Surgical Site Infection Surveillance Research Articles

A Stakeholder-Driven Framework for Evaluating Surgical Site Infection Surveillance Technologies.

Background: Patients increasingly use mobile devices to send text messages and photographic data to surgeons. There is potential to harness this patient-generated health data (PGHD) for clinical and public health surveillance of surgical site infection (SSI). Leveraging PGHD collected via remote monitoring in the post-operative period has the potential to produce important benefits for patients, surgeons, care teams, and infection surveillance and prevention. Methods: We conducted a health technology assessment (HTA), drawing heavily on stakeholder engagement to better understand current and potential uses of PGHD in post-operative care. Stakeholder engagement activities included assembling an advisory board composed of stakeholder experts, interviewing key informants, and seeking out stakeholder guidance to synthesize evidence from interviews, literature review, and technical app review in order to develop recommendations on the use of PGHD in SSI surveillance. Results: We conducted a review of the published literature, a technical/market scan of available apps for capturing post-operative PGHD, and two rounds of key informant interviews with stakeholders. In addition, we held a day-long workshop to solicit stakeholder feedback on initial findings of the project and to guide additional work. These activities culminated in an HTA report that provides guidance and recommendations on the use of PGHD in SSI surveillance, including practice, research, and public health surveillance, and identifies open issues on post-operative use of PGHD for which additional evidence and experience are needed to optimize application of those data for clinical and public health purposes. Conclusion: Stakeholders, individuals with direct experience, or interest in a given topic are critical to the HTA process. They provide insight to guide the work conducted, ensure that the topics addressed are relevant and important, and that products of the work are accessible and meaningful to the individuals who will be most impacted.

Burden of surgical site infections in the Netherlands: cost analyses and disability-adjusted life years

Surgical site infections (SSIs) are associated with morbidity, mortality and costs. To identify the burden of (deep) SSIs in costs and disability-adjusted life years (DALYs) following colectomy, mastectomy and total hip arthroplasty (THA) in the Netherlands. A retrospective cost-analysis was performed using 2011 data from the national SSI surveillance network PREZIES. Sixty-two patients with an SSI (exposed) were matched to 122 patients without an SSI (unexposed, same type of surgery). Patient records were studied until 1 year after SSI diagnosis. Unexposed patients were followed for the same duration. Costs were calculated from the hospital perspective (2016 price level), and cost differences were tested using linear regression analyses. Disease burden was estimated using the Burden of Communicable Disease in Europe Toolkit of the European Centre for Disease Prevention and Control. The SSI model was specified by type of surgery, with country- and surgery-specific parameters where possible. Attributable costs per SSI were €21,569 (THA), €14,084 (colectomy) and €1881 (mastectomy), mainly caused by prolonged length of hospital stay. National hospital costs were estimated at €10 million, €29 million and €0.6 million, respectively. National disease burden was greatest for SSIs following colectomy (3200 DALYs/year, 150 DALYs/100 SSIs), while individual disease burden was highest following THA (1200 DALYs/year, 250 DALYs/100 SSIs). For mastectomy, these DALYs were <1. The total cost of DALYs for the three types of surgery exceeded €88 million. Depending on the type of surgery, SSIs cause a significant burden, both economically and in loss of years in full health. This underlines the importance of appropriate infection prevention and control measures.

Performance of surgical site infection risk prediction models in colorectal surgery: external validity assessment from three European national surveillance networks.

To assess the validity of multivariable models for predicting risk of surgical site infection (SSI) after colorectal surgery based on routinely collected data in national surveillance networks. Retrospective analysis performed on 3 validation cohorts. Colorectal surgery patients in Switzerland, France, and England, 2007-2017. We determined calibration and discrimination (ie, area under the curve, AUC) of the COLA (contamination class, obesity, laparoscopy, American Society of Anesthesiologists [ASA]) multivariable risk model and the National Healthcare Safety Network (NHSN) multivariable risk model in each cohort. A new score was constructed based on multivariable analysis of the Swiss cohort following colorectal surgery, then based on colon and rectal surgery separately. We included 40,813 patients who had undergone elective or emergency colorectal surgery to validate the COLA score, 45,216 patients to validate the NHSN colon and rectal surgery risk models, and 46,320 patients in the construction of a new predictive model. The COLA score's predictive ability was poor, with AUC values of 0.64 (95% confidence interval [CI], 0.63-0.65), 0.62 (95% CI, 0.58-0.67), 0.60 (95% CI, 0.58-0.61) in the Swiss, French, and English cohorts, respectively. The NHSN colon-specific model (AUC, 0.61; 95% CI, 0.61-0.62) and the rectal surgery-specific model (AUC, 0.57; 95% CI, 0.53-0.61) showed limited predictive ability. The new predictive score showed poor predictive accuracy for colorectal surgery overall (AUC, 0.65; 95% CI, 0.64-0.66), for colon surgery (AUC, 0.65; 95% CI, 0.65-0.66), and for rectal surgery (AUC, 0.63; 95% CI, 0.60-0.66). Models based on routinely collected data in SSI surveillance networks poorly predict individual risk of SSI following colorectal surgery. Further models that include other more predictive variables could be developed and validated.

Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England.

Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.

Antibiotic Prescription Review Improves Cesarean Section Surgical Site Infection Surveillance

BACKGROUND Post cesarean section (CS) surgical site infections (SSI) surveillance may be challenging due to short postoperative hospital stays and time and resource intensive post discharge surveillance methods. At our obstetrical/gynecological facility, which is housed within a large pediatric hospital, surveillance was limited to inpatient readmissions and patients who presented to an urgent care center. Our purpose was to expand CS SSI surveillance to include outpatient clinics in our system by creating and implementing the use of a custom surveillance tool in October 2018. METHODS Reports of patients who underwent CS within the past 30?days were generated from the electronic data warehouse. Of these, patients who presented to our outpatient clinics and were prescribed antibiotics were considered. After chart review, two infectious diseases physicians further refined the list of antibiotics based on local prescribing patterns for wound infections. Patients queried through this tool received an additional full medical chart review by an infection preventionist to determine the possibility of SSI following CS. RESULTS After two months of implementation, 4 of 8 (50%) of CS SSI were identified through the use of this surveillance method. Compared to the previous year, enhanced surveillance resulted in a 1.7 fold increase in the CS SSI rate. CONCLUSIONS CS SSI surveillance using antibiotic prescription data in the outpatient setting is an efficient method to enhance traditional SSI surveillance. In our facility, implementation of this tool has improved the identification of CS SSI. Accurate case identification will aid in identifying trends and guide targeted interventions.

Increase in Post-Coronary Artery Bypass Graft Surgical Site Infections (SSIs) Following Cease of Active Surveillance Demonstrates Need for Continued Active Surveillance for SSIs Following Cardiac Procedures

BACKGROUND Surveillance and prevention of surgical site infections (SSIs) is becoming increasingly important as the number of surgical procedures performed in the United States rise. Despite improvements in technology and infection prevention best practices, SSI's are major cause of morbidity and mortality. It is estimated that half of SSIs are preventable by applying evidence-based strategies, including systemic surveillance with attention to multiple factors, including patient risk factors, procedural risk factors, and risk factors related to the hospital environment. In one Minnesota hospital active surveillance for infections following coronary artery bypass grafts ceased at the end of 2017 due to low incidence of infection. The following fall, through passive surveillance, Infection Preventionists detected an increase in surgical site infections following cardiac procedures. Cases were analyzed for similarities and active surveillance was reinitiated. METHODS Through surveillance for methicillin-susceptible Staphylococcus aureus (MSSA) in sterile sites, two deep incisional primary SSI's were detected in patients in September 2018 following coronary artery bypass grafts (CBGs). Using the definitions provided by the National Healthcare Safety Network (NHSN) all cardiac procedures performed at this facility between April 1st and September 30th, 2018 were reviewed for additional infections. RESULTS The review revealed an additional four SSI's following CBGs: Two superficial incisional primary infections and one superficial incisional secondary infection. As a result, the SSI rate associated with CBG surgeries for that time period increased to 4.84/100 procedures, above the target rate of ≤1.0/100 procedures. Four of 6 (67%) infections were a result of Staphylococcus aureus raising concern for improper nasal decolonization practices prior to surgery. Infection Preventionists engaged the Cardiac Surgery Council to discuss infection prevention best practices before and during surgical procedures. CONCLUSIONS Continued surveillance for SSI's following cardiac procedures is a necessary means of preventing infections in a facility and detecting breaches in infection control during surgical procedures.

Improving Detection of Surgical Site Infections After Cesarean Delivery: What Are Diagnosis Codes Missing? [28Q

INTRODUCTION: Surveillance for surgical site infections (SSI) following cesarean can be challenging. We sought to identify cases of SSI over two years and describe our methods of case ascertainment. METHODS: We queried our hospital's data warehouse for cesareans deliveries from 2016-2017 among women >18 years of age. Three methods for case finding were used: i) ICD-10 diagnoses codes, ii) reporting complications in postoperative notes, and iii) infection control surveillance activities. For ICD-10 codes, we sought endometritis following delivery and infection of obstetrical surgical wound, infection following procedure, cellulitis, and/or peritoneal abscess. We included endometritis as an organ/space SSI by CDC definitions. Chart review was performed for all cases identified by any of the 3 methods to confirm SSI diagnosis as per CDC criteria. RESULTS: Among 3,507 cesareans, ICD-10 codes identified 76 confirmed cases of endometritis and 31 SSI. The positive predictive value for endometritis was 88.0% (95% CI 80.2-93.1) and for SSI codes, 53.5% (95% CI 43.0-63.6). Adding puerperal sepsis produced one additional SSI case, and searching the postoperative note yielded another 26 cases of endometritis and one wound infection. Six SSI were identified by infection control not identified by other methods. In total, we identified 141 SSI, including 98 endometritis-only cases. The incidence of all SSI, endometritis, and SSI excluding endometritis was 4.02%, 2.79%, and 1.23%. CONCLUSION: Improved ascertainment methods are needed to inform and assess performance improvement efforts for cesarean SSI. Reliance on diagnosis codes may miss a significant number of cases and is poorly predictive of SSI other than endometritis.

Cardiovascular daytime varying effect in cardiac surgery on surgical site infections and 1-year mortality: A prospective cohort study with 22,305 patients.

Afternoon aortic valve replacement surgery may provide perioperative myocardial protection and improve patient outcomes compared with morning surgery. The results of our large observational study based on Swiss cardiac surgical site infection surveillance data suggest that the current evidence is insufficient to generally promote afternoon cardiac surgeries.

A nationwide surveillance of surgical site infection after mid-urethral slings in Japan

We performed a questionnaire-based, retrospective, nationwide survey on perioperative management and antimicrobial prophylaxis for mid-urethral sling surgery for stress urinary incontinence in Japan to realize the clinical practice and risk factors for SSI.Records of women receiving transobturator tape (TOT) and tension-free vaginal tape (TVT) surgeries from 2010 to 2012 were obtained from hospitals belonging to the Japanese Society of Pelvic Organ Prolapse Surgery. The questionnaire addressed hospital volume, perioperative management, and SSI. Risk factors for SSI were investigated by comparing cases with and without SSI.The data from 97 hospitals and a total 1627 TOT and 1045 TVT surgeries were analyzed. Mean case volumes of TOT and TVT surgeries were 7.3 ± 14.9 and 7.1 ± 17.8 cases per year, respectively. Preoperative hair removal, bowel preparation, and urine culture were routinely performed at 44 (45.3%), 31 (32.0%), and 22 (22.7%) hospitals, respectively. First-generation (51.5%) or second-generation (34.0%) cephalosporin was mostly used for antimicrobial prophylaxis. SSI was reported only in 6 patients (0.22%) and none of them developed abscesses. None of the factors we could evaluate from the questionnaire were found to be significantly associated with SSI.SSI after mid-urethral slings rarely occurred in Japan (0.22%) and no parameters about perioperative managements significantly increased SSI. However, further studies with more detail information of each patient and operation are required to confirm their appropriate perioperative managements for mid-urethral slings.

The value of calling-back patients to detect surgical site infections following orthopaedic and neurological surgeries in a tertiary care centre in Lebanon

Surgical Site infections (SSIs) are a major source of morbidity, mortality and increased medical costs among patients undergoing surgeries. SSIs may be detected during hospitalization following surgery, upon readmission, through Emergency Department or clinic visits. Calling-back patients might be used to detect SSIs in patients who seek medical care in different centres. An active, patient-based, prospective surveillance for SSI following orthopaedic and neurological procedures was conducted between July and September 2016 at the American University of Beirut Medical Centre (AUBMC). &#x0D; Trained infection control preventionist conducted the surveillance based on the CDC/NHSN (Centers for Disease control and Prevention/National Health Care Safety Network) definition of SSI and the NHSN methodology for data collection by calling-back patients and assessing the signs and symptoms of SSIs at 30 or 90 days after the operative procedure using a standardized checklist. Calling-back patients was initiated following an increase in the SSI rates for particular surgeons in these specialties. Rates were expressed as number of SSI in a designated specialty per 100 operative procedures of the same specialty and were benchmarked with NHSN and the International Nosocomial Infection Control Consortium (INICC) rates.&#x0D; No SSIs were identified through the phone calls among the 178 patients who were assessed throughout the surveillance period. Whereas, 2 SSIs were identified through the routine surveillance of hospital re-admissions and one SSI was identified from the review of the outpatient clinic records. SSI rates remained unchanged compared to the adopted surveillance methodology and were 3.7% following neurological surgeries and zero following orthopaedic surgeries at the time of the active surveillance. &#x0D; Call-back programs may be beneficial to obtain additional post-discharge surveillance information. However, patients may have a difficult time assessing their status and the possibility of developing an SSI. Moreover, this process was found to be time consuming, and was not successful in identifying additional SSIs. Re-assessment of this method is essential to examine the value of calling-back patients in detecting SSIs.

Surveillance of surgical site infections following gynecological surgeries in a rural setup – Lessons learnt

Surveillance of surgical site infections following gynecological surgeries in a rural setup – Lessons learnt - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/2394-2754.2019.0013, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery.

Surveillance of surgical site infections (SSIs) is important for infection control and is usually performed through retrospective manual chart review. The aim of this study was to develop an algorithm for the surveillance of deep SSIs based on clinical variables to enhance efficiency of surveillance. Retrospective cohort study (2012-2015). A Dutch teaching hospital. We included all consecutive patients who underwent colorectal surgery excluding those with contaminated wounds at the time of surgery. All patients were evaluated for deep SSIs through manual chart review, using the Centers for Disease Control and Prevention (CDC) criteria as the reference standard. We used logistic regression modeling to identify predictors that contributed to the estimation of diagnostic probability. Bootstrapping was applied to increase generalizability, followed by assessment of statistical performance and clinical implications. In total, 1,606 patients were included, of whom 129 (8.0%) acquired a deep SSI. The final model included postoperative length of stay, wound class, readmission, reoperation, and 30-day mortality. The model achieved 68.7% specificity and 98.5% sensitivity and an area under the receiver operator characteristic (ROC) curve (AUC) of 0.950 (95% CI, 0.932-0.969). Positive and negative predictive values were 21.5% and 99.8%, respectively. Applying the algorithm resulted in a 63.4% reduction in the number of records requiring full manual review (from 1,606 to 590). This 5-parameter model identified 98.5% of patients with a deep SSI. The model can be used to develop semiautomatic surveillance of deep SSIs after colorectal surgery, which may further improve efficiency and quality of SSI surveillance.

A Quality Improvement Study Project to Improve Post Cesarean Section Surgical Site Infection Surveillance in a District Hospital in Kigali City

Post-caesarean surgical site infection (PCSI) is one of the most common cesarean section-related complications. In low- and middle-income countries (LMIC), PCSI prevalence is often under-reported and inaccurate because LMIC surveillance systems are often unable to detect PCSIs developed after discharge; this can ultimately wrongly inform the decision-making related to reducing PCSIs.This paper describes the establishment of a post-discharge PCSI surveillance system for identification of PCSI rate in a district hospital in Rwanda.A total of 540 women underwent CS in the hospital from November 2017 to February 2018, and 536 (99.3%) consented to participate in the surveillance. Among those consented, 22 had no telephone and 174 could not be reached by telephone despite multiple attempts. At the end of this study, a total of 340 women completed the entire surveillance period. The total PCSI rate was 11.5%.Out of all PCSIs, 21% were detected during hospitalization period and 79% were detected during the post-discharge period.The PCSI surveillance system developed in this project covered the 30-day period after surgery and provided a more accurate estimate of PCSI rate. The system was able to track PCSIs developed after a patient was discharged from the hospital. Long term sustainability of the project must be evaluated.

Maximizing Interpretability and Cost-Effectiveness of Surgical Site Infection (SSI) Predictive Models Using Feature-Specific Regularized Logistic Regression on Preoperative Temporal Data.

This study describes a novel approach to solve the surgical site infection (SSI) classification problem. Feature engineering has traditionally been one of the most important steps in solving complex classification problems, especially in cases with temporal data. The described novel approach is based on abstraction of temporal data recorded in three temporal windows. Maximum likelihood L1-norm (lasso) regularization was used in penalized logistic regression to predict the onset of surgical site infection occurrence based on available patient blood testing results up to the day of surgery. Prior knowledge of predictors (blood tests) was integrated in the modelling by introduction of penalty factors depending on blood test prices and an early stopping parameter limiting the maximum number of selected features used in predictive modelling. Finally, solutions resulting in higher interpretability and cost-effectiveness were demonstrated. Using repeated holdout cross-validation, the baseline C-reactive protein (CRP) classifier achieved a mean AUC of 0.801, whereas our best full lasso model achieved a mean AUC of 0.956. Best model testing results were achieved for full lasso model with maximum number of features limited at 20 features with an AUC of 0.967. Presented models showed the potential to not only support domain experts in their decision making but could also prove invaluable for improvement in prediction of SSI occurrence, which may even help setting new guidelines in the field of preoperative SSI prevention and surveillance.

Surveillance of Surgical Site Infection in General Surgery Department at Sohag University Hospital

Surveillance of Surgical Site Infection in General Surgery Department at Sohag University Hospital

Impact of participation in a surgical site infection surveillance network: results from a large international cohort study

Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale. To determine the time-trend of SSI rates in surveillance networks. SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept. Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis. In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.

Surveillance of surgical site infections after cholecystectomy

Background: The objective of present study is find out various patient factor including demographic data as well as operative data on occurrence of surgical site infection in patients of cholecyctectomy.Methods: A Prospective observational study of 273 patients of cholecystitis undergoing cholecystectomies for Surveillance of surgical site infections was conducted in the Department of General Surgery at the SSG hospital and Medical College Baroda during a period from 1st December 2013 to 30th November 2015. All patients operated for cholecystectomy are included irrespective of technique. Data collected from each patient were: Case start date and time, case end date and time, discharge date &amp; time, case length, postoperative length of stay in hospital, patients characteristics (age, sex, ASA score), operative characteristics like, pathological diagnosis report of specimen, microorganism isolated based on culture report and antibiotic resistance pattern from infected wounds, antibiotic prophylaxis given perioperatively and antibiotics administered to treat SSI`s, intra operative spillage and bleeding, date of infection, urgent/elective procedure.Results: During the period of 24 months total 273 patient were undergone cholecystectomy out of which 12 (4.3%) patients were developed SSI. SSI rate is affected by various factors which are statistically significant are sex of patients, age, type of procedure, ASA score &gt;3.Conclusions: The overall incidence of SSIs in the present study was 4.3%. The rates of SSI were more in patient with higher age, with male sex, emergency procedure and higher ASA score.

2173. Surgical Site Infection Determination in Epic® ICON: A Utilization Model

BackgroundPrior to 2016, our hospital used microbiology results alone to investigate surgical site infections (SSI). Previous studies show that this practice can miss as many as half of clinically significant infections. To improve accuracy for fiscal year 2016 SSI surveillance was done by manual chart review of 100% of the surgeries we report to NHSN. While more accurate, this process was time and labor intensive. In May 2016, we began using Epic® ICON as our data mining software. ICON can abstract (create denominator data), determine SSI status (create numerator data) and upload to NSHN. Data indicates that partially automated SSI surveillance reduce manual chart review but our team found that many charts were being reviewed unnecessarily.We developed a computerized algorithm within ICON that would that would capture SSIs but limit the number of charts to be reviewed.MethodsAlgorithm variables within Epic® ICON were modified to limit data collection to the following parameters: readmission, chief complaint, surgical log, diagnosis, antibiotic administration post 48 hours, and specific microbiology results. We excluded 31 keywords that were part of the Epic® ICON foundation system from our algorithm. For example, we removed the keyword “infection” which flagged whenever “no infection” was charted. The chief complaints grouper was most important as it allowed only meaningful complaints to be considered. Microbiology results were also limited to only include Aerobic, Anaerobic, Fungus, AFB, and wound cultures. To validate the algorithm, it was run retrospectively for fiscal year 2016.ResultsThere was 100% concordance of results comparing SSIs identified using chart review to the use of our computerized algorithm and Table 1 shows the average number of charts requiring review pre and post implementation.Table 1:Comparison of Charts Requiring ReviewMonthly Average with Chart ReviewMonthly Average with Computerized AlgorithmImproved Efficiency, %BRST632757COLO432152HYST38782HPRO723059KPRO592755CBGB30583ConclusionCareful modification of the ICON foundations system resulted in a 55% decrease overall in the need for chart review without affecting accuracy of reporting.Disclosures All authors: No reported disclosures.

2135. Costs vs. Earnings in Colon Surgery and Coronary Artery Bypass Grafting Under a Prospective Payment System: Sufficient Financial Incentives to Reduce Surgical Site Infections?

BackgroundLittle is known about actual hospital earnings in patients with and without surgical site infections (SSI) under a prospective payment system. To exemplify respective financial incentives for hospitals to prevent SSI, we aimed to compare hospital costs and earnings in colon surgery and coronary artery bypass grafting (CABG) patients, with and without SSI.MethodsBased on a national and validated SSI surveillance cohort, we performed a nested financial analysis at a participating tertiary care center in Switzerland. Consecutive patients with colon operations and CABGs from January 2015 through December 2016; and from January 2015 through October 2016, respectively, were included. Co-primary outcome measures were actual hospital costs and earnings under a prospective payment system (SwissDRG), stratified by SSI status. Ascertainment of SSI status was performed as part of a standardized follow-up protocol at 1 month and one year after surgery.ResultsIn colon surgery (n = 229), the median costs were $68,796 (interquartile range [IQR], $39,600–$95,217) with SSI and $26,556 (IQR, $18,282–$54,230) without SSI (unadjusted P < 0.001; adjusted P = 0.001). In CABGs (n = 433), the median costs were $117,170 (IQR, $57,329–$201,953) with SSI and $48,855 (IQR, $40,053–$67,860) without SSI (unadjusted P < 0.001; adjusted P < 0.001). In colon surgery, the median earnings were −$10,738 (IQR, −$33,275 to −$3,492) with SSI and −$2,223 (IQR, −$13,009 to $4,917) without SSI (unadjusted P = 0.001; adjusted P = 0.038). In CABG, the median earnings were −$25,050 (IQR, −$54,060 to −$10,882) with SSI and −$2,485 (IQR, −$11,597 to $3,375) without SSI (unadjusted P < 0.001; adjusted P < 0.001).ConclusionHospital costs and earnings for two common surgical interventions varied substantially under a prospective payment system: SSIs after colon and CABG operations resulted on average in higher costs and lower earnings. A prospective payment system may add a strong financial incentive to reduce SSI rates after colon and CABG operations.Disclosures All authors: No reported disclosures.

Utilization of a Dual Surveillance Program to Reduce Surgical-site Infections.

Background:Surveillance plays a pivotal role in the surgical-site infections (SSIs) prevention through identifying infections, monitoring changes in infection rates, and evaluating the effectiveness of intervention strategies.Methods:This retrospective study reviewed SSI surveillance systems implemented at the Children’s National Health System in 3 phases between 2007 and 2016 including all surgical procedures. The targeted surveillance was conducted in cardiovascular, spinal fusion, and ventricular shunt surgeries and required an infection preventionist (IP) to review all procedures, to identify SSIs that meet the CDC’s National Healthcare Safety Network definition. SSIs in the remaining surgical procedures were identified through the review of positive microbiology reports daily and followed by full chart review if the specimen type and/or patient location were suggestive of a surgical history. Timely feedback of SSI to stakeholders was the primary mode of intervention, with additional interventions implemented for the 3 targeted surveillance procedures. Data collected between 2013 and 2016 were analyzed to account for a definition change in 2013.Results:For the 3 targeted surveillance procedures, IP reviewed 2,255 procedures and identified 43 SSIs. For the remaining procedures, IPs identified 123 SSIs confirmed by one or more pathogens. The overall SSI rate had a 31% decrease. The cardiovascular and spinal fusion SSI rate had a 61% and 84% decrease, respectively. The ventricular shunt SSI rate increased 29% due to 2 episodes of recurrent infections in 2 patients.Conclusions:It is prudent for hospitals to continue monitoring SSI by establishing surveillance programs with optimal approaches.