The Journal of Hospital Infection is the official journal of the prestigious London, England-based group, the Healthcare Infection Society. We are proud to announce that just this week, The Journal published Dr. Elizabeth Bryce’s year-long study at the Vancouver General Hospital on the effect of MRSAid on surgical site infections. But let’s begin at the beginning …
Undergoing major surgery is tough stuff. Having undergone spinal surgery I can speak from experience. The whole ordeal is fraught with anxiety and whether it works or not is life-changing, not to mention potentially life-saving. When you get out of the OR and wake up in a fog of pain and anesthetic you immediately have just one question: Did it work? When you’re told it has, it’s like a comfort drug rushes through you and for the first time since you were told you needed the operation – in my case 5 weeks – you are able to relax.
But here’s what I can’t imagine: being told that you’ve contracted an infection in the surgical wound. You’re already physically and psychologically broken down. To have to cope with an additional injury at the very place in your body that has already given out would be – devastating.
Surgical site infections (SSIs), however, are common. They represent almost 1/3 of all hospital infections and affect about 5% of surgery patients. That’s a ton of people given that about 16 million operative procedures are performed each year in acute care hospitals in the United States.
Hospitals have a standard way of preventing SSIs: cleaning the skin with an antiseptic, usually chlorhexidine (CHG) wipes, and/or nasal decolonization (a lot of germs live in the nose) with an antibiotic ointment, usually mupirocin.
But there are 2 problems with this: (1) antibiotics are increasingly losing their effectiveness, so much so that the World Health Organization and others consider antibiotic resistance to be a worldwide crisis, and (2) compliance: you have to apply the antibiotic over a period of 5 – 7 days and studies show that outpatients forget or otherwise just don’t do it; and if you’re in the hospital it takes up valuable nursing time to get it done.
So Canada’s Vancouver General Hospital, the second largest hospital in the country, decided to try something different: they replaced the antibiotic ointment – which causes both the resistance and compliance problems – with photodisinfection therapy (PDT). PDT is a promising antimicrobial strategy that uses light energy to activate a colored dye applied inside the nose (where the antibiotic ointment was applied) which in turn kills the germs (see Figure 1 at the back of the study for a photo display of how it works).
The VGH study, led by Elizabeth Bryce, MD, and reported just this week in The Journal of Hospital Infection, did this over a 1 year period with 3068 cardiac, orthopedic, spinal, vascular, thoracic, and neurosurgical patients. They used PDT and CHG wipes in the surgery holding-area in the 24 hour period before surgery (vs the protracted 5 – 7 days with the antibiotic ointment). The researchers compared the rate of SSIs using this procedure, versus the SSI rate over the previous 4 years using the former CHG-antibiotic ointment procedure, which involved some 12,387 patients.
The result? They found a “significant reduction” in the SSI rate with this procedure versus the former one. The greatest decreases in SSI rates were found in orthopedic and spinal patients: a 42% reduction in SSIs was realized, the majority which would have been hard-to-treat deep/organ space infections.
But it was something else in the study that caught my eye: “Importantly,” they say, “immediate [decolonization] ensured a very high degree of compliance (94% of patients) without interrupting normal workflow. Intranasal PDT took approximately 10 min compared with five to seven days with traditional mupirocin. In fact, the nurses were able to treat 1,912 patients in addition to those targeted for intervention.”
From a patient and staffing point of view that’s huge because the researchers, to their credit, are talking about the effect of this procedure on real-world medicine: i.e. PDT not only fits the hospital environment, it actually helps nurses do their jobs.
While my surgeon showed up once or twice a week after the surgery, it was the nurses who were my lifeline: they managed my pain, they dealt with my fears, and they helped me take my first steps again.
But that was decades ago. These days, nurses increasingly find themselves overwhelmed by their workloads. For example, an investigation conducted last year by the CBC’s Fifth Estate found that nurses “Carry out a dizzying array of … tasks during each shift … Nearly 40 per cent told us they feel burnt out to a high degree. Research shows nurse burnout is associated with risks to patient safety. Nurses we heard from also expressed fear that stress is leading to mistakes.”
A recent opinion piece in the New England Journal of Medicine also argues for more technology to deal with infection control: “Infection prevention eliminates the need to use antibiotics. Traditional infection-prevention efforts must be buttressed by new technologies that can more effectively disinfect environmental surfaces, people, and food.”
The Vancouver General Hospital has done just that and they continue to use PDT as part of their universal pre-operative decolonization protocol.
This study was reported previously at the International Conference of Infection Prevention and Control, and awarded first place at the Innovation Academy, Geneva, Switzerland, June 2013.
Tomorrow morning around 6:35, Carolyn Cross, the head of the company who produce the PDT technology will discuss its applications and the VGH study on a Vancouver radio program.
Here is a video of PDT at VGH: