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Alberta surgeons aren't always following guidelines aimed at minimizing the risk of patients developing an infection as a result of their surgery, a new survey reveals.

Experts in infection control and health-care safety say the findings are probably reflective of surgical practice in other parts of the country as well.

"We have a long way to go. It's really hit or miss right now whether or not you're going to get all these things done properly," said Marlies van Dijk, a nurse and leader of the Western Canadian efforts of Safer Healthcare Now, a campaign to promote practices that improve patient safety.

"We know that we ought to be doing better," said Dr. Andrew Simor, head of microbiology at Toronto's Sunnybrook Health Sciences Centre.

"And I think this study very neatly shows ... that indeed at least among surgeons in Alberta - and I suspect they're probably representative of surgeons across the country - there is clearly an opportunity for great improvement."

The study was done by researchers in the University of Alberta's medical faculty. Neither Ms. van Dijk nor Dr. Simor was involved in the study.

The aim was to see if Alberta surgeons were following four evidence-based recommendations for reducing surgical site infections, which are estimated to make up about 17 per cent of all infections people acquire in hospitals.

The guidelines were published by the U.S. Centers for Disease Control in 1999 and three of the four are accepted as essential practice for minimizing infection risks. The evidence is not conclusive for one, the recommendation that patients should be asked to bathe with an antiseptic soap before surgery.

The other three guidelines say surgeons or their surgical team members should remove body hair, if necessary, with clippers, not razors; clean skin with antiseptic products in a prescribed manner before making an incision; and ensure antibiotics given before surgery to lower infection risks are timed appropriately.

The researchers sent out surveys to 589 surgeons registered in the province in the summer of 2006, receiving responses from 247 of them - about 42 per cent. The report on their findings will be published in the December issue of the journal Infection Control and Hospital Epidemiology.

While the results suggest surgeons are in the main following the guidelines, there were some key areas where improvements are needed, said Dr. Sarah Forgie, a specialist in pediatric infectious diseases and the senior author of the paper.

For instance, 32 per cent of surgeons who responded to the questions about hair removal said they used razors instead of clippers - a clear breach of protocol.

Even when handled with care, razors make tiny nicks and abrasions - entry points for bacteria on the skin. In fact, studies have shown a 5-per-cent increase in surgical-site infection rates in patients whose hair was shaved rather than clipped.

While all surgeons were using recommended antiseptic agents for cleaning the skin before making an incision, about one-third said they applied it by wiping back and forth.

Antiseptics like chlorhexadine or iodine are supposed to be applied in a circular fashion from the intended site of incision outwards, so that any germs on the skin are moved away from where the cut will be made. Wiping back and forth can recontaminate areas after they've been cleaned.

Questions designed to find out how well surgeons were doing at timing the administration of antibiotics for surgery - a procedure known as antibiotic prophylaxis - showed a lot of variability in practice.

The idea behind antibiotic prophylaxis is to load up a person's blood stream and tissues with the drugs just before an incision is made. That's the time when the risk of introducing bacteria into the body is greatest. Dr. Forgie said from the results, it looks as if a number of surgeons worked within systems that saw patients getting the antibiotics earlier than advised.