Reporting surgeon SSI rates reduces infections
Reduced SSI rates yield $375,000 two-year savings
Enhanced surveillance of surgical site infections (SSIs) — including confidentially reporting individual infection rates to surgeons — dramatically reduced SSIs and saved a hospital more than $187,000 annually, an epidemiologist reported recently in San Francisco at the annual meeting of the Society for Healthcare Epidemio logy of America.
Edward Smyth, MD, FRCP, epidemiologist at the Royal Hospitals in Belfast, Northern Ireland, analyzed 6,256 surgical procedures from January 1995 to June 1997.1 Surveillance methodology and patient risk index were based upon the Centers for Disease Control and Pre vention’s National Nosocomial Infections Sur veillance (NNIS) system. The researchers established an SSI rate during the first six months of the study and made the assumption that this rate would continue in the absence of infection control interventions.
"Over the study period, the number of surgical procedures didn’t vary much," Smyth told SHEA attendees. "Using the first six-month period as the baseline, we then calculated an expected SSI rate. The main intervention that occurred at the end of the first six-month period was confidential surgeon-specific rates."
At the end of the first period and for each subsequent six-month period, surgeons received confidential SSI rates regarding their own practice. Over a period of four consecutive six-month intervals, Smyth observed a downward trend in the SSI rate from the initial baseline of 4.7% to 2.3% over the ensuing two years. Over the 24-month intervention period, the researchers recorded 117 SSIs, but that figure would have been a projected 230 SSIs had the rate of infection prior to the interventions continued. (See chart, above.)
Thus, the intervention resulted in a 49% reduction in expected SSIs. The 113 infections prevented translated to substantial savings by slashing lengths of patient stay. Investigators calculated that development of an SSI in patients with no apparent risk factors for infection resulted in a median of 11 additional days of hospital stay.
"Based on an additional cost [estimate] of $3,320 per SSI, we appeared to achieve a potential savings of $375,160," Smyth told SHEA attendees. The results confirm the positive value of SSI surveillance and will be invaluable when negotiating his next infection control budget with hospital administration, Smyth added.
The cost estimate is generally in line with a 1992 U.S. analysis that found that an SSI resulted in 7.3 additional hospital days and added $3,152 in extra charges.2 Another study presented at SHEA in 1997 estimated that the total excess cost of an SSI, including hospital readmission, was approximately $5,000 per infected patient. (See Hospital Infection Control, June 1997, p. 87.)
Smyth conceded that "the $64,000 question" is to determine exactly how telling surgeons their infection rates results in lower rates. He said the process of providing continuous feedback seems to improve the surgeon’s technique. In addition, the process raised general awareness about preventing infection among both surgeons and nursing and surgical support staffs who were aware that such data were being collected, he noted.
References
1. Smyth E, Barr J, Webb C, et al. Potential savings achieved due to a reduction in surgical site infections over a twenty-four month period. Abstract 58. Presented at the Conference of the Society for Healthcare Epidemiology of America. San Francisco; April 18-20, 1999.
2. Martone WJ, Jarvis WR, Culver DH, et al. "Incidence and Nature of Endemic and Epidemic Nosocomial Infections." In: Bennett JV, Brachman PS, eds. Hospital Infections. 3rd ed. Boston: Little, Brown and Co.; 1992, pp. 577-596.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content