Becker's Clinical Quality & Infection Control

14 INFECTION CONTROL & PATIENT SAFETY Study: Overlapping Surgeries Boost Complication Risks By Mackenzie Bean C oncurrent surgeries in which a surgeon runs two operations at once increase the risk of surgical complications for patients undergoing hip surgery, according to a study published in JAMA Internal Medicine. Members of the healthcare community have argued over the safety of overlapping surgeries ever since The Boston Globe's Spotlight Team is- sued a controversial report about Boston-based Massachusetts General Hospital's use of the surgical practice in 2015. Since then, research- ers have published numerous peer-reviewed studies, which showed little difference in com- plication rates between single and concurrent surgeries in U.S. hospitals. "is seems to be the first study to show an adverse effect from the practice of overlapping surgery," Alan L. Zhang, MD, an orthopedic s12urgeon at UC San Francisco Medical Center, wrote in an op-ed accompanying the study. For the study, researchers analyzed clinical data from several health administrative databases for more than 90,000 hip operations at about 75 hospitals in Ontario, Canada. Researchers also looked at patient outcomes one year aer surgery. Of the procedures analyzed, 2,520 overlapped by more than 30 minutes with another surgical procedure performed by the same attending surgeon. Most surgeries overlapped for 30 to 60 minutes, although some were performed concurrently for up to three hours. Researchers found the longer the surgeries overlapped, the more likely patients were to experience a serious surgical complication within one year. e risk of a surgical complication increased from 1.4 percent to 2.3 percent for patients undergoing elective hip replacements when the surgery over- lapped with another procedure. For patients who underwent a hip fracture surgery, the risk rose from 6.4 percent to 10.4 percent. "If your surgeon is in multiple places, there's an increased risk of having a complication," lead study author Bheeshma Ravi, MD, PhD, a hip surgeon at Sunnybrook Health Sciences, told e Boston Globe. "I think that just makes sense." n Scarlet Fever Is Making a Comeback — And No One Knows Why By Mackenzie Bean S carlet fever is reemerging in certain parts of the world for reasons unknown to researchers and health officials, reported Vox. Scarlet fever is a bacterial infection caused by the bacteria Streptococcus pyogenes. The infection, spread via coughing or sneezing, causes a red rash on the body, high fever, and sore throat, and can lead to serious health complications such as heart and kidney damage. While the illness became more manageable with the development of an- tibiotics in the mid-20th century, scarlet fever cases mysteriously fell in the 19th century without the help of those medications. Over the years, scarlet fever cases have continued to fluctuate, with many parts of the world cur- rently seeing another reemergence of the illness. England and Wales saw three times the amount of scarlet fever cases in 2014 compared to the year before, according to a study published Nov. 27 in Lancet Infectious Diseases. Vietnam, South Korea, Hong Kong and China have also reported significant increases in scarlet fever cases since 2009. While the U.S. does not require states to track scarlet fever, the CDC told Vox there are no signs of an uptick in national cases. Researchers proposed several explanations for the infection's re-emergence. Changes to people's immune systems may be making them more suscepti- ble to S. pyogenes. A different pathogen may also be co-infecting individu- als, thereby predisposing them to scarlet fever, according to the report. n C. Diff Most Frequently Found in Floor Corners After Disinfection By Anuja Vaidya A study published in Infection Control & Hospital Epidemiology identi- fied environmental sites where spores of Clostridium difficile persist despite cleaning and hydrogen peroxide aerial decontamination. Researchers conducted the study at a tertiary referral teaching hospital. Before and after terminal or hydrogen peroxide disinfection, researchers sampled 16 sites representing high-frequency contact or difficult-to-clean surfaces in a single-isolation room or bed area in patient bed bays. They used the results of C. diff sampling to focus cleaning. Over one year, researchers sampled 2,529 sites from 146 rooms and 44 bays. They found C. diff: • On 131 of 572 surfaces (22.9 percent) before terminal cleaning • On 105 of 959 surfaces (10.6 percent) after terminal cleaning • On 43 of 967 surfaces (4.4 percent) after hydrogen peroxide disinfection The study also shows that C. diff persisted most frequently in floor cor- ners (29 percent) after disinfection. "Although feedback of results did not improve the efficacy of manual dis- infection, numbers of C. difficile following hydrogen peroxide gradually declined," study authors noted. n

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