to more frequent infections.
We need to understand what it is about a smoker's microbiota that
increases the risk of post-op infection. Would that eliminate SSIs?
Maybe not, but it's worth attempting because we're spending a lot of
time, energy and effort on traditional methods aimed at eliminating
infections, yet still haven't achieved the ultimate goal — zero infec-
tions.
There are more practical steps to focus on in the short term, which is
especially important as more complex procedures move to the outpa-
tient setting and raise the infection control bar even higher. For exam-
ple, by participating in the American College of Surgeons National
Surgical Quality Improvement Program (NSQIP), your facility's wound
infection rate is benchmarked against the performance of similar
facilities across the country. If your rate is an outlier, you'll be able to
identify issues that are leading to the increased infection rate and
determine how those issues can be fixed.
Your patients must also shoulder some of the responsibility. You
might tell smokers to kick the habit in the weeks before their proce-
dures and instruct patients to bathe with CHG the night before sur-
gery, but are you sure they're complying with the directives? We often
take for granted that patients are doing what they're being asked to
do, and their failure to take action could have a significant impact on
their risk of infection. Make sure your patients are active participants
in their own care and understand the importance of partnering with
you to reduce, and ultimately eliminate, SSIs.
OSM
Dr. Cook (chcook@bidmc.harvard.edu) is an associate professor of surgery
at Harvard Medical School in Boston, Mass.
.
On Point
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