Research for infection protection

Surgical procedures: where are the risks?

More than 230 million surgical procedures are conducted every year worldwide. In most cases, the surgeries are without complications. Studies show, however, that surgery-related complications may have deadly outcomes. In Europe, 37 000 patients die from a nosocomial infection every year.

The most important risk factor: the ten fingers of healthcare workers, or better still, the five fingers of the right hand and the five fingers of the left hand. This “two times five fingers” symbolism lies behind the date of the world’s largest hand hygiene day of the World Health Organization (WHO), taking place on the 5 May each year. For WHO, the year 2016 is entirely centred on the safety of surgical procedures. The focus: hand disinfection as a core element of patient safety.

However, the risk of infection not only lies in wait for patients that need to undergo surgery in the operating theatre. In addition to the actual surgery, WHO identified critical aspects of nursing activities that involve a high risk of infection which can be reduced by proper hand disinfection: for example, when tasks associated with peripheral venous accesses, central venous accesses, postoperative ventilation, urinary tract catheters and postoperative wound care.

Crime scene operating theatre: surgical site infection

Most surgical site infections (SSIs) are caused during surgery: microorganisms of the patient or from the environment enter the actually sterile surgical wound. SSI is the second most common type of infection among all nosocomial infections. Infections are considered as SSI when they occur in patients within 30 days after the surgery; in case of implants even within one year after the surgery. Patients concerned need to stay in hospital longer, require more intensive care, additional drugs and wound care, and often also further surgeries. The direct and indirect costs per SSI may be very high, for example USD 30 000 in case of a severe organ infection.

High risk through catheters

A closer look into the wards that a patient passes through because of her/his surgery makes clear that the fist risk of infection already occurs during the preparation, for example, when the peripheral venous catheter is placed. This invasive measure before the surgery not only is a measure that every patients has to undergo, but also involves a previously underestimated risk of intravascular catheter-associated bloodstream infection.

Particularly worrying is the higher mortality in patients with PVC-associated infections compared to with CVC-associated infections, especially when considering that the peripheral venous catheter is used much more often in clinical routine. Hence, WHO regards both intravascular catheter measures that are often connected to surgical procedures as nursing activities involving a risk of infection.

Postoperative risks in wards

The postoperative treatment in the ward is of crucial significance for patient safety. Critical factors are device-associated measures here as well, such as ventilation and the insertion and manipulation of urinary catheters. It becomes more frequent that patients who underwent surgery are ventilated in intensive care units. When microorganisms enter the lung during treatment, there is a risk of ventilation-associated pneumonia – the most common fatal nosocomial infection. Nosocomial catheter-associated urinary tract infection, however, only rarely involves severe consequences. But it often requires a treatment with antibiotics, which further promotes the risk of resistances. In postoperative intensive therapy, urinary catheters are frequently left in place too long, which increases the risk of infection also due to catheter manipulation.

Experts agree: zero infection won’t be feasible. But up to 40 per cent of all nosocomial infections could be reached by correct hand hygiene alone.