A 'big-picture' approach to Joint Commission SSI goal
IP sees infection rates fall with SCIP measures
As the Joint Commission makes preventing surgical-site infections (SSIs) a national patient safety goal next year some infection preventionists may be more ready than others to meet the full panoply of phased-in requirements.
For her part, Jeanine Woltmann, RN, BS, CIC, infection control manager at Glen Cove (NY) Hospital, should have no problem passing muster with Joint Commission surveyors. She has ramped up a comprehensive program to prevent SSIs, implementing multiple interventions over time as recommended by the national Surgical Care Improvement Project (SCIP). A national quality partnership of organizations focused on improving surgical care, SCIP's goal is to reduce the incidence of surgical complications nationally by 25% by the year 2010.
In 2007, Woltmann expanded her SSI prevention program to include all inpatient surgical cases being monitored for the SCIP measures. Compliance with SCIP measures since June 2007 has been greater than 90%, she says. Some of the results of the effort include:
- Class I & Class II SSIs have fallen 22% from 1.4% in 2004 to 1.1% in 2007.
- Although numbers of total joint replacement (TJR) procedures increased from 785 in 2003 to 1,054 in 2007, the number of infections decreased 63% from 13 (1.7%) in 2003 to five (0.47) in 2007.
- Venous thrombo embolism (VTE) cases decreased 45% from 44 in 2005 to 24 in 2006.
- Post-op pneumonias decreased 75% from 12 in 2003 to three in 2006.
The big picture
"It takes a lot of teamwork — getting everybody on board with it," Woltmann tells Hospital Infection Control."We're looking at the whole picture now."
Indeed, there is quite a landscape to survey if your goal is prevent infections and other complications from surgery. According to the Centers for Disease Control and Prevention, SSIs are the second most common cause of health care-associated infections, with approximately 500,000 occurring annually in the United States. Costs and outcomes secondary to SSIs can vary by location and surgery type, but it is safe to say the direct and indirect costs of SSIs run in the billions annually.1 More importantly, SSIs are a major cause of patient morbidity and mortality, so successful prevention is sometimes a literal life-and-death issue. SCIP began as the Surgical Infection Prevention (SIP) in 2003, with its first target the appropriate and timely administration of antibiotics related to surgery. As result, monitoring of antibiotic prophylaxis for TJR, vascular procedures and colon surgeries began, recalls Woltmann. The focus was on giving the correct pre-op antibiotic within one hour before incision and discontinuing it within 24 hours of surgery end time. In 2005, under its new name, the SCIP initiative began monitoring the additional perioperative measures of appropriate hair removal, glucose control, beta-blocker for appropriate surgical candidates, VTE prophylaxis for all surgical patients and prevention of respiratory complications, such as post-op- and ventilator-associated pneumonia, she says.
"All of these are [designed] to prevent any complications during the surgical admission," Woltmann says. "We not only monitor the antibiotics but we are also looking at the [administration of] beta-blockers to prevent any venous clots or pulmonary embolisms. We also monitor their glucose to make sure we keep it at normal levels to enhance healing. Some patients come in, do not know they are diabetic and the stress of surgery raises their glucose levels. They may be a Type II diabetic and not know it yet."
Another Joint Commission requirement in the 2009 patient SSI safety goal is to conduct post- discharge SSI surveillance, typically the Achilles heel of any prevention program. The Joint Commission calls for following all patients for 30 days and those with total joint replacement out to one year.
"We have been doing that," Woltmann says. "We have a post-discharge letter that goes to the surgeons so that we do get feedback. Also — at least within New York state — if we identify an infection [in a patient discharged] from another hospital, we notify that hospital of that infection. There is communication back and forth. That's especially important in today's world because patients are discharged so quickly now."
Indeed, with lengths of stay shorter than ever, post-discharge surveillance is critical to get the full spectrum of SSIs. "We do a large volume of total joint infections and if they get infected, they will have to be readmitted," she says. "So we will see that with readmission. If they are readmitted to another hospital, they will call me; and if their patient is admitted here, I will call them. You need that feedback — you need to know."
Reference
- Perencevich EN, Sands KE, Cosgrove SE, et al. Health and economic impact of surgical-site infections diagnosed after hospital discharge. Emerg Infect Dis 2003 Feb. Available at: www.cdc.gov/ncidod/EID/vol9no2/02-0232.htm.
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