BALTIMORE – Dr. James Pepple is chief of anesthesiology at Sinai Hospital, but lately he has found himself saddled with another job — hall monitor.
Pepple has tried to get surgeons at his hospital to quit shaving patients right before surgery, a practice that has been shown to significantly increase the chance of infection because of the occasional nicks and cuts to the patient. But some surgeons still insist on shaving their patients.
“A few of them bring in their own razor. You have to catch them, and take it away,” Pepple said, noting that surgeons are supposed to only use clippers at the hospital.
His frustration is shared by administrators from other hospitals around the state, some of which have been able to cut surgical infection rates almost in half with some simple precautions — if the doctors follow the new rules.
At a meeting near Baltimore/Washington International Airport last week, 18 Maryland hospitals reported the results of a 13-month project to reduce infections by giving patients antibiotics within an hour of surgery, making sure surgeons use antibiotics specifically approved for preventive use and cutting off antibiotics 24 hours after surgery.
Five of the hospitals said they were able to reduce the rate of infections by as much as 50 percent among the patients they monitored for the project. As a group, all the participating hospitals reported increased compliance with the guidelines since starting the project.
In a 2001 study by the Centers for Medicare and Medicaid Services, only 65.3 percent of hospitals in Maryland reporting giving patients antibiotics in the hour before surgery.
The hospitals that participated in the agency’s Surgical Infection Prevention Collaborative project reported last week that they had raised that percentage to 91.9 percent in 2003. The goal, program representatives said, was to get the rate of compliance up to 100 percent.
But hospital representatives expressed frustration at implementing the rules.
Dr. Marshall Benjamin, chief of surgery at North Arundel Hospital, said the guidelines are not new. The challenge, he said, is convincing surgeons to adopt new techniques.
“Most doctors don’t feel it’s a problem,” Benjamin said of the chance of surgical infections, which he believed is nonsense.
About 100 people die every day in this country because of surgical infections, according to the Institute of Medicine.
Following the recommendation of several medical organizations, Medicare issued the guidelines for reducing the infection rate. The Centers for Medicare and Medicaid Services then funded projects around the country, like the one in Maryland, to push their use.
Dr. Dale Bratzler, who helps states develop their programs, said that infections contracted during surgery increase the average length of stay for a patient by about seven days, cost the U.S. healthcare system up to $845 million per year and cost individual patients thousands of dollars in extra care.
He said the most important statistic is that 40 to 60 percent of surgical infections are preventable.
Pepple led the project at Sinai, which was one of the hospitals that reduced its rate of infection by 50 percent among the patients studied.
He described surgeons as “creatures of habit” and said the easiest way to convince them to change their ways is to have scientific literature supporting the guidelines ready for them to look at.
The Delmarva Foundation, which receives money from Medicare to improve healthcare quality in hospitals, helped coordinate the project. Representatives from the nonprofit organization said that they will continue to work with Maryland hospitals to implement the guidelines throughout all of their departments and work with the state to implement them throughout all its hospitals.
Bratzler said that by next year, hospitals will publish their rates of compliance with the guidelines. But all hospital administrators who spoke at last week’s conference said a lot of work remains to be done before everyone understands the importance of the guidelines.
“It takes about 17 to 25 years to implement change in the medical community,” Pepple said.
-30- CNS 04-02-04