IBJI Physicians Discover Link To Post Op Infections

Illinois Bone and Joint Institute (IBJI) physicians associated with Evanston Northwestern Hospital (ENH) have discovered a link between nasal staff bacteria and post-surgical infections.

The study, published in the March issue of Clinical Orthopaedics and Related Research, was conducted by Dr. Lance Peterson, an infection disease specialist, and IBJI surgeons Dr. James Kudrna and Dr. William Robb. The study which began in 2003 involved a simple pre-operative nasal swab test for Staphylococcus Aureus or S. Aureus. S. Aureus is responsible for the majority of post-surgical infections in Total Knee and Total Hip Arthroplasty surgeries.

“About 25% of the general population has S. Aureus in their nasal passages and don’t have symptoms,” says Dr. Robb. “One quality of staph bacteria is that it spreads in fresh wounds. A patient with S. Aureus in the nasal passages can unknowingly transfer the bacteria simply by touching his nose and then the surgical area.”

In the pilot program, nearly 1,500 patients received the pre-op nasal swabs. Patients who tested positively for staph were then treated with an ointment for five days prior to surgery. This pre-surgical topical antibiotic therapy was the key to driving down post-surgical infections. At the conclusion of the pilot program in February 2005, ENH instituted pre-op nasal screening as a standard protocol for all major surgeries.

What made the treatment more practical was an emerging technology called Polymerase Chain Reaction (PCR). PCR testing increased the speed at which the staph bacteria were identified. The old method, which required incubation of the mucus sample and used cultures, could take two or three days. The use of PCR ensured that there would be no significant delays for surgeries as a result of the nasal screening program.

Before the initial study was concluded, Dr. David Shapiro, an IBJI spine surgeon, noted the encouraging preliminary results of the study. Dr. Shapiro, also affiliated with ENH, decided to study spine patients to determine if the methodology had the same benefit for that group of patients. Dr. Gary Shapiro, an IBJI spine surgeon, and Dr. Peterson co-authored an orthopaedic spine surgery study.

The study compared the post-surgical infection rates of nearly 1,400 patients. About half were screened pre-operatively and about half were not. The screened group had a surgical infection rate of 0.7% compared to 1.5% for the non-screened group. The results of the spine study were presented in October 2007 to attendees at the North American Spine Society meeting.

“Surgeons tend to be most interested in techniques,” said Dr. David Shapiro. “But at IBJI, we’re crazy about infection prevention.” Dr. David Shapiro is continuing his research in a second study where he is looking at more specific issues affecting infection rates. The results of the second study will be available some time next year.

The Illinois Bone and Joint Institute is an orthopaedic medical practice that specializes in the diagnosis, treatment and management of injuries and diseases of the musculoskeletal system. IBJI has over 90 physicians and over 90 rehabilitation therapists at over 25 locations throughout the Chicagoland area.

For further information on the Illinois Bone and Joint Institute write to Illinois Bone and Joint Institute 8930 Waukegan Road Suite 200 Morton Grove, IL 60053, call 847-324-3975, email tbone@ibji.com or visit www.ibji.com.