The Performance Gap

There are approximately 300,000 surgical site infections (SSIs) annually (17% of all HAI; second to UTI). SSIs occur in 2%-5% of patients undergoing inpatient surgery.\cite{28077567} The SSIs mortality rate is 3 %, with a 2-11 times higher risk of death versus other infections. Seventy-five percent of deaths among patients with SSI are directly attributable to the SSI. Long-term disabilities can result from SSIs and while studies have been done on mortality, no studies have been done on the life-altering long-term disabilities and associated financial burdens that can result from SSIs.
A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. Some of the common symptoms of a surgical site infection include redness and pain around the surgical site area, drainage of cloudy fluid from the surgical wound, and fever.
Surgical site infections can result in 7-10 additional postoperative hospital days due to an SSI. Direct costs can be between $3,000-$29,000 per SSI, depending upon the procedure and pathogen. On a national scale, direct and indirect medical costs combined can reach up to $10 billion annually.\cite{28674667b} These estimated costs do not account for the additional costs of rehospitalization, post-discharge outpatient expenses, and long-term disabilities.
The pathogenesis of SSIs can be endogenous (patient flora, seeding from a distant site of infection) and exogenous (surgical personnel, OR physical environment and ventilation, tools, equipment, and materials brought to the operative field). Challenges exist in detecting SSIs such as the lack of standardized methods for postdischarge/outpatient surveillance due to an increased number of outpatient surgeries and shorter postoperative inpatient stays. Another challenge is the increasing trend toward resistant organisms which may undermine the effectiveness of existing recommendations for antimicrobial prophylaxis.
Education and awareness of risk factors amongst healthcare workers, physicians and nurses followed by the implementation of standardized guidelines can minimize the incidence of SSIs in hospitals. Some key preventive measures include appropriate antimicrobial prophylaxis, preoperative identification and treatment of existing infections, proper site preparation methods (hair removal, skin site), maintenance of normothermia in the immediate postoperative period, and keeping OR doors closed during surgical procedures.

Leadership Plan

Practice Plan

Technology Plan

Suggested practices and technologies are limited to those proven to show benefit or are the only known technologies with a particular capability. As other options may exist, please send information on any additional technologies, along with appropriate evidence, to info@patientsafetymovement.org

Metrics

Topic

Colon Surgical Site Infection Rate (Colo SSI): Rate of patients with a Colon Surgical Site Infection per 100 NHSN colon operative procedures

Observed Hand Hygiene Compliance

Numerator: Colon surgical site infections based on CDC NHSN definitions
Denominator: Total number of colon operative procedures based on CDC NHSN definitions
* Rate is typically displayed as SSI/100 Operative Procedures

Metric Recommendations

Indirect Impact:  All patients requiring a colon operative procedure
Direct Impact: All patients requiring a NHSN colon operative procedure
Lives Spared Harm:
\(Lives\ =\ \left(SSI\ Rate_{baseline}\ -\ SSI\ Rate_{measurement}\right)\ x\ Operative\ procedures\ _{baseline}\)

Notes:

To meet the NHSN definitions, infections must be validated using the hospital acquired infection (HAI) standards.

Data Collection: 

All NHSN colon operative procedures require infection surveillance for 30 days following the procedure date.
Operative procedures are defined by ICD and CPT codes.
Colon SSIs can be displayed as a Standardized Infection Ratios (SIR) using the following formula:
\(SIR=ObservedSSI/ExpectedSSI\)
Expected infections are calculated by NHSN and available by location (unit type) from the baseline period.

Mortality (will be calculated by the Patient Safety Movement Foundation):

The PSMF, when available, will use the mortality rates associated with Hospital Acquired Conditions targeted in the Partnership for Patient’s grant funded Hospital Engagement Networks (HEN). The program targeted 10 hospital acquired conditions to reduce medical harm and costs of care. “At the outset of the PfP initiative, HHS agencies contributed their expertise to developing a measurement strategy by which to track national progress in patient safety—both in general and specifically related to the preventable HACs being addressed by the PfP. In conjunction with CMS’s overall leadership of the PfP, AHRQ has helped coordinate development and use of the national measurement strategy. The results using this national measurement strategy have been referred to as the “AHRQ National Scorecard,” which provides summary data on the national HAC rate.\cite{28675924a}

Topic:

Abdominal Hysterectomy Surgical Site Infection Rate (Hyst SSI)

Rate of patients with an abdominal hysterectomy surgical site infection per 100 NHSN abdominal hysterectomy operative procedures

Outcome Measure Formula:

Numerator: Abdominal hysterectomy surgical site infections based on CDC NHSN definitions\cite{28675853a}
Denominator: Total number of abdominal hysterectomy operative procedures based on CDC NHSN definitions
* Rate is typically displayed as SSI/100 Operative Procedures

Metric Recommendations:

Direct Impact:
All patients requiring a NHSN abdominal hysterectomy operative procedure
Lives Spared Harm:
\(Lives=(SSIRate_{baseline}-SSIRate_{measurement})\ X\ Operative\ procedures_{baseline}\)

Notes:

To meet the NHSN definitions, infections must be validated using the hospital acquired infection (HAI) standards.\cite{28675796}

Data Collection:

All NHSN abdominal hysterectomy operative procedures require infection surveillance for 30 days following the procedure date. Operative procedures are defined by ICD and CPT codes.
Colon SSIs can be displayed as a Standardized Infection Ratios (SIR) using the following formula:
\(SIR=ObservedSSI/ExpectedSSI\)
Expected infections are calculated by NHSN and available by location (unit type) from the baseline period.

Mortality (will be calculated by the Patient Safety Movement Foundation):

The PSMF, when available, will use the mortality rates associated with Hospital Acquired Conditions targeted in the Partnership for Patient’s grant funded Hospital Engagement Networks (HEN). The program targeted 10 hospital acquired conditions to reduce medical harm and costs of care. “At the outset of the PfP initiative, HHS agencies contributed their expertise to developing a measurement strategy by which to track national progress in patient safety—both in general and specifically related to the preventable HACs being addressed by the PfP. In conjunction with CMS’s overall leadership of the PfP, AHRQ has helped coordinate development and use of the national measurement strategy. The results using this national measurement strategy have been referred to as the “AHRQ National Scorecard,” which provides summary data on the national HAC rate. (Quicho 2016)