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More surveillance techniques increase rate of superficial SSIs
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Hospital infection preventionists who used more surveillance techniques for surgical site infections reported more superficial infections, but not complex infections, researchers from Denver Health Medical Center have found.
“Previous publications state that 6% to 88% of [surgical site infections (SSI)] occur after hospital discharge, when superficial SSI are most common and surveillance techniques of infection preventionists are most variable,” the researchers wrote in Infection Control and Hospital Epidemiology. “When [infection preventionists] perform minimal postdischarge surveillance, the reported rates of superficial SSI falsely decrease. This misinforms consumers who compare hospitals on these factors and limits opportunities to implement SSI prevention practices.”
Heather Young, MD, and colleagues, developed an online survey for infection preventionists to evaluate how they detect SSIs. Local hospitals that performed at least 20 colon surgeries from August 2012 through July 2013 were eligible. Along with survey data, the researchers analyzed hospital-specific information reported to the state health department.
Heather Young
Of the 37 qualifying hospitals, 26 completed the surveys. Half of the infection preventionists used at least two microbiology or laboratory tests to indicate a chart review. Twelve infection preventionists reported using communication with two other health care personnel, and 17 infection preventionists evaluated at least three types of postoperative visits.
Using the individual surveillance methods did not increase the number of superficial or complex SSI rates. The combination of using two laboratory results and communicating regularly with at least two health care personnel resulted in a higher median rate of superficial SSIs: 3.31 vs. 1.01 per 100 procedures (P = .048). There was a significantly higher adjusted mean rate of superficial SSIs when more techniques were used, but no rate increase was observed for complex SSIs.
“Future nationwide evaluations of the association between SSI surveillance techniques and SSI rates should be undertaken,” the researchers wrote. “A national survey could characterize practice patterns and influence recommendations for best [infection preventionist] surveillance practices. Colon SSI rates are used for both public hospital comparison and financial reimbursement. The intensity of SSI surveillance can impact the superficial SSI rate. Care must be taken to ensure that facilities that capture all SSI, both superficial and complex, are not unjustly punished for utilizing more rigorous surveillance techniques.” – by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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