Airborne Contaminants Causing Surgical Site Infections In Operating Rooms

A report in Infection Control Today discussed how hospital-acquired infections (HAIs) and surgical site infections (SSIs) are major concerns among medical providers, agencies such as the Centers for Disease Control and Prevention (CDC), and Centers for Medicare & Medicaid Services (CMS). Medicare and Medicaid implemented the Hospital-Acquired Condition (HAC) Reduction Program, which is saving these programs over $300 million annually by penalizing hospitals with the worst rates of HAIs.

The report claims that too much emphasis is focused on the decontamination of hard surfaces, overlooking infections caused by contaminated air. Air within the operating room environment may contain bacteria and other airborne contaminants.

Prevalence of Infection from Airborne Particles

In the 1970s, a study by Brachman estimated that contaminated air caused between 10 and 20% of HAIs specifically. In recent years airborne transmission is being increasingly studied as it relates to SSIs. A University of Glasgow report suggests that airborne contamination is the most “consistent” means of surgical wound infection. For example, in 2015 it was discovered how aerosolized bacteria that contaminated heater-cooler units while they were manufactured was exposing 60% of heart-bypass patients to risks such as Mycobacterium chimera infections.

Prosthetic Joint-Related Infections

Surgeons are now performing more hip and knee replacements than ever, in part because of the rise in the number of older Americans. A study in Orthopedics Today says the annual number of prosthetic joint implants is expected to well exceed three-million by 2030. Prosthetic joint infections (PJIs) are a concern, as the five-year survival rate is higher than that of some types of cancer. Contaminants in the air such as dust, fibers, and skin contain organisms such as Staphylococcus aureus that collects on surgical tools and where incisions to the skin are made.

Changing Medical Malpractice Standards

Medical malpractice (negligence) in Pennsylvania is when the professional breaches or violates the standards of care. These standards of what is reasonable continue to evolve in the medical community. A question may arise whether the action(s) were reasonable relative to the current advancements in surgical care. In making such an assessment you may reference the “current clinical practice guidelines” or the more evolved “evidence-based” method; both of which include a “duty to stay abreast”. Medical providers must remain aware of advancements in HAI and SSI prevention, which are expected to occur rapidly in the coming years.

Pennsylvania Case

Cases of medical malpractice that involve these infections will be evaluated in court by looking at whether the infection could have been avoided by employing current evidence-based technology that reflects the latest standards of care. In DiMeo v. St. Agnes Hospital, the plaintiff had her knee replaced that became severely infected. The jury agreed that the hospital had failed to employ the latest preventative measures. These cases are increasingly appearing with allegations such as failing to clean (disinfect) tools used in surgery.

Malpractice Case Settlements Obscure the Data

Many malpractice cases are settled between the parties by entering into a nondisclosure agreement. As a result, the detailed information about the case is not released. Often defendants prefer to settle claims in this manner to avoid lengthy litigation and limit negative public exposure.