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IBJI Surgeons Cut Post-Surgical Infection Rate in Half

IBJI physicians at Glenview are at the forefront of a growing trend in surgery that drastically cuts post-operative infections. Best of all, it's easy, painless and inexpensive.

It began in late 2003 when Dr. Lance Peterson, at Evanston Northwestern Hospital (ENH) in Glenview, IL, approached IBJI surgeons James Kudrna and William Robb. Promising research being done in Europe led Dr. Peterson, an infection disease specialist, into partnership with Dr. Kudrna and Dr. Robb in order to hospital-borne infections. The ENH pilot program involved the physicians performing a simple pre-operative nasal swab on their patients undergoing Total Knee and Total Hip Arthrosplasty. This screening protocol reliably identified the presence of the bacteria, Staphylococcus Aureus (or S. Aureus), which is responsible for the majority of post-surgical infections. Though the media have focused recently on MRSA (Methicillin-resistant Staphylococcus Aureus), non-MRSA staph infections are actually much more common in patients recuperating from surgery and can be just as serious.

"About 25% of the general population have S. Aureus in their nasal passages," says Dr. Robb. "None of them have symptoms." The staph carried in the nasal passages rear its ugly head after surgery, when the patients unknowingly inoculate their wounds by touching their noses and then their surgical wounds, causing infections and complicating the surgical recovery.

"One quality of staph bacteria is that it spreads in fresh wounds," explains Dr. Robb. "This isn't true of all bacteria." A patient with S. Aureus in the nasal passages can unknowingly transfer the bacteria simply by touching his nose and then the surgical area.

In the pilot program, nearly 1,500 patients received the pre-op nasal swabs. Patients who tested positively for staph were then treated with an ointment for five days prior to surgery. This pre-surgical topical antibiotic therapy was the key to driving down post-surgical infections. What made the treatment more practical was an emerging technology called Polymerase Chain Reaction (PCR). PCR testing increased the speed at which the staph bacteria were identified. The old way, which required incubation of the mucus sample and used cultures, could take 2 or 3 days. No significant delays of surgeries occurred in the study as a result of the nasal screening program. .

At the conclusion of the pilot program in February 2005, ENH instituted pre-op nasal screening as a standard protocol for all major surgeries. In March 2008, the research results were published in Clinical Orthopaedics and Related Research.

Before the initial study was concluded, its encouraging preliminary results got the attention of IBJI spine surgeon David Shapiro. Dr. Shapiro, also of IBJI and affiliated with ENH, decided to study spine patients to determine if the methodology had the same benefit for that group of patients. IBJI's Dr. Gary Shapiro and Dr. Peterson were co-authors on the orthopaedic spine surgery study. They compared the post-surgical infection rates of nearly 1,400 patients. About half were screened pre-operatively and about half were not. The screened group had a surgical infection rate of 0.7%, compared to 1.5% for the non-screened group. The results of the spine study were presented in October 2007 to attendees at the North American Spine Society meeting.

"Surgeons tend to be most interested in techniques," Dr. David Shapiro says. "But at IBJI, we're crazy about infection prevention." Unlike drugs, clinical protocols do not require FDA approval. A wave of similar studies will be conducted by other surgical professionals as the accepted way to scientifically endorse research results. Dr. David Shapiro is already doing his own second study, looking at more specific issues affecting infection rates; the results of that study will be available some time next year.

But for now, the patients of IBJI Glenview physicians are benefiting from the exciting outcomes of the initial research. "All our patients get the nasal screening," states Dr. David Shapiro. In this era of high-cost medical technology, pre-op nasal screening is especially appealing. "It's painless, it's easy, it's cheap, and it cuts infection rates by at least half," says Dr. Shapiro. "These are very compelling reasons to screen."

To find other IBJI physicians who do the pre-op nasal screening for major surgeries performed at Evanston-Northwestern Hospital, go to our physician-hospital finder.