Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-29T08:00:08.126Z Has data issue: false hasContentIssue false
  • English
  • Français

The Impact of Depth of Infection and Postdischarge Surveillance on Rate of Surgical-Site Infections in a Network of Community Hospitals

Published online by Cambridge University Press:  02 January 2015

David Y. Ming ,
Luke F. Chen ,
Becky A. Miller ,
Daniel J. Sexton  and
Deverick J. Anderson
David Y. Ming
Affiliation:
Duke University Medical Center, Duke Program for Infection Prevention and Healthcare Epidemiology, Duke Infection Control Outreach Network (DICON), Duke University Prevention Epicenter Program, Durham, North Carolina
Luke F. Chen*
Affiliation:
Duke University Medical Center, Duke Program for Infection Prevention and Healthcare Epidemiology, Duke Infection Control Outreach Network (DICON), Duke University Prevention Epicenter Program, Durham, North Carolina
Becky A. Miller
Affiliation:
Division of Infectious Diseases, North Shore University Health System, Evanston, Illinois
Daniel J. Sexton
Affiliation:
Duke University Medical Center, Duke Program for Infection Prevention and Healthcare Epidemiology, Duke Infection Control Outreach Network (DICON), Duke University Prevention Epicenter Program, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Duke University Medical Center, Duke Program for Infection Prevention and Healthcare Epidemiology, Duke Infection Control Outreach Network (DICON), Duke University Prevention Epicenter Program, Durham, North Carolina
*
Division of Infectious Diseases and International Health, DUMC 102359, Durham, NC 27710 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To describe the epidemiology of surgical-site infections (SSIs) in community hospitals and to explore the impact of depth of SSI, healthcare location at the time of diagnosis, and variations in surveillance practices on the overall rate of SSI.

Design.

Retrospective cohort study.

Setting.

Thirty-seven community hospitals in the southeastern United States.

Patients.

Consecutive sample of patients undergoing surgical procedures between July 1, 2007, and December 31, 2008.

Methods.

ANOVA was used to compare rates of SSIs, and the F test was used to compare the distribution of rates of SSIs. Wilcoxon rank-sum was used to test for differences in performance rankings of hospitals.

Results.

Following 177,706 surgical procedures, 1,919 SSIs were identified (incidence, 1.08 per 100 procedures). Sixty-four percent (1,223 of 1,919) of these were identified as complex SSIs; 87% of the complex SSIs were diagnosed in inpatient settings. The median proportion of superficial-incisional SSIs was 37% (interquartile range, 29.6%–49.5%). Postdischarge SSI surveillance was variable, with 58% of responding hospitals using surgeon letters. As reporting focus was narrowed from all SSIs to complex SSIs (incidence, 0.69 per 100 procedures) and, finally, to complex SSIs diagnosed in the inpatient setting (incidence, 0.51 per 100 procedures), variance in rates changed significantly (P = .02). Performance ranking of individual hospitals, based on rates of SSIs, differed significandy, depending on the reporting method utilized (P = .0006).

Conclusions.

Inconsistent reporting mediods focused on variable depths of infection and healthcare location at time of diagnosis significandy impact rates of SSI, distribution of rates of SSI, and hospital comparative-performance rankings. We believe that public reporting of SSI rates should be limited to complex SSIs diagnosed in the inpatient setting.

Infect Control Hosp Epidemiol 2012;33(3):276-282

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 3 , March 2012 , pp. 276 - 282
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a.

D.Y.M. and L.E.C. contributed equally to this article.

References

1. de Lissovoy, G, Fraeman, K, Hutchins, V, Murphy, D, Song, D, Vaughn, BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37(5):387–397.Google Scholar
2. Anderson, DJ, Chen, LF, Sexton, DJ, Kaye, KS. Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. Infect Control Hosp Epidemiol 2008;29(10):941–946.Google Scholar
3. Broex, EC, van Asselt, AD, Bruggeman, CA, van Tiel, FH. Surgical site infections: how high are the costs? J Hosp Infect 2009;72(3):193–201.CrossRefGoogle ScholarPubMed
4. Scott, R II. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Atlanta: Centers for Disease Control and Prevention; March 2009.Google Scholar
5. Schaefer, MK, Jhung, M, Dahl, M, et al. Infection control assessment of ambulatory surgical centers. JAMA 2010;303(22):2273–2279.Google Scholar
6. Association for Professionals in Infection Control and Epidemiology. HAI reporting laws and regulations. http://www.apic.org/downloads/legislation/HAI_map.gif. Updated luly 6, 2011. Accessed August 18, 2011.Google Scholar
7. Patient Protection and Affordable Care Act. Pub L No 111-148, 124 Stat 388–389 (2010).Google Scholar
8. Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32(4):315–322.Google Scholar
9. Gaynes, RP, Culver, DH, Horan, TC, Edwards, JR, Richards, C, Tolson, JS. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33(suppl 2):S69–S77.Google Scholar
10. Centers for Disease Control and Prevention. Surgical site infection (SSI) event. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Published August 2011. Accessed luly 29, 2009.Google Scholar
11. Centers for Disease Control and Prevention. National Health Safety Network (NHSN) procedure-associated (PA) module: protocols and definitions. http://www.cdc.gov/nhsn/PDFs/slides/NHSN_PAModule.pdf. Updated May 4, 2010. Accessed June 13, 2011.Google Scholar
12. US Department of Health and Human Services. Hospital Compare. http://www.hospitalcompare.hhs.gov. Accessed June 13, 2011.Google Scholar
13. Bratzler, DW, Hunt, DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006;43(3):322–330.Google Scholar
14. Werner, RM, Asch, DA. The unintended consequences of publicly reporting quality information. JAMA 2005;293(10):1239–1244.Google Scholar
15. Kao, LS, Ghaferi, AA, Ko, CY, Dimick, JB. Reliability of superficial surgical site infections as a hospital quality measure. J Am Coll Surg 2011;213(2):231–235.Google Scholar
16. Petherick, ES, Dalton, JE, Moore, PJ, Cullum, N. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infect Dis 2006;6:170.CrossRefGoogle ScholarPubMed
17. Niedner, MF. The harder you look, the more you find: catheter-associated bloodstream infection surveillance variability. Am J Infect Control 2010;38(8):585–595.Google Scholar
18. Haut, ER, Pronovost, PJ. Surveillance bias in outcomes reporting. JAMA 2011;305(23):2462–2463.Google Scholar
19. Manniën, I, van den Hof, S, Brandt, C, Behnke, M, Wille, JC, Gastmeier, P. Comparison of the National Surgical Site Infection surveillance data between the Netherlands and Germany: PREZIES versus KISS. J Hosp Infect 2007;66(3):224–231.Google Scholar
20. Urban, IA. Cost analysis of surgical site infections. Surg Infect 2006;7(suppl 1):S19–S22.CrossRefGoogle ScholarPubMed
21. National Quality Forum. National Voluntary Consensus Standards for the Reporting of Healthcare-Associated Infection Data. http://vww.qualityforum.org/Publications/2008/03/National_Voluntary_Consensus_Standards_for_the_Reporting_of _Healthcare-Associated_Infection_Data.aspx. Published March 2008. Accessed August 18, 2011.Google Scholar
22. Kaye, KS, Engemann, JJ, Fulmer, EM, Clark, CC, Noga, EM, Sexton, DJ. Favorable impact of an infection control network on nosocomial infection rates in community hospitals. Infect Control Hosp Epidemiol 2006;27(3):228–232.CrossRefGoogle ScholarPubMed
23. Centers for Disease Control. Health—United States 2010. Atlanta, GA: National Center for Health Statistics; 2010.Google Scholar

A correction has been issued for this article:

Erratum