Good medicine: How to lower the risk of post-surgical infections

Shortly after Patricia Henderson Shimm had her hip replaced, the surgical site became infected. It was the start of a three-year nightmare for the New York author and early-childhood educator.

Her doctors gave her intravenous antibiotics and extracted the infected tissue. But eventually they had to remove the artificial joint itself, leaving Mrs. Shimm temporarily wheelchair-bound. After a second hip replacement followed by two years of excruciating pain, Mrs. Shimm only recently started walking without a cane.

"They told me this is just one of those things that happens sometimes," she says.

Largely because of mounting resistance to common antibiotics, complications from surgery that were once easily treatable have become increasingly difficult to handle. The consequences are alarming: more post-surgery deaths, amputations, and other severe complications.

Patients who develop surgical-site infections are 60 percent more likely to spend time in an intensive-care unit, five times more likely to be readmitted to the hospital and twice as likely to die than patients who don't get infections. Such complications also add more than $1 billion annually to the nation's health-care bill, according to federal health analysts.

But many dangerous surgical infections don't have to happen. For the past four years, the government has had in place — and almost every major surgical society has endorsed — simple guidelines to help hospitals and doctors prevent them. Yet, recent studies show that in anywhere from 25 percent to 50 percent of surgeries, doctors aren't following the most basic prevention steps, like administering the recommended antibiotics before the operation.

It is a sobering example of how medical care often doesn't adhere to evidence of what works best for patients — and it underscores the need for patients and their families, as well as hospitals themselves, to be more vigilant. Mrs. Shimm wasn't given any antibiotics prior to her surgery. Though the cause of her infection can't be known now, the guidelines clearly state that in joint-replacement surgery, antibiotics before surgery offer the best protection from infection.

Now federal health agencies are trying to bring surgeons and hospitals into line. The Centers for Disease Control, which issued the guidelines in 1999, and the Center for Medicare and Medicaid Services have joined forces in a far-reaching prevention effort. The goal is to cut the number of surgical infections in half by 2005.