WHO issues global guidelines to stop surgical infections, superbugs

November 07, 2016
by Thomas Dworetzky, Contributing Reporter
The World Health Organization has issued new surgical guidelines to help reduce the spread of hospital-acquired infections.

"No one should get sick while seeking or receiving care," Dr. Marie-Paule Kieny, WHO’s Assistant Director-General for Health Systems and Innovation, stressed in a statement. "Preventing surgical infections has never been more important but it is complex and requires a range of preventive measures. These guidelines are an invaluable tool for protecting patients."

The guidance advised that those preparing for surgery should “always have a bath or shower but not be shaved, and antibiotics should only be used to prevent infections before and during surgery, not afterwards."

Not only will such measures save lives, they will also save the health care system money and reduce the spread of “superbugs,” stressed the international agency.

WHO's "Global Guidelines for the Prevention of Surgical Site Infection" includes a list of 29 concrete recommendations culled from leading experts and based on 26 reviews of the latest evidence.

The guidelines have been published in The Lancet Infectious Diseases.

Surgical site infections afflict 11 percent of surgical patients who undergo surgery in low- and middle-income countries, stated WHO, and, for example, in Africa up to 20 percent of caesarean sections lead to wound infection.

Even in advanced health care systems post-surgery infections pose challenges. They cause U.S. patients to spend over 400,000 extra days in the hospital, and run up $900 million annually in additional expenses.

There are 13 pre-op and 16 post-op anti-infection recommendations.

WHO stated that this is the first time that guidelines applicable everywhere had been issued. “No international evidence-based guidelines had previously been available and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines,” it advised.

"Sooner or later many of us will need surgery, but none of us wants to pick up an infection on the operating table," said Dr. Ed Kelley, Director of WHO’s Department of Service Delivery and Safety. "By applying these new guidelines surgical teams can reduce harm, improve quality of life, and do their bit to stop the spread of antibiotic resistance. We also recommend that patients preparing for surgery ask their surgeon whether they are following WHO’s advice."

The guidelines go hand-in-hand with WHO's "Surgical Safety Checklist.”

These latest guidelines advised antibiotic use before and during surgery only – to help combat the spread of resistance.

A pilot study in four African countries showed that use of some of the new guidelines could lead to as much as a “39 percent reduction in surgical site infections.”

Care-related infection has long been a challenge, and in the news.

The subject has been addressed repeatedly in HCB News Magazine by Thom Wellingon, the CEO and a stockholder in Infection Control University, a company that provides staff training programs and control processes for infectious microorganisms in hospitals, clinics, long-term care facilities and other health care-related institutions.

He has noted that “HAIs are considered mostly preventable incidents and require changes in behavior. Health care program reforms have focused greater emphasis on reducing infections. Actions taken under the Affordable Care Act (ACA), along with the Centers for Medicare and Medicaid Services (CMS), including the elimination of hospital reimbursement for HAIs, have indirectly improved outcomes. Annual patient deaths from HAIs have fallen drastically from nearly 100,000 to 75,000. More progress is needed, but change is producing results.”

Most dramatically, the well-publicized cleaning problems of duodenoscopes that led to superbug infections highlighted the potential tragedies that can result.

A U.S. Senate report “determined that, between 2012 and spring 2015, closed-channel duodenoscopes were linked to at least 25 different instances of antibiotic-resistant infections that sickened at least 250 patients worldwide."

The problems led the FDA to issue an order to three manufacturers of these sophisticated scopes marketed in the U.S. to start using post-market surveillance to get better insight into the way these devices are reprocessed in the real world.

“This is a significant step in the effort to combat infections spread through duodenoscopes. The FDA has undertaken an in-depth investigation into the factors that may play a role in infection transmission associated with duodenoscopes, and is now requiring manufacturers to study the devices in the clinical setting where they are being used,” said Dr. William Maisel, deputy director for science, and chief scientist at the FDA’s Center for Devices and Radiological Health, in a statement at the time.