1248. 30-Day Colon Surgical Site Infections: Using NSQIP to Cross Check NHSN

Abstract

BackgroundWhile infection prevention (IP) programs utilize National Health Safety Network (NHSN) definitions, surgical site infection (SSI) case-finding methods may vary between facilities based on resources and availability/type of healthcare-associated infection (HAI) electronic surveillance tracking software. Furthermore, surgeons may receive SSI data from other databases such as National Surgery Quality Improvement Project (NSQIP) which has slightly different definitions and case finding methodologies. Our goal was to compare colon SSIs across our health system found by IP using NHSN definitions to those obtained utilizing NSQIP case finding methodology and definitions.MethodsBetween January 2018 and September 2018 across 8 acute care facilities ranging in size from 100 to 898 beds, HAI electronic surveillance tracking triggered IP and infectious diseases (ID) trained physician review for NHSN SSI criteria if a patient was either readmitted or had a positive culture within 30 days of colon surgery. SSI results were compared with NSQIP SSI data which reviews all charts and conducts post-discharge surveillance during active surveillance periods. All discrepant cases were reviewed by an infection preventionist, an ID physician and surgery physician champion. Cases were classified as discrepant due to different case inclusion criteria, different case finding or clinical misclassification.Results69 cases were reviewed. Both databases called 11 cases (16%) an SSI initially. NSQIP identified 35 cases that were not detected by IP surveillance. Of the 35 NSQIP detected SSI, 17 (49%) were felt to meet NHSN SSI criteria after review (7 organ space, 10 superficial). Majority (76%) were discordant due to case finding issues (diagnosed as outpatient, same hospital course with no cultures to flag for review). Two infections were missed because of human error. Once the SSIs were entered into NHSN, only one facility had an increase in the SIR which impacted interpretation of SSI performance (from 0.949 up to 1.423). NHSN identified 23 cases that were not identified in the NSQIP database. There were 8 organ space infections and 8 superficial site infections.ConclusionWithout 100% surveillance, SSIs may be missed. Not all missed infections were superficial. Opportunities were found for both NHSN and NSQIP.Disclosures All authors: No reported disclosures.