Surgical infections | Globe Editorial

Easy steps avoid grievous end

August 2, 2010

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WHEN THE solution to a lethal problem is inexpensive and easy to implement, there’s no reason why that problem should persist. Yet even though most so-called surgical-site infections are preventable, they are still the second most common kind of hospital-based infection. Doctors and hospitals must take the basic steps needed to stamp them out.

Infections at the site of an incision or deep within nearby tissues occur in about 2 percent of patients who undergo surgery. Unchecked, they can progress to severe infection and septic shock, the leading causes of multiple organ failure and death in intensive care units. Severe cases cost the US healthcare system an estimated $17 billion. And according to a new study of over 360,000 general surgery patients from across the country, septic shock is 10 times more frequent a post-operative complication than heart attacks — and ends up killing 10 times as many people.

The problem described in the study, which was published in the Archives of Surgery, is largely avoidable. There are national guidelines aimed at preventing surgical site infections, and studies have shown that they work. The guidelines include relatively simple measures such as pre-surgery antibiotic use, proper wound site preparation, and keeping patients’ body temperature stable. Also crucial is the prompt recognition of the beginning symptoms of a spreading infection, given that septic shock, once full-blown, kills quickly. By monitoring every patient for four basic criteria — elevated heart rate, higher temperature, higher respiratory rate and higher white blood cell count — the Houston-based authors of the study reduced the mortality rate from infection in their intensive care unit by more than half. That’s a lot more people who got to go home.

Not every death from septic shock is avoidable, but no more lives should be lost simply because someone wasn’t watching closely.

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