Patient Safety Awareness Week 2019
Anesthesiology and patient safety have been interlinked since at least the 1840s. John Snow, a British physician who is considered one of the fathers of modern epidemiology, also was a pioneer in the use of ether and chloroform as surgical anesthetics. Perhaps most famously, he administered chloroform to Queen Victoria for the births of two of her children. He also traced a cholera outbreak in London in 1854, and his findings inspired significant improvements to water and waste systems in London and around the world. Today, anesthesiology is widely recognized as the pioneering leader in patient safety efforts. It was the first medical specialty to champion patient safety as a specific focus, and the Anesthesia Patient Safety Foundation (APSF) was the first independent multi-disciplinary organization (practitioners, equipment and drug manufacturers, and many related professionals) created expressly to help avoid preventable adverse clinical outcomes, especially those related to human error.
Today: Tackling the pervasive problem of healthcare-associated infections
When the U.S. Centers for Disease Control and Prevention released a report last week saying drug-resistant staph infections are just as prevalent as they were five years ago, Randy Loftus, MD, an internationally recognized expert on infection control, wasn’t surprised.
“The problem is actually getting worse. The more we have to use antibiotics, the less effective they are, and we’re not creating new drugs,” the associate professor in the Department of Anesthesia says. “So we really have to do three things. We have to prevent infection for surgical patients. We have to prevent infections from spreading between patients. And we have to improve our stewardship of antibiotics.”
After years of decline, staph infections plateau
The CDC reported more than 119,000 bloodstream staph infections in 2017, and nearly 20,000 of those patients died. Overall, healthcare-associated infections, including drug-resistant infections, cost the healthcare industry an estimated $20 billion a year and cause 99,000 deaths. Despite years of promoting basic infection control measures like hand-washing, numerous studies have reported that at least 3 percent of hospital patients – and between 7 percent and 9 percent of surgical patients – still are likely to contract a healthcare-associated infection.
A CDC spokeswoman told CNN that the “national plateau” in methicillin-resistant staph aureus (MRSA) infections “probably stems from dropping off in using” the CDC’s recommended infection control measures, such as hand-washing, use of gowns and gloves, and proper environmental cleaning.
An innovative, proactive approach
Loftus has been championing a proactive approach to improving infection control for surgical patients through a new surveillance system called OR PathTrac. (Loftus is co-founder, shareholder, chief medical officer, and director of research for RDB Bioinformatics, which owns PathTrac.) The software tracks bacteria from known locations in the operating room and provides real-time information to OR personnel so they can take preventive measures to keep an infection from spreading.
“This is a brand-new approach to infection control,” Loftus says. “Most surveillance to date has been retrospective; a patient gets an infection and we try to figure out how it happened. Proactive surveillance helps healthcare providers do the right thing at every opportunity to prevent the spread of infection.”
For example, if particular groups of providers are struggling with hand hygiene, steps can be taken at the group level to improve compliance.
And, if lapses in routine and terminal cleaning procedures are detected, residual contamination can be mitigated. Automated OR PathTrac reports map OR exposure to major bacterial pathogens, which can be addressed with targeted deployment of limited resources, such as robotic UVC light. At present, such lapses generally go undetected, increasing patients’ risk of infection.
Clinical trials at Iowa and Georgetown
University of Iowa Hospitals & Clinics isn’t the only academic medical center to try this innovative approach. Russell T. Wall, MD, professor and chairman of the Department of Anesthesiology at Georgetown University Medical Center, also is implementing a coordinated “bundle of prevention measures” in the Georgetown MedStar Health System.
The bundle employed at both UIHC (in a clinical trial sponsored by the Anesthesia Patient Safety Foundation) and the MedStar Health System involves:
- Improved hand hygiene among providers
- Improved environmental cleaning
- Better organization of the anesthesia workspace, and
- Improved intravascular catheter design and disinfection.
The primary goal of these approaches is to prevent within and between-patient spread of dangerous S. aureus bacteria, the number one cause of surgical site infections.
Continuing anesthesia’s pioneering role in patient safety
Drs. Wall and Loftus are embracing the past and current role of anesthesiologists as leaders in patient safety, efforts that also honor John Snow, a 19th-century pioneer in the use of anesthetics and one of the fathers of modern epidemiology.
In addition to his current research, Loftus is pursuing additional studies to assess the impact of germicidal lights on controlling the spread of bacteria in operating rooms and to test new anesthesia machine designs to improve workflow and reduce the potential for infection to spread from one patient to another in the OR.
The movement to address HAIs in new, more effective ways appears to be gaining momentum. In December 2018, the Society for Healthcare Epidemiology of America (SHEA) issued new guidance on reducing infections in the operating room; the guidance builds on research by Loftus and other experts and addresses the same areas being tested at UIHC and Georgetown.
SHEA’s guidance document has been endorsed by at least four anesthesiology professional organizations and received a letter of support from the American Society of Anesthesiologists.
“There’s a growing awareness, I think, that we haven’t done enough to address this very pervasive issue,” Loftus says. “Iowa is taking innovative steps to address both the persistence of healthcare-associated infections and the continuing prevalence of MRSA infections.
“I’m hopeful that, if we can provide the right information and the right tools in a comprehensive, multidisciplinary program, we can cut the number of infections and improve patient safety and outcomes.”