CDC Promotes Campaign to Prevent Antimicrobial Resistance in Surgical Patients

WASHINGTON, D.C. -- The Centers for Disease Control and Prevention (CDC) has introduced an educational campaign for helping surgeons prevent antimicrobial resistance in their patients. The CDC made the announcement at the American College of Surgeons conference in Chicago, which wraps up this week. The surgeons' campaign is a component of CDC's Campaign to Prevent Antimicrobial Resistance in Healthcare Settings.

The campaign for surgeons focuses on four key strategies for preventing antimicrobial resistance in healthcare settings: 1) preventing infection, 2) diagnosing and treating infection effectively, 3) using antimicrobials wisely, and 4) preventing transmission of drug-resistant pathogens. The strategies include 12 action steps derived from evidenced-based guidelines and recommendations developed by CDC with the support of other medical and public health organizations.

"Surgical patients are at risk for antimicrobial-resistant infections due to surgical incisions and exposure to medical devices like ventilators, central lines, and urinary catheters," said Dr. Denise Cardo, director of CDC's Healthcare Quality Promotion Program. "This campaign, developed in collaboration with surgeons, offers 12 steps that surgeons can take to protect their patients from these ongoing risks."

The action steps for surgeons who provide care for surgical patients include:

Action Step 1: Prevent surgical site infections

Monitor and maintain normal glycemia

Maintain normothermia

Perform proper skin preparation using appropriate antiseptic agent and, when necessary, hair removal techniques

Think outside the wound to stop surgical site infections

Action Step 2: Prevent device-related infections: get the devices out

Use catheters only when essential

Use proper insertion and catheter-care protocols

Use drains appropriately

Remove catheters and drains when they are no longer essential

Action Step 3: Prevent hospital-acquired pneumonia

Wean from the ventilator when appropriate

Elevate head of bed to 30 degrees

Drain circuit/tubing condensate away from patient

Prevent contamination of respiratory therapy equipment, ventilator circuits and respiratory medications

Action Step 4: Target the pathogen

Target empiric antimicrobial therapy to likely pathogens

Obtain appropriate cultures

Target definitive antimicrobial therapy to known pathogens

Optimize timing, regimen, dose, route, and duration of antimicrobial therapy

Practice safe source control (e.g. debridement, or open wound as indicated)

Action Step 5: Access the experts

Consult the appropriate expert for complicated infections:

surgeons, infectious disease experts, clinical pharmacists

Action Step 6: Start prophylactic antimicrobials promptly

Give the initial dose within one hour preceding incision

Use the appropriate antimicrobial and dosing

Repeat the dose during surgery as needed to maintain blood levels

Action Step 7: Stop prophylactic antimicrobials within 24 hours

Discontinue use even with catheters or drains still in place

Action Step 8: Use local data

Know your local antibiogram

Know your formulary

Know your patient population

Action Step 9: Know when to say "no" to vanco

Vancomycin should be used to treat known infections, not for routine prophylaxis

Treat staphylococcal infection, not contaminants or colonization

Consider other antimicrobials in testing methicillin-resistant staphylococcus aureus (MRSA)

Action Step 10: Treat infection, not contamination or colonization

Use proper antisepsis for drawing blood cultures

Get at least one peripheral vein blood culture, if possible

Avoid culturing vascular catheter tips

Treat bacteremia, not the catheter tip

Action Step 11: Contain contaminant and contagion

Follow infection control precautions

Consult infection control teams

Action Step 12: Practice hand hygiene

Set an example

Wash your hands or use an alcohol-based handrub

Do not operate with open sores on hands

Do not operate with artificial nails

Promote good habits for the entire surgical team

"Antibiotic resistance poses a major threat to everyone," said Cardo. "This educational campaign will increase patient safety by preventing these infections. CDC is developing similar programs for clinicians who care for hospitalized children and patients in long-term care facilities."

Antimicrobial-resistant infections in healthcare settings pose a major threat to patient safety. Each year in the United States, an estimated 2 million hospitalized people acquire infections that result in more 90,000 deaths. Bacteria cause more than half of these infections, which are resistant to at least one of the antimicrobials commonly used to treat them, according to CDC. Previous studies have shown that surgical patients who develop drug-resistant infections are at increased risk of illness, longer hospital stays, and death.

The 12 steps for surgeons are endorsed by the American College of Surgeons and the Surgical Infection Society. The campaign was made possible through support from the CDC Foundation. Materials being developed for the campaign include a slide set featuring the 12 action steps and the evidence to support them, posters, and a scratch pad listing the12 action steps. The campaign also features a web site where surgeons may access the 12 action steps as well as information to share with their patients.

For more information on CDC's campaign to prevent antimicrobial resistance in healthcare settings go to www.cdc.gov/drugresistance/healthcare.