Surveillance of selected bowel surgeries for surgical site infection (SSI) rates in-hospital plus post-discharge

Abstract

BACKGROUND: This health center is a 750-bed tertiary-care community hospital. Surveillance data from October 2002 through September 2004 on selected bowel surgeries were analyzed to determine SSI rates in-hospital plus post-discharge. METHODS: The automated infection control expert (AICE) program was interfaced with the operating room's computer program to generate a record on each selected surgical patient. To collect SSI data, the infection control practitioner (ICP) reviewed culture and sensitivity reports, emergency and urgent care visits, re-admissions, consult notes, antibiotic prescribing, and patient charts. Quarterly reports of patient lists were sent by the ICP via intra-hospital computer, e-mail, or letter to the responsible surgeon for post-discharge SSI feedback. Each patient's record was completed with the remaining data, including any 30-day post-op SSI information, and entered into AICE. The ICP collected data by incorporating a PDA (personal digital assistant) and uploading into AICE. RESULTS: There were 596 selected bowel surgeries that included abdominal perineal resections (29), bowel resections lithotomy (203), bowel resections supine (272), Hartmann procedures (43), and laparoscopic colon resections (49). The SSI rate for in-hospital plus post-discharge from October 2002 through September 2003 was 69/272 (25%) and from October 2003 through September 2004, was 69/324 (21%). The ICD-9 codes listed for the National Nosocomial Infection Surveillance (NNIS) system report for colon surgeries are extensive which limits study comparison. There were 88/596 (15%) SSIs detected in-hospital and 50/596 (8%) SSIs detected post-discharge. Compliance with post-discharge surveillance by surgeons was 73% (8/11). CONCLUSIONS: The in-hospital plus post-discharge surveillance is a more accurate reflection of SSI rates. Comparing SSI rates to consecutive years of data and not to NNIS were determined. A process for consistent pre-operative antibiotic prophylaxis was initiated in the second year. Opportunities to initiate further strategies to improve SSI rates, e.g., shaving, skin preparation and traffic flow in the operating room, are underdiscussion.