This article was medically reviewed by Dr. Joseph Kim.
When thinking of members of a surgical team, the first healthcare professionals that come to mind are surgeons, anesthesiologists, nurses, and perhaps surgical technicians. However, believe it or not, embedded in the protocol for every surgery is an infectious disease doctor contributing to a course of perioperative antibiotics. And it doesn’t end there, dependent upon the nature of a procedure ( i.e. how long the procedure is going to take, the invasive nature of the procedure, or if the patient has a predisposition to infections) the expertise of an infectious disease specialist sometimes plays an even bigger role in the makeup of a surgical team.
ID Care is the largest independent infectious disease practice on the East Coast, and the second largest in the United States. We’ve helped some of the most renowned healthcare organizations in New Jersey improve patient care before, during, and after surgery. In this article, infectious disease expert and ID Care team member Dr. Joseph Kim will discuss the many ways ID Care physicians help our healthcare partners improve their surgical capabilities through enhanced surgical protocols, antibiotic stewardship, and contributing to leading-edge surgical programs.
Infectious Disease Care: Before, During, and After Surgery
An infectious disease specialist can be a vital resource for any surgical team, providing hospitals with the expertise required for routine procedures and protocols, but also when unseen circumstances may arise. “For any surgery an infectious disease specialist plays a role in prescribing an antibiotic prophylaxis that may help with infection prevention measures that might be germane to any particular case,” said Dr. Kim. “For low risk surgeries, hopefully the patient doesn’t require our direct assistance afterwards, because the best scenario for us is to assist with the perioperative antibiotics and monitor from afar. But certainly, we’re always accessible and waiting to help if needed. But I would say we do have a large role in many surgeries, because we’re the ones that are looked upon to provide solutions when things don’t go as planned. Whether it’s an antibiotic-resistant organism that’s isolated, or whether we’re helping to make a decision on further surgical procedures, we are the ones that are consulted to deal with some of the most complex and difficult problems when it comes to patient management before, during, and after surgery.”
However, the size of the role an infectious disease specialist plays on a surgical team changes on a case-by-case basis, and the most successful healthcare organizations know when to tap into a resource like the network of physicians at ID Care. “The decision to bring us in is usually initiated by the surgeon,” said Dr. Kim. “They may ask a patient about a history of staph or MRSA infections. And if the patient does have a history, we’re definitely called in right away to advise on and monitor those situations very closely.”
All that being said, perhaps the most important role an infectious disease specialist can play is improving protocols when it comes to infectious diseases and surgical procedures. “Under normal circumstances, when a patient doesn’t have a medical history directly related to infectious diseases, we usually help our hospital partners implement and maintain standard protocols, such as deciding on the right antibiotics a patient must take before and after their surgical procedures. Afterwards, we monitor patients very closely, especially those that are at high risk for developing infections because they’re on mechanical ventilation or they have many intravascular lines or vascular access devices. Initiating and maintaining these protocols are vital to any surgical procedure and so valuable to hospitals to ensure patient safety.”
Whether upholding standard procedures or being called in for an emergency, an infectious disease specialist, like those at ID Care, can be a valuable resource for healthcare organizations looking to improve their surgery departments. However, an infectious disease specialist can also improve the entirety of a healthcare operation (including the surgical department) in another simple way: antibiotic stewardship.
Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harm caused by unnecessary antibiotic use, and combat antibiotic resistance. A diligent antibiotic stewardship program plays an important role in protecting patients during surgery as well as over the duration of their hospital stay.
So, who is best to lead such an important initiative?
“An infectious disease specialist is probably the most mindful steward of antibiotic utilization,” said Dr. Kim. “At ID Care, we protect hospitals by preventing the development of antibiotic resistance, the development of complications associated with antibiotics, and ultimately, we provide the most intelligent and prudent utilization of the antibiotics that are given to patients.”
“This is certainly a benefit to our hospital partners, and also to the community at large, because our antibiotic stewardship philosophy is really to protect the antibiotics that we use to make sure they’re useful in the future so that the development of resistance doesn’t occur. This protects our patients who have not yet had an infection, in addition to those who currently have infections. And obviously, proper antibiotic stewardship is so vital for patients undergoing surgical procedures.”
The main focus of ID Care’s antibiotic stewardship program is to provide the highest quality infectious disease services to patients, communities, and partners at healthcare facilities across the state. By identifying problems, collecting and analyzing data, as well as providing intervention through changes in policies and procedures, ID Care is able to improve the safety and capabilities of clinical organizations, improve patient care, and minimize antibiotic resistance. In fact, ID Care’s partners claim a position among the highest performers in this sector across New Jersey. To date, our partner facilities have some of the lowest levels of antibiotics usage with the highest level of effectiveness for patients.
Clearly, ID Care takes antibiotic stewardship very seriously, but that’s not the only way we help our hospital partners reach higher standards. When it comes to new surgical programs, we’re ensuring new procedures are as safe as they are breakthrough.
Heart Success Program
The Heart Success Program at Morristown Medical Center is designed to provide specialized heart care for patients with advanced heart failure, cardiomyopathies, and pulmonary hypertension. One of the ways Morristown Medical Center and Atlantic Health System helps patients in this way is through a breakthrough left ventricular assist surgery designed to help weak hearts pump more efficiently. In the case of such an invasive procedure, and a device that will ultimately remain inside the body, an infectious disease specialist is crucial in ensuring such surgeries are safe for patients. Because of this, Dr. Kim, and fellow ID Care specialist, Dr. Stephen J. Williams, have helped formulate an antibiotic prophylaxisdesigned especially for left ventricular assist surgery. Such a prophylactic antibiotic strategy is crucial in ensuring breakthrough surgeries, such as left ventricular assist surgery, are a success.
“With left ventricular assist surgery, we see patients before surgery and answer questions and help advise on what antibiotics to give based on allergies and standard protocols,” said Dr. Kim. “We follow trends and what types of infections occur in these types of devices. The left ventricular device is essentially unable to be removed and it’s a major surgical event placing devices in and out of the heart into the aorta to help forward the flow of blood when the heart is unable to do so on its own. So in that situation, where there’s a major type of surgical procedure, we need to administer a very specific prophylactic antibiotic regimen before surgery and then continue seeing the patient on an ongoing basis throughout their hospital stay, and in some cases, even after they leave.”
Patients from all over the state have come to Morristown Medical Center to undergo left ventricular assist surgery, and ID Care couldn’t be prouder of the roles our physicians have played in improving patients’ outcomes and lives. This is one of many roles an infectious disease expert can play on a surgical team, and each role is important in its own right. The ability for a healthcare organization to excel comes down to a unified effort to ensure every department has the support it needs to provide the best possible patient care. When it comes to surgery, the right infectious disease expert can make all the difference.
As the largest independent infectious disease practice on the East Coast, ID Care has helped many of our healthcare partners improve patient care before, during, and after surgical procedures – and we’d love to help your organization as well. If you have questions about infectious disease protocols in regard to surgical procedures, antibiotic stewardship, or you’d like to find out more ways we can help improve your facility, please call 908-281-0221 to schedule a consultation with an ID Care expert or visit the ID Care partner page to learn more.