Creative Approach to Reducing Worldwide Problem of Surgical Infection

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Infections after surgery are the leading cause of morbidity for patients and costs to the health care system. World Health Organizations and International Surgical Societies are trying to mandate surgical hand hygiene as a top priority to decrease surgical infections.

A September 2023 landmark publication in The New England Journal of Medicine (NEJM) has a creative solution for this critical surgical problem. In collaboration with the International Surgical Infection Society and Alberta Health Services, Surgery Strategic Clinical Network, Dr. Khadaroo, Professor of Surgery, Surgeon and Critical Care Medicine Specialist at the University of Alberta, has evolved, an 8-minute video which teaches best practices of surgical hand hygiene. This is accessible to all surgery team members and all levels of medical and nursing trainees worldwide. In 2017, Dr. Khadaroo published with the Surgical Infection Society, a Randomized Control Trial demonstrating that video education significantly improves traditional education in teaching sterile surgical technique. The NEJM video and publication is being released on September 7, 2023. Dr. Khadaroo has been invited by NEJM to develop further videos in the area.

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Rachel Khadaroo, MD, PhD, FRCSC, FACS
Professor of Surgery, Department of Surgery & Department of Critical Care Medicine, University of Alberta Interim Scientific Director, Surgery Strategic Clinical Network (SCN), Alberta Health Services Certified Change Management Practitioner, Prosci

Surgery, ID and Pharmacy Alliance Key For Optimal Infection Management

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A strong, interconnected relationship between the surgeon, infectious disease physician and infectious disease pharmacist is essential for optimal antibiotic stewardship and management of challenges ranging from surgical site infections and ventilator-assisted pneumonia to severe Clostridioides difficile infections and necrotizing soft tissue infections, agreed experts from each of these specialties during a session at the 2022 annual meeting of the Surgical Infection Society.

“I envision this relationship as a trio,” said James Sanders, PhD, PharmD, the antimicrobial stewardship director and an assistant professor in the Division of Infectious Diseases and Geographic Medicine at UT Southwestern Medical Center, in Dallas. “At all the institutions I’ve worked at, the surgeons have been my allies to help enforce antimicrobial stewardship principles, and without them I don’t think the programs I’ve worked with would have been as successful. I really think there needs to be interplay between the surgeon, the ID pharmacist and the ID physician, not only to promote antimicrobial stewardship but in day-to-day patient care. We’re navigating the review of patients on antimicrobials throughout the hospital, and often ensure providers reach out to surgery or the ID providers.”

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AI Tool Predicts Surgical Infections, but Is Highly Site Specific

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An artificial intelligence tool developed by researchers in the Netherlands proved quite accurate at predicting postoperative surgical infections in a local hospital, but less so when extended to a large academic center, emphasizing the need to retrain AI data on external data as these tools gain ground in medicine.

Despite multipronged efforts to reduce the incidence of postoperative infections, they still occur in approximately 20% of all patients. On average, these infections are not diagnosed until postoperative day 5, said Siri van der Meijden, a junior data scientist and PhD candidate at Leiden University Medical Center (LUMC), in the Netherlands, who presented her team’s research at the Surgical Infection Society’s 2022 annual meeting.

To be more proactive in the care of postoperative patients, Ms. van der Meijden and her colleagues developed an AI tool to estimate the risk for infection based on preoperative and interoperative variables; the tool is meant to be applied directly after surgery. Patients deemed at high risk could be closely monitored, “and ideally patients with a low risk of infection could be discharged from the hospital earlier,” she said.

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