Measure For Surgical Site Infection Research Articles

SP1.8 - Reducing the burden to deliver remote postoperative surveillance using machine learning for surgical-site infection (SSI)

Abstract Aims Remote postoperative wound (RPW) surveillance has been shown to improve the delivery of care and minimise the harm to patients from surgical-site infection (SSI). The burden for healthcare staff to deliver is a major barrier to implementation, therefore we aimed to develop novel methods for automated assessment of RPW surveillance to reduce this. Methods This was a secondary analysis of two interventional studies on RPW surveillance: “Tracking wound infection with smartphone technology” (TWIST) and “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). Adult general surgery patients could submit images of their surgical wound(s), and patient-reported outcome measures (PROMs) of SSI for 30-days postoperatively. A multi-input neural network (MNN) was developed to predict a clinical diagnosis of SSI within 48h based on symptoms and wound images. Performance was evaluated using area under the curve (AUC) and externally validated. Results There were 1540 submissions containing PROMs (48h SSI rate = 3.7%, n=57) and 2615 images (48h SSI rate = 3.1%, n=82). The MNN exceeded performance of the component models within the external validation subset (AUC: 0.94, 95% CI: 0.89-0.99) and remained equivalent to clinician triage (AUC: 0.92, 95% CI: 0.90-0.94). Usage to screen out “low-risk” responses prior to clinical triage was estimated to reduce the staff-time required to deliver (6.3h vs 25.5h). Conclusion Automated assessment can be successfully deployed within RPW surveillance pathways to reduce the burden on staff to deliver without compromising care, and allow resources to be appropriately directed to those at greatest risk of SSI.

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli.

BackgroundThere are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI.MethodsWe searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software.ResultsA total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate).ConclusionsThere are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.

Clinical applications of the chimeric anterolateral thigh (ALT) flap in head and neck reconstruction

Background Surgical site infection (SSI) is a common complication following head and neck surgery. Dead space at the excision site can increase the risk of infection, abscess formation, and mortality. Herein, we evaluated the performance of the chimeric anterolateral thigh (ALT) flap in addressing these concerns. Methods Patients who underwent oncologic head and neck reconstruction between October 2016 and November 2021 were divided in two groups: a normal ALT flap and a chimeric dead space filling (DSF) ALT-vastus lateralis flap group. We evaluated the postoperative outcomes. Results Twenty-five patients treated with normal ALT flaps (34.7%) and 47 with DSF ALT flap group (65.2%) were included. Only one ALT per case was necessary. Most of the cases involved tongue (31.9%) and lower gingival reconstruction (27.8%). The time to harvest the DSF ALT flap was 134.3 min when compared to the normal ALT flap (116.2 min, p < .001). Vascular occlusion, flap loss, partial necrosis, and fat necrosis were not observed among the different groups. Conclusion The DSF process can be used as a preventive measure for SSI or vessel exposure due to radiation-induced skin damage. This flap allows same-site reconstruction if the primary tumor recurs by using the pedicle of the chimeric flap for reattachment of another free flap.

KNOWLEDGE AND PRACTICE OF STAFF NURSES REGARDING PREVENTION OF POSTOPERATIVE SURGICAL COMPLICATIONS OF PATIENT UNDERGOING ABDOMINAL SURGERY AT SELECTED HOSPITALS, SIKKIM.

The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. After abdominal surgeries, patients are at the risk of developing complications. The common postoperative complications after the abdominal surgery include pneumonia, deep vein thrombosis and surgical site infections. The aim of the present study was to assess knowledge and practice of staff nurses regarding prevention of postoperative surgical complications of patient undergone abdominal surgery. Adescriptive survey study was conducted in hospitals, of Gangtok, Sikkim. Data were collected using structured knowledge questionnaires and observational checklist from 60 staff nurses working in Surgical ICU and surgery ward selected by non-probability purposive sampling technique. The ndings revealed that majority of the staff nurses i.e out 60 staff nurses, 49(82%) had average knowledge and 11(18%) had good knowledge. Majority of staff nurses 44(73%) had good practice and 16(27%) had poor practice regarding prevention of postoperative surgical complications and also showed that there was a moderately positive correlation between knowledge and practice of staff nurses regarding prevention of postoperative surgical complications (r=0.2). Based on the ndings of the study, it can be concluded that in spite of having good practice level regarding prevention of postoperative surgical complications, staff nurses had average knowledge level. Knowledge and practice of the staff nurses in some certain area of prevention of postoperative surgical complications such as providing steam inhalation and chest physiotherapy, preventive measures for surgical site infection, assessment of pain in calf muscle, providing education to patient and family members need to be improved.

61 Use of Ketamine Sedation for the Treatment of Minor Plastic Surgery Procedures in the Paediatric Emergency Department

Abstract Aim To determine if ketamine sedation is a safe and cost-effective way of treating paediatric patients presenting with minor injuries, requiring plastic surgery procedures, in the emergency department. Method A retrospective cohort study was carried out over a 9-month period in children between ages 18 months and 16 years old, presenting to the paediatric emergency department at Chelsea and Westminster Hospital with minor injuries requiring plastic surgery input. The data collected included previously validated co-primary outcome measures of surgical site infection at 7 days and cosmetic appearance summary score at a minimum of 4 months. Parental satisfaction surveys were completed at 4 months to assess perceived quality of treatment. A cost analysis comparison against procedures completed under general anaesthetic was also undertaken. Results During the 9-month period of study, 24 minor procedures were performed under ketamine in the paediatric emergency department. There were no serious adverse events recorded. Three cases exceeded the recommended 20-minute maximum procedure duration, but there was no associated adverse outcome. No cases required further procedures under general anaesthesia and there were no cases of surgical site infections at 7 days. Parents reported extremely favourable outcomes using this technique, with an average overall satisfaction score of 9.2 (assessed over a number of parameters, where 10 is complete satisfaction). Conclusions Ketamine procedural sedation in the paediatric population is a safe and cost-effective method for the treatment of minor plastic surgery procedures, with low risk for surgical site infection post-operatively, and high parent satisfaction rates

How infection present at time of surgery (PATOS) data impacts your surgical site infection (SSI) standardized infection ratios (SIR), with focus on the complex 30-day SSI SIR model

This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network's (NHSN) health care-associated infection (HAI) surveillance definitions. This is the first analytic case study published in AJIC since the CDC/ NHSN updated its HAI risk adjustment models and rebaselined the standardized infection ratios (SIRs) in 2015. This case describes a scenario that Infection Preventionists (IPs) have encountered during their analysis of surgical site infection (SSI) surveillance data. The case study is intended to illustrate how specific models can impact the SIR results by highlighting differences in the criteria for NHSN's older and newer risk models: the original versions and the updated models introduced in 2015. Understanding these differences provides insight into how SSI SIR calculations differ between the older and newer NHSN baseline models. NHSN plans to produce another set of HAI risk adjustment models in the future, using newer HAI incidence and risk factor data. While the timetable for these changes remains to be determined, the statistical methods used to produce future models and SIR calculations will continue the precedents that NHSN has established.An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers, explanations, rationales, and summary of teaching points.Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of the NHSN's HAI data analysis.There are 2 baselines available for SSI standardized infection ration (SIRs) in the National Healthcare Safety Network (NHSN); one based on the 2006-2008 national aggregate data and another based on the 2015 data. Each of the 2 baselines has a different set of inclusion criteria for the SSI data, which impact the calculation of the SIR. In this case study, we focused on the impact of the inclusion of PATOS in the calculation of the 2006-2008 baseline SSI SIR and the exclusion of PATOS from the calculation of the 2015 baseline SSI SIR. In the 2006-2008 baseline SSI SIRs, PATOS events and the procedures to which they are linked are included in the calculation of the SSI SIR whereas in the 2015 baseline SSI SIRs, PATOS events and the procedures to which they are linked are excluded from the calculation of the SSI SIR. Meaning, if we control for all other inclusion criteria other than PATOS data for both baselines, we will notice differences in the number of observed events as well as the number of predicted infections for the 2 baselines. For details of the 2015 baseline and risk adjustment calculation, please review the NHSN Guide to the SIR referenced below. For details of the 2006-2008 baseline4 and risk adjustment, please see the SHEA paper “Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safety Network” by author Yi Mu.

Effect of Evidence-Based Measures protocol on Nurses' Performance regarding Prevention of Surgical Site Infection

Background: Surgical site infection (SSI) is a serious complication of surgical procedures and the most common type of healthcare-associated infections in low- and middle-income countries. Although, SSI prevention is complex and requires the integration of a range of measures before, during, and after surgery; except that up to 60% of these infections are estimated to be largely preventable by using evidence-based guidelines. Hence, as frontline caregivers, nurses can play a golden role in SSI preventing efforts through advancing their knowledge, attitude, and practice in accordance with the latest evidence-based preventive measures of SSI. Study aim: to evaluate the effect of evidence-based measures protocol on nurses' performance regarding prevention of surgical site infection. Study Design: a quasi-experimental design. Setting: General surgery departments and surgical operating theater at Zagazig University Hospitals, Al Sharkia Governorate, Egypt. Subject: A convenience sample of all available nurses (70), who are working at the previously mentioned settings. Tools: A self administered questionnaire to assess nurses' socio-demographic characteristics and knowledge; Likert scale to assess attitudes, and observation checklist to assess nurses' practice of evidence-based SSI preventive measures. Results: There was a lack in nurses' knowledge, positive attitude, and practice about evidence-based preventive measures for SSI in the pre-intervention phase of the evidence-based measures protocol, with mean±SD of 14.6±3.7,17.1 ± 8.5, and 56.7±12.2 respectively, which increased in post phase of the protocol intervention with mean±SD of 20.2±3.9, 20.6±11, and 66.2±10.5 respectively, also there was a highly statistically significant difference and improvement in total nurses' knowledge, attitude and practice post-intervention (p < 0.001), with a percentage of improvement equal 38%, 20.65%, and 16.89% in nurses' knowledge, attitude, and practice respectively. Conclusions: Evidence-based measures protocol implementation had improved nurses' knowledge that in turn had shaped their positive attitude, which results in improving nurses' practice of evidence-based preventive measures of SSI, as each one connected with the other. Recommendations: Evidence-based preventive measures of SSI should be incorporated into comprehensive surgical nursing quality improvement programs to improve patient safety.

The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis

BackgroundSurgical site infections after cesarean section are very common clinically, it is necessary to evaluate the risk factors of surgical site infections after cesarean section, to provide evidences for the treatment and nursing care of cesarean section.MethodsThis study was a retrospective cohort study design. Patients undergone cesarean section in a tertiary hospital of China from May 2017 to May 2020 were identified, we collected the clinical data of the included patients, and we analyzed the infection rate, etiological characteristics and related risk factors of surgical site infection after caesarean section.ResultsA total of 206 patients with cesarean section were included, and the incidence of surgical site infection in patients with cesarean section was 23.30%. A total of 62 cases of pathogens were identified, Enterococcus faecalis (33.87%) and Escherichia coli (29.03%) were the most common pathogens. Both Enterococcus faecalis and Escherichia coli were highly sensitive to Cefoperazone, Meropenem, and Levofloxacin. Logistic regression analyses indicated that Age ≥ 30y (OR 4.18, 95%CI: 1.23–7.09), BMI ≥ 24 (OR 2.39, 95%CI: 1.02–4.55), duration of cesarean section ≥ 1.5 h (OR 3.90, 95%CI: 1.28–5.42), estimated blood loss ≥ 400 ml (OR 2.35, 95%CI: 1.10–4.37) and the duration of urinary catheter ≥ 24 h (OR 3.18, 95% CI: 1.21–5.71) were the independent risk factors of surgical site infection after cesarean section (all p < 0.05).ConclusionsAge, BMI, duration of surgery, blood loss and urinary catheter use were associated with higher risk of the surgical site infection after cesarean section. Clinical preventions and interventions are warranted for those population to reduce the occurrence of surgical site infection.

Controle glicêmico e suas evidências para prevenção de infecção de sítio cirúrgico em cirurgias de coluna

Objetivo: Analisar as evidências disponíveis na literatura sobre o controle glicêmico como medida de prevenção para a infecção de sítio cirúrgico (ISC) em cirurgias de coluna. Métodos: Revisão integrativa desenvolvida com a seleção de artigos primários nas bases de dados Medical Literature Analysis and Retrieval System on-line (MEDLINE), Biblioteca Virtual em Saúde (BVS) e no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) utilizando-se os descritores: Glycemic control, wound infection, spine, spine surgery, surgical site infection e hemoglobinaA1c. Resultados: Os resultados evidenciaram a hiperglicemia como fator de risco independente para ISC em pacientes submetidos a cirurgia de coluna. O nível de hemoglobina glicada foi associado à infecção de ISC sendo que o risco se torna maior à medida em que há aumento do nível de hemoglobina glicada. O Diabetes Mellitus foi apontado como preditor independente significativo para ISC. Considerações finais: A hiperglicemia perioperatória, independentemente da condição de Diabetes Mellitus, está relacionada a ocorrência de ISC. Observou-se a falta de parâmetros quanto o nível glicêmico ideal o que aponta a necessidade de novos estudos capazes de nortear essa lacuna.

Usefulness of a circumferential wound retractor in emergency colorectal surgery as a preventive measure for surgical site infection. Alexis O-Ring® and emergency surgery

Introduction and aimsMore than 20% of healthcare-associated infections correspond to those at surgical sites, and there is a higher incidence of infections in colorectal surgery due to the associated bacterial load. Surgical wound protectors are designed to prevent contamination and mechanical trauma. Our aim was to demonstrate the usefulness of a circumferential wound retractor/protector for the prevention of surgical site infections (SSIs) in emergency colorectal surgery. MethodsForty-one patients that underwent emergency open surgery at a tertiary care hospital were randomized into 2 groups: 20 cases without the retractor (group A) and 21 cases with the retractor (group B). Subjects were assigned to a group in a 1:1 randomization allocation ratio. The chi-square and Fisher's exact tests were employed for the quantitative variables, and the statistical analysis was performed using the IBM Statistical Package for the Social Sciences software for Mac, version 16.0 (IBM SPSS Inc., Chicago, IL, USA). ResultsThe SSI rate was 17%. Six group A patients developed SSI versus one group B patient. The use of a circumferential wound retractor/protector was statistically significant for the prevention of surgical wound infections, with a p = 0.031 and an OR of 8.5. In addition, preoperative blood glucose levels below 200 mg/dl provided a 3.2-times higher protective effect, compared with glucose levels above 200 mg/dl. ConclusionsIn the present prospective randomized pilot study, the use of the circumferential wound retractor/protector significantly decreased the likelihood of surgical wound infection in emergency colorectal surgery.

Usefulness of a circumferential wound retractor in emergency colorectal surgery as a preventive measure for surgical site infection. Alexis O-Ring® and emergency surgery.

More than 20% of healthcare-associated infections correspond to those at surgical sites, and there is a higher incidence of infections in colorectal surgery due to the associated bacterial load. Surgical wound protectors are designed to prevent contamination and mechanical trauma. Our aim was to demonstrate the usefulness of a circumferential wound retractor/protector for the prevention of surgical site infections (SSIs) in emergency colorectal surgery. Forty-one patients that underwent emergency open surgery at a tertiary care hospital were randomized into 2 groups: 20 cases without the retractor (group A) and 21 cases with the retractor (group B). Subjects were assigned to a group in a 1:1 randomization allocation ratio. The chi-square and Fisher's exact tests were employed for the quantitative variables, and the statistical analysis was performed using the IBM Statistical Package for the Social Sciences software for Mac, version 16.0 (IBM SPSS Inc., Chicago, IL, USA). The SSI rate was 17%. Six group A patients developed SSI versus one group B patient. The use of a circumferential wound retractor/protector was statistically significant for the prevention of surgical wound infections, with a P=.031 and an OR of 8.5. In addition, preoperative blood glucose levels below 200mg/dl provided a 3.2-times higher protective effect, compared with glucose levels above 200mg/dl. In the present prospective randomized pilot study, the use of the circumferential wound retractor/protector significantly decreased the likelihood of SSI in emergency colorectal surgery.

Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery.

Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this study was to determine the actual practice and surgeon beliefs about preventative measures in elective colorectal operations and to compare them with established recommendations.Methods: Web-based survey was sent to colorectal surgeons assessing knowledge, beliefs, and practices regarding the use of preventative measures for SSI.Results: Of 355 surgeons, 33% had no feedback of SSI rate; 60% believed in evidence for normothermia, wound edge protection, and use of alcohol solution, and reported use of these strategies. There was a discrepancy in the assumed evidence and use of hyperoxia, glove replacement after anastomosis, surgical tools replacement, and saline surgical site lavage. Most of respondents believe that oral antibiotic prophylaxis diminishes infection, but is indicated only by one third of them. Few surgeons believe in MBP, but many actually use it. Most surgeons believe that there is a discrepancy between published guidelines and actual clinical practice. As proper means to implement guidelines, checklists, standardized orders, surveillance, feedback of SSI rates, and educational programs are rated most highly by surgeons, but few of these are in place at their institutions.Conclusions: Gaps in the translation of evidence into practice remain in the prevention of SSI in colorectal surgical procedures. Several areas for improvement have been identified. Specific implementation strategies should be addressed in colorectal units.

Determinants of surgeons\u2019 adherence to preventive intraoperative measures of surgical site infection in Gaza Strip hospitals: a multi-centre cross-sectional study

BackgroundSurgical site infection (SSI) is one of the most common hospital-acquired infections and is associated with serious impact on the rates of morbidity, mortality as well as healthcare costs. This study examined factors influencing the application of several intraoperative preventive measures of SSI by surgeons and surgical residents in the Gaza Strip.MethodsA cross-sectional study was conducted from December 2016 to February 2017 at the operation rooms of the three major hospitals located in the Gaza-Strip, Palestine. Inclusion criteria for patients were being adult (aged ≥18 years), no history of wound infection at time of operation and surgical procedure under general anaesthesia with endotracheal intubation. The association between different patient- and procedure-related SSI risk factors and adherence to several intraoperative SSI preventive measures was tested.ResultsIn total, 281 operations were observed. The mean patient age ± standard deviation (SD) was 38.4 ± 14.6 years and the mean duration of surgery ± SD was 58.2 ± 32.1 minutes. A hundred-thirty-two patients (47.0%) were male. Location and time of the operation were found to have significant associations with adherence to all SSI preventive measures except for antibiotic prophylaxis. Type of operation had a significant association with performing all measures except changing surgical instruments. Patient age did not have a statistically significant association with adherence to any measure.ConclusionThe results suggest that the surgeon could be a major factor that can lead to a better outcome of surgical procedures by reducing postoperative complications of SSI. Operating department professionals would benefit from clinical guidance and continuous training, highlighting the importance of persistent implementation of SSI preventive measures in everyday practice to improve the quality of care provided to surgical patients.

Risk factors for surgical site infection in colon surgery in our population.

Surgical site infection (SSI) is the most common nosocomial infection in surgical patients with an incidence that varies between 5-30%. Identify the risk factors for SSI in colonic surgery in our population. The secondary aims are to determine the incidence and type of SSI, as well as the incidence of an anastomotic leakage (AL). Case-control study of patients undergoing colectomy between 2010-2014 at the Hospital Privado Univeristario de Córdoba and Hospital Raúl Ferreyra. Conventional and laparoscopic interventions, with a 30-day postoperative follow up, between 20-85 years and an ASA I-III were included. Patients undergoing emergency surgery and recto-anal resections were excluded. SSI was defined as an infection that occurred within 30 days after surgery. We included 238 patients. SSI was diagnosed in 27.7% (n=66) of the patients of which 12.2% were superficial, 4.6% deep incisional and 10.9% organ/space. Multivariate analysis showed that SSI was independently associated with male sex (odds ratio [OR] 3.15; IC95%:1.43-6.92; p=0.004), having undergone previous chemotherapy (OR 6.72; IC95%:1.48-30.93; p=0.01), need for conversion (OR 3.32; IC95%:1.13-9.77; p=0.02), reintervention within the 30 postoperative days (OR 12.34; IC95%:2.65-57.37, p=0.001) and AL (OR 12.83; IC95%:2.97- 55.5; p=0.001). AL had an incidence of 9.6%, of which 91% presented SSI and all were organ/space. We found that male sex, having undergone previous chemotherapy, conversion, reintervention within 30 postoperative days and AL are risk factors for SSI in our population. These results should be considered in implementing preventive measures for SSI.

Development of a single, practical measure of surgical site infection (SSI) for patient self-report and observer completion: a novel method of questionnaire design

Randomised controlled trials in surgery often aim to measure SSIs but accurate assessment is difficult, particularly after hospital discharge when most SSIs present. Commonly used SSI criteria and grading scales exist but require experienced observers, do not identify SSIs consistently and have not considered patients' perspectives. We aimed to develop a novel single measure for SSI, suitable for patient self-report and observer completion, for accurate and efficient outcome assessment for use in RCTs. Content analyses of existing tools (applying CDC and ASEPSIS definitions) and semi-structured interviews with patients and professionals (n=19) identified SSI domains. Domains were used to inform item development using standard methods for designing patient questionnaires. Medical terms describing the underlying domains were included at the end of items in parentheses. Iterative cognitive interviews with patients (n=28) and professionals (ongoing) pre-tested face validity and acceptability of a single measure for SSI assessment. Content analyses of existing tools identified 18 domains, supplemented by one additional domain identified from interviews. These were operationalised into a provisional questionnaire with 24 items. Cognitive interviews and discussions within the research team led to six iterations of the questionnaire including 16 changes to items, six changes to instructions and two changes to response categories. It was acceptable to patients to include medical terminology alongside lay terms. A single SSI measure has been developed for patients and observers to provide outcome data for use in RCTs. Ongoing work will continue to examine the validity and reliability of this approach and its applicability to other settings.

Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safely Network

The National Healthcare Safety Network (NHSN) has provided simple risk adjustment of surgical site infection (SSI) rates to participating hospitals to facilitate quality improvement activities; improved risk models were developed and evaluated. Data reported to the NHSN for all operative procedures performed from January 1, 2006, through December 31, 2008, were analyzed. Only SSIs related to the primary incision site were included. A common set of patient- and hospital-specific variables were evaluated as potential SSI risk factors by univariate analysis. Some ific variables were available for inclusion. Stepwise logistic regression was used to develop the specific risk models by procedure category. Bootstrap resampling was used to validate the models, and the c-index was used to compare the predictive power of new procedure-specific risk models with that of the models with the NHSN risk index as the only variable (NHSN risk index model). From January 1, 2006, through December 31, 2008, 847 hospitals in 43 states reported a total of 849,659 procedures and 16,147 primary incisional SSIs (risk, 1.90%) among 39 operative procedure categories. Overall, the median c-index of the new procedure-specific risk was greater (0.67 [range, 0.59-0.85]) than the median c-index of the NHSN risk index models (0.60 [range, 0.51-0.77]); for 33 of 39 procedures, the new procedure-specific models yielded a higher c-index than did the NHSN risk index models. A set of new risk models developed using existing data elements collected through the NHSN improves predictive performance, compared with the traditional NHSN risk index stratification.

Electronic Measures of Surgical Site Infection: Implications for Estimating Risks and Costs

Electronic measures of surgical site infections (SSIs) are being used more frequently in place of labor-intensive measures. This study compares performance characteristics of 2 electronic measures of SSIs with a clinical measure and studies the implications of using electronic measures to estimate risk factors and costs of SSIs among surgery patients. Data included 1,066 general and vascular surgery patients at a single academic center between 2007 and 2008. Clinical data were from the National Surgical Quality Improvement Program (NSQIP) database, which includes a nurse-derived measure of SSI. We compared the NSQIP SSI measure with 2 electronic measures of SSI: MedMined Nosocomial Infection Marker (NIM) and International Classification of Diseases, Ninth Revision (ICD-9) coding for SSIs. We compared infection rates for each measure, estimated sensitivity and specificity of electronic measures, compared effects of SSI measures on risk factors for mortality using logistic regression, and compared estimated costs of SSIs for measures using linear regression. SSIs were observed in 8.8% of patients according to the NSQIP definition, 2.6% of patients according to the NIM definition, and 5.8% according to the ICD-9 definition. Logistic regression for each SSI measure revealed large differences in estimated risk factors. NIM and ICD-9 measures overestimated the cost of SSIs by 134% and 33%, respectively. Caution should be taken when relying on electronic measures for SSI surveillance and when estimating risk and costs attributable to SSIs. Electronic measures are convenient, but in this data set they did not correlate well with a clinical measure of infection.

Preventive measure for surgical site infection with prophylactic intravenous administration of vancomycin in spinal instrumentation surgery

Preventive measure for surgical site infection with prophylactic intravenous administration of vancomycin in spinal instrumentation surgery

Electronic measures of surgical site infection: Implications for estimating risk and costs

objective. Electronic measures of surgical site infections (SSIs) are being used more frequently in place of labor-intensive measures. This study compares performance characteristics of 2 electronic measures of SSIs with a clinical measure and studies the implications of using electronic measures to estimate risk factors and costs of SSIs among surgery patients. methods. Data included 1,066 general and vascular surgery patients at a single academic center between 2007 and 2008. Clinical data were from the National Surgical Quality Improvement Program (NSQIP) database, which includes a nurse-derived measure of SSI. We compared the NSQIP SSI measure with 2 electronic measures of SSI: MedMined Nosocomial Infection Marker (NIM) and International Classification of Diseases, Ninth Revision (ICD-9) coding for SSIs. We compared infection rates for each measure, estimated sensitivity and specificity of electronic measures, compared effects of SSI measures on risk factors for mortality using logistic regression, and compared estimated costs of SSIs for measures using linear regression.