Surveillance Methodology and Economic Burden of SSIs
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Transcript of Surveillance Methodology and Economic Burden of SSIs
Surveillance Methodology and
Economic Burden of SSIs
Maureen Spencer, RN, M.Ed, CICInfection Preventionist Consultant
Boston, MA - USA
Purpose of the Infection Control and Prevention Program
•Surveillance – detect cases
•Control - outbreaks, clusters or increasing trends in data
•Implement prevention measures
Surveillance System and CDC Definitions
Micro cultures auto printed daily from Meditech
IC Adm Assist Runs daily list of
IP and OP Visits
Surgeon Post Discharge Surveillance
Precaution patients currently in house - auto printed daily
by Meditech
New Precaution Patients ? HAI or CA ?
Case Management Monthly Reports (listing of
complications, infections, etc)
ACU Consult Reports (prints directly on IC Adm Assist Printer) for patients with a
question of infection
Developed Algorithms For Surveillance (Each Category)
All positive cultures are
entered in log book
Follow CDC criteria for Hospital Acquired Infections
Info includes Pt name, MR#, Room, Date of Adm, Date of
Cult, MD
Review and log patient’s last adm
and/or surgery
IC RN Reviews all department reports (op
notes, prev disch noted, RN notes,
etc)
Summary of potential HAI is given to IC MD
for review
HAI report is summarized and submitted to ICC
for review, discussion, etc
Was the infection preventable?
Information forwarded to
surgeon and dept chair
If previous hosp adm, list
adm date, disch date MD,
surg procedure, unit
etc.
Sample questions: Did pt have surgery: if
yes, was it within 30 days of last
adm; or 1 year if surgery involved
an implant?
Was patient previoiusly
admitted with an infection?
Micro cultures auto printed daily from
Meditech
IC Adm Assist performs
preliminary review of all
cultures
If cultures taken on previous adm,
are they same organism?
Patients with potential HAI are flagged for IC RN/
MD review
Yes
Run daily list of IP and OP
Review patient diagnosis for
signs of potential infection
Was patient admitted with
infection, sepsis, pain s/p surgery?
Highlight for IC RN to follow
Enter Info in Log Book to include Pt
name, MR#, Room, Date of
Adm, diagnosis, MD,
along with previous
admission info
Yes
Case definition
•Case definitions are designed to capture all potential cases of a disease/condition without contaminating the dataset with extraneous materials
•NHSN is, by definition, our basic service•Special case definitions may be required
for specific issues or for outbreaks
Case definitions
•Outbreak▫May want to date or unit define▫May want to include symptoms or
manifestations•Case control studies
▫Permit selection of control group (those without the condition under study)
▫Associated with the event or process
Data analysis
•Data are systematically compiled and interpreted▫Data are analyzed using statistical methods▫Date are compared over time to internal
and external databases▫Comparative databases are used when
undesirable variation is identified
Numbers
•Numerator – the “top” number which is also the number of cases identified
•Denominator – the “bottom number” –(down below) is the total number of individuals studied
•Rate – the result of dividing the numerator by the denominator and multiplying by a factor
The “Factor”
•There is no established “factor” for most statistical math in epidemiology
•Generally report surgical and other similar infection as x/100 events
•Generally report device related infections by device day x/1000 device days
Measures of occurrence
•Incidence▫Measure of frequency with which an event
occurs in a population over a specified period of time New cases
•Prevalence ▫Proportion of persons in a population with
a particular disease at a specific point in time (point prevalence) or over a specified time period (period prevalence) Existing cases
Studies
•Case Control – two groups, identical, but one with the characteristic under study, and other without. General 1:3 (power)
•Cohort – all people in a group (enter together, and then observe for occurrence of disease/condition)
•Prospective – looking forward•Retrospective – looking backward
Bias
•Bias can be defined as “any systematic error in the design, conduct or analysis of a study that results in a mistaken estimate of an exposure’s effect on the risk of disease”
•Selection Bias•Information Bias
The monthly record of cases • Record demographic data for each case
▫ Use consistent methods Column A: Last Name Column B: First Name
• Column C: Medical Record #Physician▫ Physician name▫ Physician identification # (check, as often there are
two different numbers in the hospital)• Age – useful in stratification• Gender – equivocal data set• Admission date (critical!)• Onset date (used to calculate # hospital days
admission to onset)
Line Listing
Line List: A line list is an organized, detailed list of each record of a surgical site infection
Example Suppose you are interested in looking at all
CLABSIs in 2010 that occurred in the ICU and the Orthopedic Unit
You would like to produce a line list that includes basic patient demographics (patient ID, DOB, gender, and age at event), information on the event (date admitted, date of surgey, date of onset, location of patient when SSI developed
Line list heading – Depends on the HAI
• Infection site ▫ Use standard nomenclature - NHSN
SSI SST CAUTI
• Procedure codes• Procedure date• Surgeon code• Surgeon assistant and others in the room• Date of Admission• Date of Onset of Infection• Antibiotics• ASA score• Incision time• Closure time• Patient room number
Next columns
•Organism▫Use standard nomenclature!
CNS vs. Coag neg staph vs. S. epidermidis Spell the words correctly
•Culture site •Final attribution – Hosp Onset, Comm
Onset, Comm Acquired•Comment field– generally cannot sort by
anything except the first word but useful for keeping notes
Frequency Table
Frequency Table: A frequency table is an organized display of counts and percentages
The data are organized by a row variable and a column variable, and the frequency table provides a count of the number of observations in the data set that meet the specifications of both the row and column variables
Example Suppose you are interested in looking at the
distribution of each SSI across the different services in your facility, for all events that were identified in 2012
UHS HAI Dashboard
EXAMPLE OF HAI FREQUENCY TABLE IN EXCEL FILE
Descriptive Epidemiology
▫Cross tabulations: infections/organisms infections/nursing units infections/services infections/risk factors
▫Evaluate trends and clusters
▫Conduct studies and investigations Retrospective case reviews, Case-Control
Studies
Examples of Cross Tabulations
•CLABSI by ICUs•CLABSI by device type•CLABSI by organisms•SSIs by services•SSIs by surgeons•SSIs by nursing unit•Risk factors by SSIs•SSI rates over a time period
SSI by Service - 2012
SERVICE CABG TOTAL HIP
TOTAL KNEE
ABD HYSTEC
COLON
Gen Surgery
0 0 0 0 4
Cardiac Surgery
2 0 0 0 0
Orthopedic Surgery
0 2 3 0 0
Gynecology Surgery
0 0 0 3 0
Example CLABSI Analysis 2011-2012Nursing Unit 2011 (n=13) 2012 (n = 4)
SICU 34 24
NICU 3 1
PICU 2 1
MICU 42 34
4 WEST 1 0
5 SOUTH 16 23
What do these numerators mean?Next calculate rates by line days
CLABSI BY ORGANISMS - 2012
NURSUNIT
STAPH AUREUS
MRSA CNS ALPHA STREP
ECOLI PSEUDAERUG
CANDIDA
SICU 5 8 2 1 2 4 2
NICU 0 1 0 0 0 0 0
PICU 0 0 1 0 0 0 0
MICU 10 12 5 0 2 1 4
4 WEST 0 0 0 0 0 0 0
5 SOUTH
8 2 6 4 1 1 1
TOTALS 23 23 14 5 5 6 7
SSI RATESTYPE OF SURGERY
# SSIs # PROCEDURES
% RATE
THA 2 100 2%
TKA 3 75 4%
CABG 2 25 8%
COLON 4 15 27%
ABD HYSTERCTOMY
3 16 19%
SSIs BY SURGEONS - RATES
SURGEONCODE
CABG TKA THA COLON ABD HYSTER
A 1.2
B 1.0
C 0.9 1.0
D 0.4 0.8
E 0.0 0.0
F 5.6
G 4.8
H 0.0 (0/6 cases)
I 30.0 (3/10 cases)
Risk Factors for Infections
Surgery Diabetes Obese (BMI > 30)
Hema-toma
Drains Staples Smoking Steroids
THA 50% 75% 25% 90% 90% 20% 10%
TKA 60% 80% 35% 85% 95% 10% 5%
CABG 70% 70% 0% 0% 50% 60% 45%
COLON 50% 50% 0% 20% 80% 20% 10%
ABD HYSTER
70% 80% 0% 0% 90% 10% 10%
? What percentage of non-infected patients had risk factors? What percentage of Surgeon I patients had these risk factorsObesity diabetes risk factors at this institutionStaples are used often which may be increasing the riskDrains being used in orthopedic surgery – increase risk
Pie Chart
Pie Chart: A pie chart is a graphical representation of data. The different slices of the pie represent different values of a variable, with the relative size of the slice representing the amount of data included in the slice
Pie Chart Example
The top value for each slice is the value of the “chart variable” (e.g., location).
The second value is a count of the number of events included in each slice of the pie
Example: Distribution of HAIs
Bar Chart
Bar Chart: A bar chart is a graphical representation of data where the length or height of the bars represents counts of cases or rates
Number of Cases by Surgery Date
Days from Surgery to Infection- HPRO & KPRO
Orthopedic Surgical Site Infection Rates
OR Environmental controls:Traffic, Attire,Scrub, Air Handling
Antibacterial sutures
MRSA and Staph aureus Elimination Program
CHG/Alcohol Prep
Laminectomy outbreak due to locally administered steroids (depomedrol)7 x increase risk of infection if obese and diabetic
Increase in hematomas after use of Lovenox and Plavix
NEBH SSI Rates 2003 – 2010(outpatient and inpatient infections)
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GENERAL SSI FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10
# Infections 6 1 3 4 2 2 1 0# Procedures 1073 920 780 692 567 467 425Infection Rate 0.6 0.1 0.4 0.5 0.3 0.3 0.2 0
ORTHOPEDIC SSI# Infections 63 60 49 46 39 37 28 32# Procedures 8837 9669 9216 8986 9027 8884 8890 9839Overall Infection Rate 0.7 0.6 0.5 0.5 0.4 0.4 0.31 0.33#Hip Infections 14 5 4 7 5 5 10 9 Hip Prosthesis Rate 1.0 0.3 0.2 0.4 0.3 0.3 0.49 0.41#Knee Infections 21 14 11 7 7 11 9 9 Knee Prosthesis Rate 1.6 1.0 0.7 0.4 0.3 0.5 0.39 0.35#Laminectomy Infec. 6 9 7 7 12 4 0 3 Laminectomy Rate 0.7 0.9 0.6 0.8 1.3 0.5 0.0 0.53#Spinal Fusions Infec. 5 15 12 12 5 5 3 3 Spinal Fusion Rate 0.8 2.0 1.4 1.1 0.4 0.4 0.31 0.34Other infections 17 15 13 12 10 6 8 Other infection rate 0.38 0.39 0.37 0.34 0.21 0.22
2009 - Total hip investigation – increase in post-op hematomas in infected patients being evaluated by a case-control study2008 – Total knee investigation – noticed increase rate in patients receiving toradol, marcaine and duromorph – needle on syringe was not being changed between each vial – changed practice2007 – Laminectomy rate increased – case control study revealed locally adminiistered steroids increased infection rate in obese/diabetic pts
Run Chart
Run Chart: A run chart (or control chart) is a line graph showing change in a variable over a selected time period
This is a useful output if you would like to view, for example, the change in rates over time and 2 standard deviation above the mean
Instituted AMD Gauze and Standardized dressing technique
MRSA/MSSA Eradication Program
Standardized Infection Ratio (SIR)• Standardized Infection Ratio (SIR), a statistic
used to measure relative difference in HAI occurrence during a reporting period compared to a common referent period (i.e., standard population).
• SIR compares the actual number of HAIs with the predicted number based on the baseline U.S. experience (i.e., standard population), adjusting for several risk factors that have been found to be most associated with differences in infection rates
Next Step: Calculate SIR by HAI by facility and compare to national data from NHSN
The “p” value
•The p value is the probability that an event will occur in a given set of trials
•A p of 1 means it will occur every time the trial occurs (if there were 100 “z” in a pile of 100 scrabble tiles, the probability of getting a “z” is 1 “by chance”
•Thus, a p of 0.05 means that 95% of the time or 95/100 you will not get a “z” if there were a random mix of tiles with only one z
Patient-associated risk factors identified by studies in Malaysia and Vietnam
Risk Factors for SSI
1. Praveen S et al. Asian J Surg 2009. 32(1):59-63. 2. Yong KS, et al. Med J Malays 2001. 56 Suppl C:57-60.3. Nguyen D et al. Infect Control Hosp Epidemiol 2001. 22(8):485-492. 4. Sohn AH et al. Infect Control Hosp Epidemiol 2002. 23(7):382-387.5. Thu LTA et al. J Hosp Infect 2005. 60(4):360-367.
Country Source Risk variable Surgical procedure Risk estimate (95% CI) P value
Malaysia
Praveen 20091
Intra-operative adhesions Inguinal hernioplasty
Not reported 0.013
Post-operation haematoma Not reported 0.001
Yong 20012
Type 2 diabetesTotal hip replacement
OR 21.4 (1.53, 300.2) 0.023
Obesity OR 20.2 (2.13, 191.5) 0.009
Vietnam
Nguyen 20013
Dirty wound Any surgical procedure OR 5.67 (1.92, 16.74) 0.002
Sohn 20024 Dirty wound Any surgical procedure OR 2.92 (1.35, 6.15) NR
Thu 20055
Dirty wound All orthopaedic surgery
OR 8.7 (4.55, 16.44) <0.001
ASA > 2 OR 3.9 (1.77, 8.82) 0.001
Surgical site infection
1. Duerink DO et al. J Hosp Infect 2006. 62(2):219-229. 2. Sohn AH et al. Infect Control Hosp Epidemiol 2002. 23(7):382-387.3. Praveen S et al. Asian J Surg 2009. 32(1):59-63. 4. Dhillon KS et al. Med J Malays 1995. 50(3):237-240.5. Syahrizal AB et al. Med J Malays 2001. 56 Suppl D:5-8. 6. Yang K et al. J Arthroplasty 2001. 16(1):102-106.7. Kehachindawat P et al. J Med Assoc Thai 2007;90(7):1356-62.8. Thu LTA et al. Infect Control Hosp Epidemiol 2006. 27(8):855-862.
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SSI classification by surgical procedure
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Gastrointestinal surgery Incidence of SSI: 4 – 56%
Incidence of ssi
1. Mahadeva S et al. Int J Clin Pract 2009. 63(5):760-765.2. Thambidorai CR et al. Singapore Med J 2008. 49(12):994-997.
Country Source Surgical procedure Incidence (%)
Malaysia
Mahadeva 20091 Percutaneous endoscopic gastrostomy 33/103 (32%)
Thambidorai 20082 Appendectomy in childrenOpen: 34/61(55.7%)Laparoscopic: 3/51 (5.9%)
Orthopaedic surgery Incidence of SSI: 4 – 15%
Incidence of ssi
1. Dhillon KS et al. Med J Malays 1995. 50(3):237-240.2. Syahrizal AB et al. Med J Malays 2001. 56 Suppl D:5-8.3. Tay BH et al. Med J Malays 2000. 55 Suppl C:74-85.
Country Source Surgical procedure Incidence (%)
Malaysia
Dhillon 19951 All orthopaedic surgery 48/703 (6.8%)
Syahrizal 20012 Total knee arthroplasty 11/100 (11.0%)
Tay 20003 Total hip arthroplasty 10/109 (9.2%)
Gynaecology & Obstetrics surgery Incidence of SSI: 2 – 26%
Incidence of ssi
1. Huam SH et al. Med J Malays 1997. 52(1):3-7.2. Ramli R et al. Int Med J 2009. 16(4):279-282.
Country Source Surgical procedure Incidence (%)
MalaysiaHuam 19971 Caesarean section
Antibiotic prophylaxis: 3/100 (3.0%)No prophylaxis: 13/100 (13.0%)
Ramli 20092 Laparoscopic ovarian cystectomy 2/37 (5.4%)
Other surgical procedures
Incidence of SSI
1. Ahmad TS et al. Ann Acad Med Singapore 1997. 26(6):840-843.2. Hisham AN et al. ANZ J Surg 2002. 72(4):287-289.3. Ng CY et al. Asian Cardiovasc Thorac Ann 2004. 12(3):218-223.4. Praveen S et al. Asian J Surg 2009. 32(1):59-63.
Country Source Surgical procedure Incidence (%)
Malaysia
Ahmad 19971 Free flap surgery 10/61 (16.4%)
Hisham 20012 Total thyroidectomy 3/98 (3.1%)
Ng 20043 CABG 34/1594 (2.1%)
Praveen 20094 Inguinal hernioplasty 15/202 (7.4%)
Patient Factors Surgeon Technique Work Environmental Factors
Pre-operative Factors Peri-operative Team Factors Organizational and Management Factors
Care Delivery problems (CDPs)
SSI Fishbone Diagram
Lack of hand hygiene
Patient body colonization
Lack of traffic control – too many in room
Improper surgical hand antisepsis
Improper surgical attire
MRSA or MSSA nasal colonization
Infection at another site
Obese
Diabetic
Smoker
Immunosuppressive agents
Unsterile instruments
Contaminated environment
Inadequate surgical prophylaxis
Poor surgical techniqueUse of Drains
Lack of re-dosing of antibiotic
Lack of pre-op shower
Financial constraints
Poor leadershipPoor communication among team
Poor staff levels
Workload and shift patterns
Design, availability and maintenance of equipment Environment and physical plant
problems (air handling system)
Surgical irrigation
Non-coated suturesUse of Staples or steri-strips
Contamination of incision post-op
Inadequate staffing for post-op care
Lack of discontinuation of antibiotics at 24 hrs
Lack of foley catheter removal within 48 hrs
Increase hospitalization days
Contaminated environment
Lack of hand hygiene
How Much Do These Infections Cost???
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Relative Economic Burden Associated with HAIs
• SSISurgical Site Infections
• CLA-BSICentral-Line Associated Blood Stream Infections
• VAPVentilator Associated Pneumonia
• CA-UTICatheter-Associated Urinary Tract Infections
• Other / MDROs*Multi-Drug Resistant Organisms (e.g., MRSA, C. difficile, VRE, etc.)
Est. Annual # of Infections
Est. Annual # of Infections
Direct Cost per Patient (2007$)Direct Cost per Patient (2007$)
Avg. Increased Length of StayAvg. Increased Length of Stay
Attributable Mortality
Attributable Mortality
290,485(~17% of HAIs)
248,678(~14% of HAIs)
250,205(~15% of HAIs)
561,667(~32% of HAIs)
386,090(~22% of HAIs)
$34,670
$29,156
$28,508
$1,007
~$30,000
~12 days
~10-24 days
~9-13 days
1 day
~9.1 days
4%
26%
24%
1%
~4%
* NOTE: MDRO often cause other infection types (e.g., SSI, BSI, VAP, UTI); MDRO statistics reflect CDC estimates for methicillin-resistant Staphylococcus aureus (MRSA) only. SOURCES: Klevens, et al., “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002,” Public Health Review, 2007; CDC: “The Direct Medical Cost of HAIs in U.S. Hospitals and the Benefits of Prevention”, March 2009; Kirkland, et al., “The Impact of Surgical Site Infections”, Infect Control Hosp Epidemiol, 1999; Arch Internal Med, 1988; Arch Internal Med, 1974; Infect Control Hosp Epidemiol, 2002; CareFusion MedMined Analysis, 2009.
Extended hospital stay associated with SSI In Vietnam, SSI is associated with an increase in
hospital stay of 7-19 days
Economic burden of SSI
1. Nguyen D et al. Infect Control Hosp Epidemiol 2001. 22(8):485-492.2. Sohn AH et al. Infect Control Hosp Epidemiol 2002. 23(7):382-387.3. Thu LTA et al. J Hosp Infect 2005. 60(4):360-367. 4. Thu LTA et al. Infect Control Hosp Epidemiol 2006. 27(8):855-862.5. Thu LTA et al. Infect Control Hosp Epidemiol 2007. 28(5):583-588.
Country Source Surgical procedure Type of stayLength of stay (days)
SSI No SSI Difference P value
Vietnam
Nguyen 20011 Any surgical procedure Total stay 14 (SD: 10.8) 9.1 (SD: 7.1) 4.9 <0.001
Sohn 20022 Any surgical procedure Post-operative 26 10 16 <0.0001
Thu 20053 All orthopaedic surgery Post-operative 28.1 9 19.1 <0.001
Thu 20064
Orthopaedic surgery Post-operative 21 9 15 <0.001
Neurosurgery Post-operative 27 10 17 <0.001
Thu 20075 Neurosurgery Post-operative 16 9 7 NR
In Thailand, SSI is associated with an increase in hospital stay of 7-19 days
Economic cost of ssi
1. Danchaivijitr S et al. J Med Assoc of Thailand 2005;88 Suppl 10:S75-S82. 2. Kasatpibal N et al. J Med Assoc of Thailand 2005;88(8):1083-91.3. Lohsiriwat V et al. J Med Assoc of Thailand 2009;92(1):12-6.
Source Surgical procedure Type of stayLength of stay (days)
SSI no SSI Difference P value
Danchaivijitr 20051 Any surgical procedure Post-operative stay NS NS 12.6 NS
Kasatpibal 20052
Craniotomy
Post-operative stay
48.0 16.8 31.2 <0.0001
Colectomy 27.4 8.7 18.7 0.0001
Cholecystectomy 16.7 8.1 8.6 0.0147
Appendectomy 17.2 4.2 13.0 <0.0001
Mastectomy 20.5 9.8 10.7 0.0038
Herniorrhaphy 13.0 2.0 11.0 <0.0001
Lohsiriwat 20093 Colorectal surgery Hospital stay 15.9 8.3 7.6 <0.001
Hospitalization cost associated with SSI in Thailand
Economic cost of ssi
Source: Kasatpibal N et al. J Med Assoc of Thailand 2005;88(8):1083-91 .
Surgical procedureMean hospitalization cost (THB)
SSI no SSI Difference P value
Craniotomy 117,135 50,018 67,116 <0.0001
Colectomy 69,958 27,642 42,316 0.0170
Cholecystectomy 52,975 22,812 30,163 0.0341
Appendectomy 27,647 8,482 19,165 0.0004
Mastectomy 23,413 16,699 6,713 0.1449
Herniorrhaphy 17,801 6,882 10,919 0.0007
All 6 procedures 75,544 31,886 43,658 <0.0001
Edmiston, et al. APIC June 2012
Plus Antibacterial Sutures
• One year prospective study of 3789 total joints ▫ In July 2005, implemented a full-year evaluation of
antibacterial sutures usage in an orthopedic setting▫Changed product over July 4th holiday and did not tell
all surgeons (only those involved with study)• At the end of the year-long trial period:
▫45% reduction in SSIs caused by Staph aureus and MRSA
▫Reduction in total joint infections rate during trial period ▫ Infection rate dropped from 0.44% to 0.33% with
three less infections
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Spencer M, et al: Reducing the Risk of Orthopedic Infections: The Role of Innovative Suture Technology
NAON Poster Presentation - 2010
Three Less Staph Aureus Infections•Incremental cost: $6000.00
•3 x $40,000 Sensitive Staph aureus = $120,000
•3 x $100,000 MRSA = $300,000
•UHS – to convert a 25 hospital system will increase the budget by 1% or $35,000
NEBH SSI Rates 2003 – 2010(outpatient and inpatient infections)
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GENERAL SSI FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10
# Infections 6 1 3 4 2 2 1 0# Procedures 1073 920 780 692 567 467 425Infection Rate 0.6 0.1 0.4 0.5 0.3 0.3 0.2 0
ORTHOPEDIC SSI# Infections 63 60 49 46 39 37 28 32# Procedures 8837 9669 9216 8986 9027 8884 8890 9839Overall Infection Rate 0.7 0.6 0.5 0.5 0.4 0.4 0.31 0.33#Hip Infections 14 5 4 7 5 5 10 9 Hip Prosthesis Rate 1.0 0.3 0.2 0.4 0.3 0.3 0.49 0.41#Knee Infections 21 14 11 7 7 11 9 9 Knee Prosthesis Rate 1.6 1.0 0.7 0.4 0.3 0.5 0.39 0.35#Laminectomy Infec. 6 9 7 7 12 4 0 3 Laminectomy Rate 0.7 0.9 0.6 0.8 1.3 0.5 0.0 0.53#Spinal Fusions Infec. 5 15 12 12 5 5 3 3 Spinal Fusion Rate 0.8 2.0 1.4 1.1 0.4 0.4 0.31 0.34Other infections 17 15 13 12 10 6 8 Other infection rate 0.38 0.39 0.37 0.34 0.21 0.22
2009 - Total hip investigation – increase in post-op hematomas in infected patients being evaluated by a case-control study2008 – Total knee investigation – noticed increase rate in patients receiving toradol, marcaine and duromorph – needle on syringe was not being changed between each vial – changed practice2007 – Laminectomy rate increased – case control study revealed locally adminiistered steroids increased infection rate in obese/diabetic pts
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Potential SavingsOrthopedic Surgical Site InfectionsCost: ~ $25,000/each
FY03 – 63/8837 cases (0.7%) 1.6 million
FY04 – 60/9669 cases (0.6%) 1.5 million
FY05 – 49/9216 cases (0.5%) 1.2 million
FY06 – 46/8986 cases (0.5%) 1.1 million
FY07 - 39/9027 cases (0.4%) $975,000
FY08 - 37/8884 cases (0.4%) $925,000
UHS Healthcare-Acquired Infections
2010 2011 (through October)
% Rate Reduction
UHS 2011 Benchmark Rate
# HAIsReduced
Potential Cost Savings
Catheter Associated UTI (rate per Foley days)
1.39 0.64 54% 0.2 97 $90,630
CLABSI rate by catheter days)
1.44 0.66 54% 0.0 59 $1,486,956
VAP (rate by ventilator days)
1.41 0.91 35% 0.0 47 $912,256
CABG SSI (overall rate by surgical procedures)
0.71 0.20 73% 0.0 4 $138,680
Total Hip (overall rate by surgical procedures)
0.73 0.53 27% 0.0 6 $208,020
Total Knee (overall rate by surgical procedures)
0.57 0.57 0% 0.0 12 $416,040
C.Difficile (rate per 10,000 patient days)
3.23 2.41 25% 7.0 150 $948,900
MRSA (rate per 1,000 patient days)
0.36 0.14 61% 0.4 252 $7,560,000
Total 627 $11,761,482
First Year Potential Cost Savings
Healthcare Acquired Infections
2011- 2012% Reduction
UHS 2012 Benchmark Rate
Infection Prevention Measures in Process
Catheter Associated UTI (rate per Foley days)
57% 0.0 Infection Control Foley Catheter Tray and Silver Foley Catheter, CHG washcloths
CLABSI (rate by catheter days)
54% 0.0 Central Line Insertion Kits, Alcohol Caps for Injection Hub Protection, CHG washcloths, Central Line Checklist
VAP (rate by ventilator days) 11% 0.0 CHG rinse with oral care kits, VAP bundle checklist, CHG washcloths, nebulizer cleaning procedures, VAP rounds
CABG SSI (overall rate by surgical procedures)
71% 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep
Total Hip (overall rate by surgical procedures)
15% 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep
Total Knee (overall rate by surgical procedures)
50% 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep
C.Difficile (rate per 10,000 patient days)
12% 4.0/10,000 patient days
Bleach wipes and bleach disinfectant solution, Rapid PCR Diagnostics for Early Diagnosis and Precautions, Enhanced environmental cleaning, cubicle curtain changes, room decontamination units for high rates
MRSA (rate per 1,000 patient days)
62% 0.4 CHG Washcloths, Pre-admission and Pre-op Screening, Rapid PCR Diagnostics for Early Diagnosis and Precautions
The overall incidence of SSI in South East Asia varies between 1-20%. SSI account for approximately 20% of all HAI.
Variability in SSI incidence related to surgical procedure and risk factors (eg, diabetes, wound classification).
SSI have a substantial economic impact through increased hospital stay, additional treatment and consequently loss of productivity
Clinical studies in patients undergoing abdominal, spinal and cardiac surgery show that VICRYL Plus sutures significantly reduce the incidence of SSI
Conclusions