Improve hand hygiene and patient decolonization to help stem high-risk S. aureus transmission in the operating room


Arlinton, Va., November 27, 2018

Adherence to proven protocols for disinfecting surgeons’ hands, patients’ skin, and operating room surfaces could help to halt the spread of dangerous Staphylococcus aureus (S. aureus) pathogens in the operating room and beyond, according to new research published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

Despite solid evidence supporting improved practices for hand hygiene, vascular access, and patient skin disinfection, “adherence to evidence-based, basic, preventive measures is abysmal,” University of Iowa researchers report. “These failures may help to explain why up to 7 percent of patients undergoing surgery continue to contract at least one postoperative infection.”

In the midst of an increase in the spread of antibiotic-resistant S. aureus pathogens from acute care settings to healthy members of the community, researchers from the University of Iowa Hospitals and Clinics identified and characterized the epidemiology of particularly pathogenic S. aureus sequence types (STs) in the operating room. S aureus isolates were collected from three academic medical centers. Transmission dynamics for hyper transmissible, strong biofilm-forming, antibiotic-resistant, and virulent STs were assessed by using a systematic phenotypic and genomic approach combined with a new software platform, OR PathTrac (RDB Bioinformatics, Omaha, NE). The transmission story for these key pathogens was mapped and reported.

“The increase in the spread of S. aureus pathogens beyond the acute care setting is alarming, but we know that there are evidence-based practices that can address this critical patient safety issue,” said Randy W. Loftus, MD, lead study author from the Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. “The goal of the study was to increase awareness around the transmission of the different strains, with the aim of improving compliance with proven infection control measures.”

Dr. Loftus and his colleagues found that S. aureus ST 5 is a more pathogenic strain associated with increased strength of biofilm formation and increased risk of transmission and infection. Two of the ST 5 isolates were linked by whole cell genome analysis to postoperative infection, an alarming finding that likely underestimates the true magnitude of the problem. The combination of ST 5 pathogenicity, an aging patient population, and increasingly complex surgical procedures may help to explain the increase in the community spread of invasive methicillin resistant S. aureus infections; vulnerable patients could acquire these pathogens during routine care in the operating room and later develop an infection.

The researchers confirmed patient skin surfaces and healthcare provider hands as sources of ST 5 pathogen transmission. This suggests that strict compliance with processes to decolonize patients of bacteria before surgery and to maintain hand hygiene compliance during surgery will likely help control the spread of this important strain characteristic. They noted as well that operating room environmental surfaces were linked with transmission, indicating the importance of continually assessing the effectiveness of environmental cleaning protocols.

“By understanding the transmission story of an organism, we can identify areas where infection prevention practices can be strengthened,” said 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. “To improve outcomes for our patients, we need to continually assess and make process improvements to ensure that we do the right thing for every patient, every time.”

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Notes for editors
The article is “High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices,” by Randy W. Loftus, Franklin Dexter, and Alysha D.M. Robinson ( https://doi.org/10.1016/j.ajic.2018.04.211 ). It appears in the American Journal of Infection Control, Volume 46, Issue 10 (October 2018) published by Elsevier.

About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL. www.ajicjournal.org

About APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou . For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

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