Surgical Site Infection In Surgery Research Articles

Association of Methicillin-Resistant Coagulase-Negative Staphylococci on Preoperative Skin and Surgical Site Infection in Patients Undergoing Spinal Surgery: A Retrospective Cohort Study.

The aim of this study was to investigate the association of methicillin-resistant coagulase-negative staphylococci (MRCNS) on preoperative skin and surgical site infections (SSIs) in patients undergoing spinal surgery. A total of 507 cases (239 males and 268 females; mean age: 56.1 years) were included in this retrospective study, using prospectively collected data. All patients underwent skin culturing of the surgical site preoperatively. To identify independent risk factors for SSIs as the dependent variable, sequential multivariate logistic regression analyses were conducted. Age, sex, body mass index, presence of rheumatoid arthritis (RA), steroid uses, the American Society of Anesthesiologists Physical Status (ASA-PS) ≥3, MRCNS-positivity on skin bacterial culture, instrumentation, and Japanese Orthopedic Association (JOA) score were used as independent variables. Preoperatively, MRCNS was detected from skin culture in 50 (9.9%) cases. The frequency of RA, steroid uses, and ASA-PS ≥3 was significantly higher in MRCNS-positive cases than in MRCNS-negative cases. There were 21 (4.1%) post-spinal surgery SSI cases. Multivariate logistic regression analyses revealed that JOA scores (odds ratio (OR), 0.864; 95% confidence interval (CI), 0.764-0.977) and MRCNS-positivity (OR, 5.060; 95% CI, 1.787-14.323) were significantly associated with SSIs. Preoperatively, the incidence of MRCNS was 9.9%; it was the most common cause of postoperative SSIs. MRCNS-positivity was the most associated factor for SSIs.

İzole Koroner Arter Baypas Greft Cerrahisi Sonrası Gelişen Safen Ven Greft İnsizyon Alanı Enfeksiyonlarının Değerlendirilmesi: Tek Merkez Deneyimimiz

AbstractObjective: This study aimed to evaluate surgical site infection patients developing saphenous vein graft incision site infection after isolated coronary artery bypass graft surgery performed in the cardiovascular surgery clinic of our hospital in the last 12 years to reveal the causative microorganisms, risk factors, and clinical characteristics.Material and Methods: A total of 34 surgical site infection patients (23 females, 11 males; mean age 68.0±9.0 years; range 51-86 years) who underwent isolated coronary artery bypass graft surgery in the cardiovascular surgery clinic of our hospital between March 2009 and November 2020 and who postoperatively developed saphenous vein graft incision site infection were included in the study. The patients’ demographic data, underlying diseases, and preoperative, intraoperative, and postoperative risk factors were analyzed retrospectively.Results: In all isolated coronary artery bypass graft surgeries performed over a period of about 12 years, the rate of saphenous vein graft incision site surgical site infection was found to be 0.8%. Of these, 23 (67.6%) were evaluated as superficial incisional surgical site infection and 11 (32.4%) as deep incisional surgical site infection. In the patients who developed surgical site infection, the parameters of age, female sex, obesity, diabetes mellitus, smoking, emergency surgery, use of more than 1 saphenous vein graft, prolonged operation, cardiopulmonary bypass, and aortic clamp durations, intraoperative blood transfusion, length of stay in the intensive care unit, use of inotropes, and total length of hospital stay were all found to be significant. The microorganisms in purulent discharge cultures consisted of Gram-negative bacteria in 18 (53%), Gram-positive bacteria in 12 (35.3%), and fungi in 1 (2.9%). No pathogenic microorganism growth was observed in 5 (14.7%) patients. In the patients with surgical site infection, coagulase-negative staphylococci (17.6%) and Escherichia coli (17.6%) were the most frequently isolated agents.Conclusion: Particular attention should be paid to surgical site infection in patients undergoing a cardiovascular surgery intervention. It should be noted that post coronary artery bypass graft surgery surgical site infection can be reduced by determining its risk factors, modifying surgical techniques, and postoperative close monitoring of patients. Follow-up and personal care are crucial after discharge and an empirical treatment approach should be determined when an infection occurs, taking into account that coagulase-negative staphylococci and E. coli were the two leading infectious agents in our hospital.

Lumbar Spinal Steroid Injections and Infection Risk after Spinal Surgery: A Systematic Review and Meta-Analysis.

Lumbar spinal steroid injections (LSSI) are universally used as preferred diagnostic or therapeutic treatment options before major spinal surgeries. Some recent studies have reported higher risks of surgical-site infection (SSI) for spinal surgeries performed after injections, while others have overlooked such associations. The purpose of this study is to systematically review the literature and perform a meta-analysis to evaluate the associations between preoperative LSSI and postoperative infection following subsequent lumbar decompression and fusion procedures. Three databases, namely PubMed, Scopus, and Cochrane Library, were searched for relevant studies that reported the association of spinal surgery SSI with spinal injections. After the comprehensive sequential screening of the titles, abstracts, and full articles, nine studies were included in a systematic review, and eight studies were included in the meta-analysis. Studies were critically appraised for bias using the validated MINOR (methodological index for non-randomized studies) score. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Subgroup analysis was performed according to the time between LSSI and surgery and the type of lumbar spine surgery. Meta-analysis showed that preoperative LSSI within 30 days of lumbar spine surgery was associated with significantly higher postoperative infection compared with the control group (OR,1.79; 95% CI, 1.08-2.96). Based on subgroup analysis, lumbar spine fusion surgery within 30 days of preoperative LSSI was associated with significantly high-infection rates (OR, 2.67; 95% CI, 2.12-3.35), while no association was found between preoperative LSSI and postoperative infection for lumbar spine decompression surgeries. In summary, given the absence of high-level studies in the literature, careful clinical interpretation of the results should be performed. The overall risk of SSI was slightly higher if the spinal surgery was performed within 30 days after LSSIs. The risk was higher for lumbar fusion cases but not for decompression-only procedures.

Seasonal Effects on Surgical Site Infections Following Spine Surgery

Studies investigating seasonality as a risk factor for surgical site infections (SSIs) after spine surgery show mixed results. This study used national data to analyze seasonal effects on spine surgery SSIs. National Surgical Quality Improvement Program data (2011-2018) were queried for posterior cervical fusions (PCFs), cervical laminoplasties, posterior lumbar fusions (PLFs), lumbar laminectomies, and deformity surgeries. Patients aged >89 and procedures for tumors, fractures, infections, and nonelective indications were excluded. Patients were divided into warm (admitted April-September) and cold (admitted October-March) seasonal groups. End points were SSIs and reoperations for wound débridement/drainage. Stratified analyses were performed by surgery type and pre-versus postdischarge infections. Overall (N= 208,291), SSIs were more likely in the warm season (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.08-1.23, P < 0.0001) and for PCFs (OR 1.40,95% CI 1.08-1.80, P= 0.011), PLFs (OR 1.15, 95% CI 1.04-1.28, P= 0.006), and lumbar laminectomies (OR 1.13, 95% CI 1.03-1.25, P= 0.014). Postdischarge infections were also more likely in the warm season overall (OR 1.15, 95% CI 1.07-1.23, P < 0.0001) and for PCFs (OR 1.32, 95% CI1.01-1.73, P= 0.041), PLFs (OR 1.14, 95% CI 1.03-1.27, P= 0.014), and lumbar laminectomies (OR 1.15, CI 1.04-1.27, P= 0.007). In-hospital infections were more likely during the warm season only for PCFs (OR 2.54, 95% CI 1.06-6.10, P= 0.037). Reoperations for infection were more likely during the warm season for PLFs (OR 1.29, 95% CI 1.08-1.54, P= 0.005). PCF, PLF, and lumbar laminectomy performed during the warm season had significantly higher odds of SSI, especially postdischarge SSIs. Reoperation rates for wound management were significantly increased during the warm season for PLFs. Identifying seasonal causes merits further investigation and may influence surgeon scheduling and expectations.

Associations between preoperative tumor necrosis factor alpha inhibitor administration and surgical site infection in surgery for inflammatory bowel disease

Associations between preoperative tumor necrosis factor alpha inhibitor administration and surgical site infection in surgery for inflammatory bowel disease

Colorectal surgery surgical site infection prevention practices in British Columbia.

SummarySurgical site infections (SSI) pose significant morbidity after colorectal surgery. We sought to document current practices in colorectal surgery SSI prevention in British Columbia (BC). Reporting the current provincial landscape on SSI prevention helps to understand the foundation upon which improvements can take place. We surveyed all BC surgeons performing elective colon and rectal resections, and 97 surveys were completed (60% response rate). Eighty-six per cent of respondent hospitals tracked SSI rates. The reported superficial SSI was less than 5% and the anastomotic leak/organ space rate was less than 10%. All respondents gave preoperative prophylactic antibiotics, with 24% continuing antibiotics postoperatively; 62% are using oral antibiotics (OAB) and mechanical bowel preparation (MBP) and 29% use MBP without OAB. Areas for improvement include OAB with MBP and discontinuing prophylactic antibiotics postoperatively, as recommended by the World Health Organization.

Adherence to a standardized infection reduction bundle decreases surgical site infections after colon surgery: a retrospective cohort study on 526 patients

BackgroundColon surgical site infections (SSI) are detrimental to patient safety and wellbeing. To achieve clinical excellence, our hospital set to improve patient safety for those undergoing colon surgery. Our goal was to implement a perioperative SSI prevention bundle for all colon surgeries to reduce colon surgery SSI rates.MethodsThis retrospective cohort study evaluated the impact of implementing a perioperative SSI prevention bundle in patients undergoing colon surgery at Banner University Medical Center - Tucson. We compared SSI rates between the Pre- (1/1/2016 to 12/31/2016) and post-bundle (1/1/2017 to 12/31/2017) cohorts using a chi-square test.ResultsIn total, we included 526 consecutive patients undergoing colon surgery in our study cohort; 277 pre-bundle and 249 post-bundle implementation. The unadjusted SSI rates were 8.7 % and 1.2 %, pre- and post-bundle, respectively. Our CMS reportable standard infection rate decreased by 85.4 % from 3.08 to 0.45 after implementing our SSI prevention bundle.ConclusionsImplementing a standardized colon SSI prevention bundle reduces the overall 30-day colon SSI rates and national standardized infection rates. We recommend implementing colon SSI reduction bundles to optimize patient safety and minimize colon surgical site infections.

905. Surgical Site Infections Following Colon Surgery in a Large Network of Community Hospitals

BackgroundColon surgeries are commonly performed, and surgical site infections (SSIs) following these procedures are routinely reported to the National Healthcare Safety Network (NHSN). However, the impact of infections present at the time of surgery (PATOS) and emergent surgeries on the epidemiology of colon surgery SSIs has not been well described.MethodsWe retrospectively analyzed prospectively collected data on complex (i.e., deep incisional or organ space) SSIs following colon surgery performed at 34 community hospitals in the southeastern United States from January 2015 to June 2019. We excluded SSIs categorized as PATOS. We then stratified colon surgery SSI rates according to age, sex, body mass index (BMI), operation duration, diabetes diagnosis, American Society of Anesthesiologists (ASA) physical status, wound class, emergent procedure, endoscopic procedure, and hospital colon surgery volume. Finally, we explored effect measure modification of emergent surgery and open surgery on hospital volume using log-binomial modeling and tests of homogeneity.ResultsA total of 722 complex SSIs occurred following 28,642 colon surgeries (prevalence rate [PR], 2.52 per 100 procedures). After PATOS SSIs were excluded, 545 complex SSIs remained (PR 1.90 per 100 procedures). Risk factor analysis revealed that age < 75 years and operation time > 75th percentile (188 minutes) during the 5-year study period) significantly increased risk of SSI (Table 1). The most common pathogens that caused SSIs in this study cohort were Escherichia coli, Enterococcus, and Klebsiella. (Table 2) 105 (19%) SSIs were culture-negative and 378 (69%) of the SSIs were polymicrobial. We defined hospital volume as high (>500 procedures in the 5-year period) based on the median hospital volume in the dataset. No significant effect measure modification occurred between hospital volume and either laparoscopic surgery or emergent surgery (Table 3).Table 1: Characteristics of patients who underwent colon surgery from January 2015 to June 2018 in 34 community hospitals. Table 2: Count and frequency of pathogens that caused complex surgical site infections after colon surgery Table 3: Colon surgery complex surgical site infection rates, stratified by emergent, elective, open, and laparoscopic procedures and hospital colon surgery volume ConclusionIn our cohort, we found that one-fourth of colon surgery SSIs were categorized as PATOS, which are no longer publicly reported to the Centers for Medicare & Medicaid Services. While most SSI literature describes higher volume hospitals having lower SSI rates, high colon surgery volume was associated with increased SSI rates in our community hospital cohort.Disclosures All Authors: No reported disclosures

Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes.

The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery. MEDLINE/PubMed Service was searched for the terms "intraoperative MRI," "pediatric," "brain," "tumor," "glioma," and "surgery." The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included. IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6-89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1-85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7-2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients. IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.

Risk-adjustment models for clean and colorectal surgery surgical site infection for the Spanish health system.

To develop risk-adjusted models for two quality indicators addressing surgical site infection (SSI) in clean and colorectal surgery, to be used for benchmarking and quality improvement in the Spanish National Health System. A literature review was undertaken to identify candidate adjustment variables. The candidate variables were revised by clinical experts to confirm their clinical relevance to SSI; experts also offered additional candidate variables that were not identified in the literature review. Two risk-adjustment models were developed using multiple logistic regression thus allowing calculation of the adjusted indicator rates. The two SSI indicators, with their corresponding risk-adjustment models, were calculated from administrative databases obtained from nine public hospitals. A dataset was obtained from a 10-year period (2006-2015), and it included data from 21 571 clean surgery patients and 6325 colorectal surgery patients. Risk-adjustment regression models were constructed using Spanish National Health System data. Models were analysed so as to prevent overfitting, then tested for calibration and discrimination and finally bootstrapped. Ten adjustment variables were identified for clean surgery SSI, and 23 for colorectal surgery SSI. The final adjustment models showed fair calibration (Hosmer-Lemeshow: clean surgery χ2 = 6.56, P = 0.58; colorectal surgery χ2 = 6.69, P = 0.57) and discrimination (area under receiver operating characteristic [ROC] curve: clean surgery 0.72, 95% confidence interval [CI] 0.67-0.77; colorectal surgery 0.62, 95% CI 0.60-0.65). The proposed risk-adjustment models can be used to explain patient-based differences among healthcare providers. They can be used to adjust the two proposed SSI indicators.

Nasal decolonization of Staphylococcus aureus and the risk of surgical site infection after surgery: a meta-analysis

AimTo assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization.MethodsRelevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied.ResultsTwenty RCTs published between 1996 and 2019 involving 10,526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR = 0.59 and 0.47, respectively, both p < 0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR = 0.474, 95% CI 0.259–0.864), while no significant difference was shown in the use of mupirocin (RR = 0.871, 95% CI 0.544–1.394).ConclusionIt seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.

Decreasing Colon Surgical Site Infections Through Multidisciplinary Engagement Using a Practice Bundle

<h3>Background</h3> Despite an increased recognition of evidence-based interventions, surgical site infections (SSIs) remain a source of patient harm. Our 280 bed acute care hospital had an elevated colon SSI rate (18.6%) and SIR (3.81) which was higher than predicted. The purpose of this quality improvement project was to decrease colorectal surgery SSI through the implementation of a formal, measurable bundle of evidence-based actions. <h3>Methods</h3> Our hospital lacked specific actions for colon SSI prevention. We hypothesized that the SSI rate would be reduced by adherence to an evidence-based bundle. Consensus was developed to implement a 7 element prevention bundle involving all phases of perioperative care and a "stop the line" culture to promote compliance. The 7 element bundle included standardization of: 2 step surgical skin preparation, glucose management, active warming, preoperative antibiotics, wound protector use and bowel isolation technique was fully implemented in December 2018. Compliance was actively measured and reported to frontline stakeholders weekly. Full compliance took close to 4 months. <h3>Results</h3> There was a substantial reduction in colon SSI's between the periods T1 (April – December 2018) and T2 (January – September 2019). An SIR of 4.31 (95% Confidence Interval [2.50, 6.95], p-value: 0.00), with a statistical interpretation of higher than predicted, has been reduced to 0.87 (95% Confidence Interval [0.22, 2.38], p-value: 0.88), or no different than predicted. When comparing periods, an 80% reduction in colon SSI's (T1: 15 infections, T2: 3 infections) was observed. Fisher's Exact Test shows a statistically significant difference between T1 and T2 (p-value: 0.005). <h3>Conclusions</h3> The SSI rate was significantly reduced by the implementation of the 7 element bundle. Improved patient outcomes was sustained over an 8-month timeframe with over 95% compliance to each component. Successful implementation of the bundle required support from all levels of the organization and empowerment of frontline staff in full bundle compliance.

Association between preoperative tumor necrosis factor alpha inhibitor and surgical site infection after surgery for inflammatory bowel disease: a systematic review and meta-analysis.

Tumor necrosis factor-alpha inhibitor (TNFi) treatment is effective for ulcerative colitis (UC) and Crohn's disease (CD). Although several meta-analyses have been performed to evaluate the association between TNFi treatment and surgical morbidity, the results are controversial. We conducted a systematic review and meta-analysis of the prevention of surgical site infection (SSI) after surgery for UC and CD in patients on TNFis, based on literature published between January 2000 and May 2019 (registered on PROSPERO, No. CRD42019134156). Overall, 2175 UC patients in 13 observational studies (OBSs) and 7084 CD patients in 16 OBSs were included. The incidences of incisional (INC) SSI and organ/space (O/S) SSI after surgery for UC were 179/1985 (9.0%) and 176/2175 (8.1%), respectively. TNFi use was not associated with the incidences of INC SSI (odds ratio (OR) 1.04, 95% confidence interval (CI) (0.47-2.32) or O/S SSI (OR 1.85, 95% CI (0.82-4.20)) after surgery for UC. The INC SSI and O/S SSI incidences after surgery for CD were 289/3089 (9.4%) and 526/7,084 (7.4%), respectively. Preoperative TNFi use was not associated with INC SSI (OR 0.98, 95% CI (0.52-1.83)) or O/S SSI incidence (OR 1.09, 95% CI (0.78-1.52)) after surgery for CD. We did not find a significant association between preoperative TNFi use and SSI in surgery for UC or CD.

Children vs elderly in orthopedic surgery site of infection. Are there difference? Experience of a high volume plastic surgeon consultant.

Introduction: Prevention of surgical site infection in surgery and bone trauma has some hallmarks not shared with other surgical disciplines. The surgeon is not always able to open the pathogen and a key to correct therapy. The aim of our work is to verify if there are differences between pathogens, and treatment between the two groups most susceptible to skin infections by means of synthesis such as children and the elderly. Materials and Methods: From January 2011 to december 2018, we perform 3189 consultancies in various departments of orthopedics and traumatology. From the exclusion criteria we recruited 168 patients with superficial infection of the surgical site after orthopedic surgery. A group represented by children (under 12 years old) and a group of older people over 65. The evaluation criteria between the two groups were: the infectious bacterial flora; the type of antibiotic, the duration of antibiotic therapy; the type of medications used in the post-operative period, the complications.Results:The results showed that elderly patients are more likely to be bacterial superinfection due to poor hygiene. Therapy in children is shorter and has minor complications. Proper management of the surgical site showed a rapid resolution of the infection in both groups. Conclusion: The correct management and hygiene of the surgical site allows its rapid recovery from infection. The plastic surgeon management of the fracture site infection can be a winning weapon in the treatment of this problem both in the child and in the elderly.

Quality Improvement Project in Congenital Cardiothoracic Surgery Patients: Reducing Surgical Site Infections.

Background:Healthcare-associated infections are a major focus for quality improvement in hospitals today. Surgical site infections (SSIs), a postoperative complication in cardiac surgery, are associated with increased morbidity, mortality, hospital length of stay, and financial burden.Methods:A recent increase in cardiothoracic surgery SSIs (CT-SSIs) at our institution instigated a multidisciplinary team to explore infection prevention, bundle element compliance, and to identify interventions to reduce the CT-SSI rate. Key interventions included preoperative screening and decolonization of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus with repeated intranasal applications of mupirocin, universal skin prep with chlorhexidine for all patients, and additional antibiotic dosing upon initiating cardiopulmonary bypass.Results:In 2014, the CT-SSI rate at our institution was 1.9/100 cases, which increased during the “intervention period” to 3.6 infections/100 cases in 2015 (16 total infections). Postinterventions, the CT-SSI rate decreased to 0.3 infections/100 cases (2 total infections), which was significantly lower than our baseline before the spike in infection rate.Conclusions:A comprehensive interdisciplinary approach with multiple interventions was successful in significantly reducing the CT-SSI rate in cardiothoracic surgery at a tertiary care pediatric hospital.

Methodology to Reduce Healthcare Associated Infections at a Large Multi-Hospital Health System

BACKGROUND In this changing landscape of healthcare, Infection Prevention (IP) programs need to demonstrate their value to their institutions. One way to do this is through the reduction of healthcare associated infections (HAI). This improves patient outcomes and can also provide value through the avoidance of hospital acquired condition (HAC) penalties. METHODS The reduction of HAIs at the system level of a 151-hospital health system became a top priority necessitating a structured approach. Beginning in January 2017, clear expectations of what is submitted to the National Healthcare Safety Network (NHSN) and reporting deadlines were defined. Next, HAI targets were established. Data is accessed from NHSN by the analytics department via Group Administrator rights. Analysis of standardized infection ratios (SIR), standardized utilization ratios (SUR) and Cumulative Attributable Differences (CADS) relative to system targets is conducted. Follow-up with hospitals having the highest CADS begins with a discussion with the IP team. Then, collaboration and feedback with the local team continues and efforts are escalated up to and including the C-suite and may culminate in a site visit if needed. The role and engagement of the Chief Quality Officer (CQO) is critical throughout the process. RESULTS Since establishing this methodology, the HAI outcomes have approved in six of the eight categories. In the past year (October?2017-September 2018) Clostridium difficile reduced 12%, central line associated bloodstream infection (CLABSI) 16%, catheter?associated urinary tract infection (CAUTI) 11%, abdominal hysterectomy surgical site infections (SSI) 46%, colon surgery SSI?19% and hip arthroplasty SSI 15%. In addition, HAC penalties were reduced. CONCLUSIONS This methodology has been very effective in reducing the HAIs across the health system. Also, the feedback from the stakeholders is positive because it results in collaboration and often brings needed attention to an area they have been struggling with.

2183. Financial Cost, Length of Stay, and Patient Experience Associated with Healthcare-Associated Infections Across a 43 Hospital Network

BackgroundReduction of healthcare-associated infections (HAIs) is critical to improve patient safety and hospital quality. However, not all HAI-associated outcomes are well studied. We examined several of these—the financial and length of stay (LOS) burden of HAIs and patient experience of care.MethodsNational Healthcare Safety Network-reported catheter-associated urinary tract infections (CAUTI), C. difficile infections (CDI), central line-associated bloodstream infections (CLABSI), MRSA bacteremia, and colon surgery surgical site infections (SSI-COLO) were queried for the first 9 months of 2016 from 43 hospitals. Patients with an HAI were matched to controls on hospital and primary diagnosis to create a retrospective case–control study. CAUTI and CLABSI patients were matched to controls with associated device codes. LOS and total direct variable cost (TDVC) were collected for all HAI and control patients. If patients returned a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, their likelihood to recommend (LTR) response was additionally analyzed.ResultsData were analyzed for 123 CAUTI, 1,116 CDI, 166 CLABSI, 58 MRSA, and 127 SSI-COLO case–control pairs across 43 hospitals. TDVC per case was significantly higher among HAI cases than controls for CDI ($6,484), CLABSI ($14,646), and SSI-COLO ($9,770; figure 1). LOS was significantly higher for cases across all HAI groups, with attributable differences of 7.6 days for CAUTI, 6.4 for CDI, 9.7 for CLABSI, 7.4 for MRSA, and 4.5 for SSI-COLO (Figure 2). Of 3,180 subjects, 198 returned HCAHPS surveys. Response rate of “Yes, definitely” to LTR for 85 HAI patients was 63.5% compared with 72.6% for 113 control patients (Figure 3). ConclusionThis is the first investigation to our knowledge pairing patient experience of care data with TDVC and LOS for HAI patients. HAIs have a significant impact on patient experience, cost, and length of stay―further supporting the importance of preventing HAIs.Disclosures R. Olmsted, Ethicon, Inc.: Speaker’s Bureau, Speaker honorarium; APIC: External faculty HRET/CDC STRIVE project, Speaker honorarium.

2121. Shifting Surgical Site Infection Denominators and Implication on NHSN Reporting

BackgroundPer National Healthcare Safety Network (NHSN) rules, when multiple procedures are performed during a single operation, the operation is counted in the surgical site infection (SSI) denominator of each NHSN surgical procedure category. SSIs, however, are counted only in the highest-ranking procedure category. These rules result in procedures that are ineligible to have an associated SSI being counted in SSI denominators.MethodsWe analyzed 3 years (January 1, 2015–December 31, 2017) of laminectomy and rectal surgery SSI data from hospitals in the Duke Infection Control Outreach Network (DICON) that used ICD procedure codes to assign denominators per NHSN definitions. We compared SSI rates using two different denominators: NHSN denominators vs. reduced denominators that counted only primary laminectomy and rectal surgery procedures. We calculated rate ratios (RR) to compare the NHSN and adjusted SSI rates for each procedure for all hospitals that reported at least 1 SSI.ResultsEleven hospitals reported 87 infections following 17,247 laminectomy procedures. The overall SSI rate increased by 44% when only primary procedures were counted in the denominator (RR 1.44); but individual hospital RR ranged from 1.10 to 2.20 (Table 1). 5 hospitals reported seven SSIs following 740 rectal procedures. The overall SSI rate increased by 143% when only primary procedures were counted in the denominator (RR 2.43), but individual hospital RR ranged from 2.00 to 5.00 (Table 1).ConclusionNHSN’s method for calculating SSI denominators underestimates true SSI rate. The current method particularly impacts procedures that are frequently performed in conjunction with higher-ranking NHSN procedures. Counting only primary procedures in procedure category denominators would provide higher, more accurate SSI rates.Table 1.Comparison of SSI Rates Calculated Using Adjusted Denominators vs. NHSN DenominatorsLaminectomy ProceduresHospitalAdjusted RateNHSN RateRR10.550.501.1020.610.531.1530.630.551.1640.260.221.2251.180.901.3061.431.061.3470.240.181.3480.990.701.4190.820.461.77100.840.412.05111.090.502.20Overall0.720.501.44 Rectal Surgeries Hospital Adjusted Rate NHSN Rate RR 19.524.772.0020.600.272.2732.531.072.3742.700.813.3555.001.005.00Overall2.300.952.43Disclosures All authors: No reported disclosures.

Colon and rectal surgery surgical site infection reduction bundle: To improve is to change

BackgroundDespite the introduction of the Surgical Care Improvement Project, surgical site infections remain a source of morbidity. The aim of this study was to determine the value of implementing a colorectal bundle on SSI rates. MethodsBetween 2011 and 2016 a total of 1351 patients underwent colorectal operations. Patients were grouped into pre-implementation (Group A, January 1, 2011–December 31, 2012), implementation (Group B, January 1, 2013–December 31, 2014) and post-implementation (Group C, January 1, 2015–December 31, 2016). Primary endpoints were superficial SSI, deep SSI, wound separation and total SSI. ResultsAfter the bundle was implemented, there was a significant reduction in superficial (6.6%–4%, p < 0.05), deep (3.7%–1.1%, p < 0.05), and total SSI rates (10.9%–4.7%, p < 0.05). Comparing Group A to Group C there was a decrease in total SSI (9.4%–4.7%, p < 0.05). ConclusionImplementation of the bundle resulted in a reduction in overall SSI rates particularly as compliance increased. This study offers evidence that small changes can lead to significant decreases in surgical site infections.

Presentation Number DSV08 - Post-Discharge Surveillance of SSI in Bariatric Surgery

Background: Surgical site infection (SSI) are the most common complication among surgical patients increasing morbidity and mortality. In addition, SSI account for about 14% to 16% of healthcare associated infections, with a large number identified after discharge. In bariatric surgery SSI account for 49% of all complications identified after discharge. A cell phone application (app) could be a useful tool in surveillance. Our objectives were to identify SSI after bariatric surgery in post-discharge period by means of phoned surveillance and to investigate patient's predisposition to use of a cell phone app for clinical follow-up after discharge.