PATIENTS OPERATED on by a consultant surgeon rather than a junior doctor in training are less likely to develop healthcare-associated infections (HAIs), a leading specialist has said.
Prof Hilary Humphreys, professor of clinical microbiology at the Royal College of Surgeons in Ireland, told a conference in London that infection at the site of a surgical operation was the third most common cause of HAIs in the Republic.
"Measures that can have a beneficial effect in reducing surgical site infections include improved preparation of the patient pre-operatively, aspects of surgical technique during the operative procedure itself and post-operative care," he told doctors attending the Lancet Healthcare Associated Infections conference yesterday.
Surgery involving the colon and rectum (large bowel) was associated with the highest incidence of post-operative infection. And hospitals that carried out larger volumes of surgery had lower rates of surgical infection compared with centres with lower caseloads.
Prof Humphreys said a 2007 study of infection following orthopaedic surgery showed that when consultants carried out hip operations, infection rates were about half those found when non-consultant surgeons carried out the procedure.
"Seniority and experience has a positive impact on reducing surgical site infections," he said.
"A multidisciplinary approach reducing rates of surgical site infection is needed as well as improvements in the surveillance of patients following discharge from hospital."
Speaking to The Irish Times, Dr Kevin Kelliher, assistant national director of population health with the Health Service Executive, said there was a need to recognise how prescribing habits affect HAIs.
"There is an issue around doctors' prescribing habits. Doctors need to take responsibility for a more appropriate and more specific prescribing of antibiotics," he said.
Editor of the Lancet Infectious Diseases journal Dr John McConnell said: "Modern medicine faces few greater challenges than that of HAIs. In the UK, HAIs are estimated to cost the National Health Service at least £1 billion per year.
"Media attention has increased public pressure to tackle HAIs - a pressure that clinicians, researchers and policymakers must deal with".
Dr Andrew Pearson, consultant epidemiologist at the Communicable Disease Surveillance Centre, London, said the introduction of mandatory antibiotic prescribing in Bristol had contributed to a major drop in the number of cases of Clostridium difficile, the increasing prevalence of which has been linked to the over-prescribing of broad spectrum antibiotics.
The health protection agency expert said the nature of MRSA infection had changed. "We now have a huge mixture of strains in the US, both hospital-acquired and community-acquired", which he predicted would also happen in the UK and Ireland.
Dr Pearson warned that "mega-million pound" lawsuits from healthcare-associated infection would soon appear in the law courts. Looking to the future, he said there was a need for patient involvement, public reporting and legal advocacy to drive down rates of HAIs.
Dr Stephanie Dancer of the Department of Microbiology, Hairmyres Hospital, East Kilbride, Scotland, told the conference that targeted cleaning of hand-touch sites could significantly reduce the infection risk for hospital patients.