and in-house executive champions has reduced serious heart surgery infections by 96 percent, putting the hospital significantly ahead of a benchmark established by the Centers for Disease Control and Prevention (CDC). They have also worked to ensure patients receive pre-surgery antibiotics on time 92 percent of the time. Christian Hospital is fully compliant with pre-operative skin preparation guidelines issued by the Centers for Disease Control and Prevention.
St. John's Mercy Hospital a 187-bed acute care rural hospital in Washington , Missouri is using a team approach to cut surgical infections. After setting five specific goals, establishing guidelines for care that were agreed upon by all caregivers, and holding regular progress meetings, this forward-thinking hospital improved on-time antibiotic delivery to an outstanding 95 percent (December 2004). The group also appropriately discontinues antibiotics 95 percent of the time, which is well above the national average.
Freeman Health System a 322-bed hospital in Joplin , Missouri focused on improving surgical care through a multifaceted campaign. Using supporting material from Primaris and CMS, Freeman developed an education campaign for physicians and other hospital employees on the importance of new surgical infection prevention guidelines. Today, Freeman gives pre-surgery antibiotics within the recommended guideline of 1 hour almost 90 percent of the time, and makes sure the most appropriate antibiotic is given almost 100 percent of the time. Freeman also encourages the use of clippers instead of razors. The hospital recently started working on two other process-related campaigns that are now recommended by surgical infection prevention experts.
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MO-05-05-INPT This material was prepared by Primaris under contract with the Centers for Medicare & Medicaid Services (CMS). The contents presented do not necessarily reflect CMS policy.