Roughly one out of every 24 patients undergoing surgery acquires a surgical site infection. With 40 million operations performed in the U.S. each year, between 800,000 and 2 million individuals contract these infections annually.
An innovative new pilot project being launched by Sherry Lansing, a regent of the University of California, and her husband, Academy Award-winning film director William Friedkin, provides hope for the future in helping hospitals address such infections.
The couple is partnering with UCLA to lead the way in developing this initiative, known as the Surgical Infections Quality Improvement Project. In an era of greater accountability and health reform, the project offers an opportunity to pioneer best practices in helping prevent surgical site infections. The goal is to create a model program that could be established at hospitals nationwide.
Lansing, who chairs the UC Board of Regents' health services committee, is very familiar with UCLA's efforts to improve the quality of patient care and with the UCLA Innovates HealthCare Initiative, a program designed to promote and nurture innovation to improve the quality of care delivered locally and globally. The new surgical infections project provides a way to create a simple, straightforward set of guidelines that could be implemented to prevent these infections, which sometimes result in death, extend hospital stays and cost the U.S. health system millions of dollars.
"One of the most feared complications after heart surgery is infection, since deep infections around the heart can be life-threatening," said Dr. Richard J. Shemin, the Robert and Kelly Day Professor and chief of cardiothoracic surgery at UCLA, who will oversee the project as co-principal investigator. "Our goal with this study is to use evidenced-based science to figure out what really works in preventing infections and create a system that surgical teams can adopt as a reliable practice standard."
"In this new era of health reform, hospitals need to be held accountable for surgical site infections," Lansing and Friedkin said. "We are well aware of the UCLA Health System's role as a leader in innovation and accountability and are confident they can create a set of guidelines that hospitals could implement, thus preventing many of these deadly infections."
Health care-associated infections are a major cause of death in the United States, accounting for more fatalities than breast cancer, HIV/AIDS and drunk driving combined. Surgical site infections (SSIs) affect 2 percent to 5 percent of all patients who undergo surgery, increasing the likelihood of death for surgical patients by up to 11 times and increasing the cost of health care by millions of dollars a year. Yet many SSIs can easily be prevented.
"The issue of hospital infections does not always receive a lot of public attention, which is tragic, because many of them can be prevented to save lives, suffering and expense," said Dr. Daniel Z. Uslan, an assistant professor in the division of infectious diseases at the David Geffen School of Medicine at UCLA, who has been named the project's principal investigator. "The goal with our clinical multidisciplinary program is to identify a set of best practices that can be applied by an entire institution to prevent infections, from the earliest pre-operation procedures through surgery, post-op and follow-up treatment, both inside and outside the hospital."
Dr. David Feinberg, CEO and associate vice chancellor of the UCLA Hospital System, said that although awareness is increasing and research to control this problem is continuing, much remains unknown about optimal prevention of SSIs. He said patients who become infected during or after surgery prolong the length of their hospital stay by an average of seven days and raise hospital costs by approximately $25,000 per patient.
"We are motivated on many levels to address and improve this problem," Feinberg said.
The project could not have come about at a better time, said Uslan, because the bacteria most common in SSIs — methicillin-resistant Staphylococcus aureus (MRSA) — is highly resistant to treatment.
"Current treatment options are limited," Uslan said. "Therefore, deaths due to these antibiotic-resistant bacteria are on the rise."
But studies done in the past have shown that significant improvements can be made in preventing surgical infections. In addition to well-known infection-control steps such as hand-washing and the use of masks, gowns and gloves, interventions such as starting and stopping antibiotics at the right time and the application of antibiotic ointment prior to surgery are becoming more commonly used, Uslan said.
"Such improvements require a multidisciplinary approach, however, and a buy-in from all concerned departments, administrative personnel and, ultimately, patients," he said.
The new program, which is being implemented through the generosity of the Sherry Lansing Foundation, is poised to achieve that goal, Feinberg said.
"We're creating a consortium of top doctors, scientists and other health care professionals who will derive and implement best practices at UCLA and through the UC system, and hopefully beyond," he said.
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