| Primary Author: | Cynthia Segal, RN, MSN, PhDc |
| Organization | UT MD Anderson |
Abstract
Purpose
The purpose of this study is to further the understanding of superficial SSIs using data from a large national quality improvement database. Identification of the risk factors for superficial SSIs is necessary before appropriate prevention efforts can be developed and implemented. Prevention of these non-life threatening but numerous events could save millions of dollars and lost workforce hours. The increased antibiotic usage associated with them could be avoided slowing the rate of antimicrobial resistance. The population chosen to study includes adult patients that underwent colon surgery.
Background
Surgical site infections (SSIs) have long been a concern to patients and healthcare providers. Despite efforts to increase public awareness and enforce prevention measures, SSIs continue to be a burden accounting for 22% of the 1.7 million hospital acquired infections and contributing to approximately 8,205 deaths (Stone, P.W., 2005) The Center for Disease Control and Prevention (CDC) clearly defines 3 categories of SSIs: superficial, deep, and organ/space (Edwards,J.R., 2009). Most researchers and hospital administrators focus on the deep and organ/space SSIs because they are measureable, expensive and devastrating infections. Less is known about the more frequent superficial SSIs since they often occur after the patient is discharged from the hospital and being treated in the clinic (Neumayer, L., 2007).
Materials & Methods
Surgical data from 2007 to 2009 submitted to the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) will be used. The ACS NSQIP program uses strict protocols with specific definitions and training for the dedicated nurses who compile the data at each participating hospital. The relationships of preoperative and intraoperative patient factors to superficial surgical site infections that occur within 30 days of the procedure will be explored.
Results
Many variables were related to superficial SSIs in the univariate analysis. In the final multivariate analysis a few of the risk factors were extended length of operation, increased body mass index (BMI), diabetes, and chronic obstructive pulmonary disease (COPD). Several other factors were protective of developing a superficial SSI in patients that had undergone colon surgery, for example: increased age and procedures performed laparoscopically.
Conclusion
Understanding the factors related to the development of superficial surgical site infections will help teams to implement focused improvement processes, such as, systematically redosing antibiotics on long cases and exploring appropriate antibiotic dosing for patients with increased BMIs. Many factors related to increased operation time were not available including number of healthcare providers involved and surgical skin prep utilized. The database was limited in socioeconomic factors; no payor information, educational levels, or zipcode information was available. Ethnicity/race did not show any association to the development of superficial SSIs.
Bibliography
1. Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control. 2005;33:501-509.
2. Edwards JR, Peterson KD, Mu Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37:783-805.
3. Neumayer L, Hosokawa P, Itani K, et al. Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204:1178-1187.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).