Transcript

Alisha Oropallo, MD, FACS:

Hi. My name is Alisha Oropallo. I'm a vascular and general surgeon located at Northwell Health . I’m the director of the Wound Healing Center and also professor of the Feinstein Institutes for Medical Research and professor for the Zucker School of Medicine at Northwell Health.

Well, hospital-acquired wound infections, or otherwise known as surgical site infections, can lead to several serious complications, most commonly delayed healing. These are infections that may slow down the normal healing process and prolong hospital stays and increase patient discomfort as well as abscess formation, like pockets of pus can develop, requiring further surgical intervention or drainage. Sepsis is another life-threatening condition where our body's response to infection damages its own organs and tissues. And then osteomyelitis, which is an infection that spreads to the bone, can lead to chronic pain and require long-term antibiotic therapy or hyperbaric oxygen therapy or further surgery. And then you have fistula formation, which is an abnormal connection between the organs and the vessels, which can form and it complicates recovery and requires complex management. And then of course, wound dehiscence, which is where the surgical wound inherently itself opens up, requiring reclosure, and then increases the risk for further infection. So, these complications can dramatically impact patient recovery by increasing hospital stays and costs, requiring additional surgeries and procedures, causing pain and discomfort, and potentially leading to long-term disability or even death, and also a delayed return to baseline function. 

Yes, the rise of antibiotic resistant organisms like MRSA, VRE, which is vancomycin-resistant enterococci, and multi-drug-resistant gram-negative bacteria, are a significant concern. And this prevalence, whether it's community- or hospital-acquired, affects treatment protocols. And this requires more broader spectrum antibiotics and an increasing need for specialized antibiotics to treat these infections, which have more side effects and require more intravenous administration. And then you have prolonged time needed to heal and increasing the risk of treatment, failure, and complications. And then there's also a driving need for strict infection control protocols that are the sequelae of this. So, in a sense, this necessitates an interdisciplinary approach, including infectious disease specialists to optimize the antibiotic therapy and prevent further spread. And it also emphasizes the need for antibiotic stewardship to combat the rise of these resistant organisms. 

Infective medication strategies include strict adherence to aseptic techniques, and this means that during surgery, and wound care involved in the surgical procedure, preoperative patient optimization, this includes control of sugars, nutritional support, and smoking cessation. We also have to consider prophylactic antibiotics, which are administered in appropriate time before surgery, optimal wound management. So, in other words, appropriate dressings and monitoring of the wounds frequently, at least weekly, if not inpatient more frequently if needed, and postoperative surveillance for the early detection of infection. Comorbid conditions can significantly impact these strategies. For instance, diabetes increases the risk of infection, requires glucose control and wound care observation. Obesity can complicate surgical procedures like wound healing, and immunocompromised state of the patient requires enhanced infection prevention measures. And patients with peripheral vascular disease, which is impaired blood flow, hinders wound healing and increases that risk of infection. And malnutrition impairs wound healing and immune response, sonutritional optimization is critical. So, I guess in a sense, we must tailor our strategies to each patient's unique risk profile and consider these comorbid conditions. 

Well, they often discharge until the infection is under control and they require extended antibiotic therapy, sometimes needing IV home intravenous therapy. They also increase the need for specialized wound care and outpatient and home care settings. And often they demand close monitoring from healthcare professionals just to prevent that recurrence. And they require detailed patient and caregiver education just to detect any kind of infection signs and require improved coordination between the hospital outpatient clinics and home health agencies. I would say that the effective communication and coordination is really essential to ensure that smooth transition of the continuity of care of the patient from the hospital to the outpatient arena, just to prevent those readmissions. 

Some of the concerns could be, for instance, signs of infection, swelling, erythema, fever, chills are a major concern. Erythema, which is redness to the area, tenderness. All these are signs of potential infection. Patients comorbidities like diabetes mellitus can also contribute to expeditious downward spiral of wound healing. So, this has to be, these types of patients that are at risk or have significant risk factors may need to be followed or monitored more carefully.

I think there are a lot of emerging technologies that are revolutionizing our approach. For instance, antimicrobial dressings, they reduce the risk of infection and promote healing, and we're starting to see AI-powered wound monitoring, which enables remote monitoring of healing and early detection of complications. Also, I would say that rapid pathogen identification has come to play. We can now detect this at the bedside with MMPs. There's also advanced negative pressure wound therapy aiding in complex wound management, especially reducing the bioburden and debriding the wound. And then there's newer antibiotic development, like different types of antibiotics that specifically target to resistant organisms. So, I think that it's still important that we try to prevent these infections, detect the complications early, and always improve, look forward to improving patient outcomes and reducing healthcare costs. I think that we just have to stay informed about these advancements and try to think about integrating them into our clinical practice to move the needle forward to provide the best possible care for our patients.