Memo to the Centers from Medicare & Medicaid Services (CMS) from a surgeon on the literal cutting edge of infection prevention in the OR: Hospitals and federal regulators should encourage the use of newer and safer types of surgery and more transparency with patients on procedure options and possible outcomes.
That would do far more more to reduce surgical site infection (SSI) rates than inspections by CMS and other government regulators.
“My prediction is that most hospitals will be found compliant with these measures that CMS is going to check, yet wide variations in surgical site infections will continue,” says Martin A. Makary, MD, MPH, an associate professor of surgery and health policy at the Johns Hopkins Hospital in Baltimore, MD. “Unfortunately, these metrics, while important, don’t capture the variation and complexity in care, and they don’t capture the variation in surgical practice.”
While conceding that much of its effort is to emphasize “the basics,” the CMS has developed a draft hospital survey that includes a surgical procedure tracer to monitor infection control elements in the OR. The CMS survey, which is currently in a pilot testing phase, advises inspectors to assess essential infection control measures in the surgical area, including hand hygiene, sterile gloves, masks, and limiting traffic in the OR.
“It doesn’t push to any new ground like antibiotic sutures, skin closure devices, minimally-invasive surgery,” Makary says. It’s pretty much run-of-the-mill, and it won’t make any difference in infection rates.”
One change CMS could encourage that would result in much better outcomes involves requiring transparency and improved methods of informed consent, Makary says.
Patients who are considering surgery need to be fully informed and educated about the most realistic benefits and risks they face and learn
about all available options — including not having surgery at all, he says.”
“In my career and training, I’ve seen unnecessary operations that result in infections,” Makary says. “Those preventable harms or infections are not at the level of hand washing or sterile technique; they’re at the level of choice to do the procedure and informed consent that overstates benefits and understates risks.”
For more on this story see the June 2012 issue of Hospital Infection Control & Prevention.