Introduction

Technological advances in medicine, economic forces, and patients’ desire to receive care outside the hospital have resulted in an increase of health care provided outside of the hospital setting (Friedman et al, 1999). For example, there has been a rise in surgeries performed in ambulatory care settings, which were once only performed in hospitals. In the year 2003, nearly 75% of all surgeries were performed in ambulatory care settings, according to the American Association of Ambulatory Surgery Centers (Haugh, 2006).

“Traditionally, infection control professionals have considered the risk for infection in the out-patient setting to be low. However, as more invasive procedures are performed in the ambulatory care setting, patients and health care workers alike are at risk for developing or transmitting infection” (Friedman et al, 1999). One of the most common causes of postoperative complications is health care associated infections (HAI), commonly caused by surgical site infections (SSI). The Centers for Disease Control and Prevention’s (CDC) National Nosocomial Infections Surveillance (NNIS) system has defined surgical site infections as those associated with surgical procedures that occur at or near the surgical incision within 30 days of an operative procedure, or within one year if an implant is left in place (Horan et al, 1992). Common prevention techniques include prophylactic antibiotic use, use of clippers instead of razors for hair removal, flash sterilization, proper hand washing scrubs, environmental control, among others.

Surgical site infections account for 14%-16% of all HAI infections and are common complications of surgery, occurring in 2%-5% of patients after clean extra-abdominal operations and in up to 20% of patients undergoing intra-abdominal operations (Bratzer et al, 2005). In addition to patient injury, suffering, life style change, and mortality, there are substantial costs associated with SSI. It has been estimated that the average cost during the eight week period after discharge for a patient with an SSI is $5155, compared to $1773 for a patient without an SSI (Perencevich et al, 2003). To address this problem, there are currently 2 national initiatives underway; the Surgical Infection Prevention Project (SIPP), and the Surgical Care Improvement Project (SCIP) (Schragg, 2007). Although, these measures are not tied to reimbursement in ambulatory care centers, it is suggested their compliance would reduce surgical site infections, as they do in hospital settings (Hunt, 2007).

Goal

The Joint Commission is interested in gathering feedback on issues related to surgical site infections. Primarily, we are looking for your help in answering the following questions:

• How do you monitor surgical site infections in your institution?
• What are specific challenges you face in the prevention and monitoring of surgical site infections?
• How do you manage procedural specific issues related to the prevention of surgical site infections (i.e. cataract surgery)?
• What are some best practices used in your institution related to prevention and monitoring of surgical site infections that would be helpful to share with others?
• How do you use data about flash sterilization to evaluate and make improvements to the prevention strategies of surgical site infections?

References

Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, Wright C, Ma K, Red L. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg 2005; 140:174-82.

Friedman C, Barnette M, Buck A, Ham R, Harris J, Hoffman P, Johnson D, Manian F, Nicolle L, Pearson M, Perl T, Solomon S. Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: A Consensus Panel report. American Journal of Infection Control. Volume 27, Number 5. October 1999.

Haugh R. Competition keeps getting hotter for ambulatory surgery. Hospital Health Network. 2006 Oct; 80(10):68-70, 72, 2

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections 1992: a modification of CDC definitions of surgical wound infections. Infection Control Hospital Epidemiology 1992;13:606-8.

Hunt D. Setting up quality controls and systems key to ASC safety. Briefings on Ambulatory Accredication. May 2007. 6-7.

Perencevich EN; Sands KE; Cosgrove SE; Guadagnoli E; Meara E; Platt R Health and economic impact of surgical site infections diagnosed after hospital discharge. Emer Infectious Disease 2003 Feb;9(2):196-203.

Schraag J. New initiatives, practices make strides in fight against ssi’s. Infection Control Today. March 2007. Available at: www.infectioncontroltoday.com

Edit