High rate of surgical site infections (SSIs) in our nation’s hospitals

By now, most healthcare professionals — and many well-read consumers — are aware of the disturbingly high rate of surgical site infections (SSIs) in our nation’s hospitals.

Each year, approximately 500,000 surgical patients develop SSIs. In some types of operations, such as colorectal surgery, the rate is close to 10%.

Many hospitals submit information about SSIs in their institutions through the CDC’s National Healthcare Safety Network (NHSN), a web-based surveillance system for capturing data about adverse events.

However, with current trends toward shortened hospital stays and increased outpatient surgery, statisticians estimate that from 47% to 84% of SSIs may occur after discharge and thus go undetected by hospital infection surveillance programs.

The hospital costs associated with these infections are in excess of $7 billion (in 2002 dollars). When the substantial indirect costs to patients, their families, their communities, and their employers are factored in, the impact is even more dramatic.

To me and many of my colleagues, the most frustrating aspect of this issue is that a majority of these infections are preventable — and we know how to prevent them!

The simplest, most effective (and cost-effective) prevention strategy is caregiver handwashing.

Often overlooked strategies include such things as appropriate prophylactic administration and attention to blood glucose control for surgical patients with diabetes.

Today, no hospital or health system would be caught without specific protocols for preventing SSIs, but many organizations fall short when it comes to employing standardized methods for measuring and reporting compliance with these protocols.

Moreover, with the increasing number of specialties and the trend toward outpatient surgical care, it has become more difficult to ensure that the right information is getting to patients in a way that is understandable, meaningful, and useful.

So, how do we go from “easier said than done” to “mission accomplished?”

As we’ve discovered in other areas of healthcare quality and safety, the key to reducing SSIs lies in “teamwork.”

All stakeholders — governments and regulatory agencies, medical professional organizations, hospitals and health systems, health insurers, employers and other purchasers, and patients — working together in partnership to foster a “culture of safety.”

The recently launched Safe Surgery Initiative, is an example of such a multi-stakeholder approach to SSI prevention and puts an important new spin on the relatively commonplace concept of “toolkits.”

The Safe Surgery Initiative toolkit is conceived as a primary resource to reduce the incidence of SSI by raising awareness of best practices, increasing knowledge, and changing behaviors at every level and patient touch point.

Available free of charge on line, this resource represents the collective work of an academic team and collaborating stakeholders put together by us here at Jefferson School of Population Health with support from Johnson & Johnson Health Care Systems.

It is a compilation of the most up-to-date, publicly available, validated information on SSI prevention from sources including the CDC and the Agency for Healthcare Research and Quality.

Although a majority of the resources are directed towards patients — e.g., English and Spanish versions of general information on how to speak to their doctor, how to prepare for surgery, and what to look for after surgery — there is also educational information for healthcare providers regarding key pre-, intra-, and post-operative processes and procedures that have an impact on SSI.

A big “plus” is that users can package and customize any of the materials in a manner that is most appropriate for their intended audience, whether it be a healthcare provider, employer, or health plan.

Although the items can be used as stand-alone documents, this comprehensive package provides the foundation for a robust collaborative initiative for partners interested in an innovative education program.

I am optimistic that a multi-stakeholder approach such as this will help us gain some much needed traction in our efforts to stem the tides of SSIs and other hospital-acquired infections.

David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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