The Department of Health’s chief medical officer in England Sir Liam Donaldon’s latest annual report has highlighted the need for safer surgery, and the health needs of teenagers.

He also indicated the possibility of developing vaccines against healthcare associated infections such as MRSA within a decade, and Clostridium Difficil within as little as three years.

Making surgery safer
Donaldson’s report draws on figures from the National Patient Safety Agency, which received 129,416 reports of potential errors involving surgical procedures during 2007. While most of these errors do not result in harm or the risk is averted, disturbing ‘wrong site’ surgery cases remain a concern.

There were 14 cases of burr holes being drilled on the wrong side of the head during brain surgery in the last three years. In 2007, 16 operations were done on the wrong site, including knee replacements on the wrong knee; surgically implanted hearing aids in the wrong ear; removing bone from the wrong foot; and wrong incisions in the abdomen for access to organs.

One patient a day was listed for the wrong operation in 2007, and there were 1,136 errors involving operating lists, including mistaken surgery, wrongly identified patients or operations performed in the wrong place.

Donaldson’s suggested measures include the establishment of a clinical board for surgical safety; routine use of the World Health Organisation's Surgical Safety Checklist before, during and after the operation; more use of risk scores to estimate the risk to patients before the operation; and regular collection and analysis of death rates 30 days after operations, which should be made available to the public.

Teenage kicks
Donaldson’s report also points out that the teenage years are a risk-taking period of life, closely tied to the rite of passage into adulthood. High-risk behaviours such as binge drinking, drug taking and unsafe sex are not entirely unknown during this period.

As well as urging health services to take better account of the specific health needs of young people, Donaldson called for a national summit to review health programmes and services for teenagers; more involvement of teenagers in the design of health services for them; a young person's panel to be established to advise on national campaigns addressing risk taking in teenage years. He also suggested that the legal blood alcohol level limit for drivers aged between 17 and 20 years should be reduced to zero.