Preventing Surgical Site Infection Related to Abdominal Hysterectomy: We Got This!

Abstract

BACKGROUND Since the implementation of the Centers for Medicare and Medicaid Service (CMS) Hospital Value Based Purchasing (VBP) Program, much attention has been focused on prevention of total abdominal hysterectomy (TAH) related Surgical Site Infection (SSI). CMS requires that hospitals report all TAH-SSI to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN), shares individual performance measures publicly on the Hospital Compare website, and awards institutions 'bonus' incentive payments based on these performance measures. Incidence of TAH-SSI therefore not only increases patient morbidity, mortality, length of stay, and associated costs, but it is also tied to monetary penalties and reimbursement to the institution from CMS. METHODS Since SSIs are often multifactorial, they usually cannot be traced back to a single event or failure. Infection Prevention and Epidemiology (IPE) took a multidisciplinary approach to evaluate our data collection process and perform case review of each TAH-SSI to identify potential areas for improvement. IPE partnered with Obstetrics and Gynecology Service Chiefs, Surgeons, Nursing, and Antibiotic Stewardship staff to implement the following interventions: standard surgical prep and continuous education/training for staff; optimal prophylactic antibiotic selection, ordering, and timing; use of a standard closure tray; and enhanced data extraction methods. RESULTS The Standard Infection Ratio (SIR) for complex TAH-SSI decreased from 2.99 in 2013 to 0.233 in 2017. CONCLUSIONS Through collaboration with a multidisciplinary group, we were able to implement a number of process improvement measures to successfully decrease incidence of complex TAH-SSI at our institution.