Surveillance Methodology and

Economic Burden of SSIs

Maureen Spencer, RN, M.Ed, CICInfection Preventionist Consultant

Boston, MA - USA

Purpose of the Infection Control and Prevention Program

•Surveillance – detect cases

•Control - outbreaks, clusters or increasing trends in data

•Implement prevention measures

Surveillance System and CDC Definitions

Micro cultures auto printed daily from Meditech

IC Adm Assist Runs daily list of

IP and OP Visits

Surgeon Post Discharge Surveillance

Precaution patients currently in house - auto printed daily

by Meditech

New Precaution Patients ? HAI or CA ?

Case Management Monthly Reports (listing of

complications, infections, etc)

ACU Consult Reports (prints directly on IC Adm Assist Printer) for patients with a

question of infection

Developed Algorithms For Surveillance (Each Category)

All positive cultures are

entered in log book

Follow CDC criteria for Hospital Acquired Infections

Info includes Pt name, MR#, Room, Date of Adm, Date of

Cult, MD

Review and log patient’s last adm

and/or surgery

IC RN Reviews all department reports (op

notes, prev disch noted, RN notes,

etc)

Summary of potential HAI is given to IC MD

for review

HAI report is summarized and submitted to ICC

for review, discussion, etc

Was the infection preventable?

Information forwarded to

surgeon and dept chair

If previous hosp adm, list

adm date, disch date MD,

surg procedure, unit

etc.

Sample questions: Did pt have surgery: if

yes, was it within 30 days of last

adm; or 1 year if surgery involved

an implant?

Was patient previoiusly

admitted with an infection?

Micro cultures auto printed daily from

Meditech

IC Adm Assist performs

preliminary review of all

cultures

If cultures taken on previous adm,

are they same organism?

Patients with potential HAI are flagged for IC RN/

MD review

Yes

Run daily list of IP and OP

Review patient diagnosis for

signs of potential infection

Was patient admitted with

infection, sepsis, pain s/p surgery?

Highlight for IC RN to follow

Enter Info in Log Book to include Pt

name, MR#, Room, Date of

Adm, diagnosis, MD,

along with previous

admission info

Yes

Case definition

•Case definitions are designed to capture all potential cases of a disease/condition without contaminating the dataset with extraneous materials

•NHSN is, by definition, our basic service•Special case definitions may be required

for specific issues or for outbreaks

Case definitions

•Outbreak▫May want to date or unit define▫May want to include symptoms or

manifestations•Case control studies

▫Permit selection of control group (those without the condition under study)

▫Associated with the event or process

Data analysis

•Data are systematically compiled and interpreted▫Data are analyzed using statistical methods▫Date are compared over time to internal

and external databases▫Comparative databases are used when

undesirable variation is identified

Numbers

•Numerator – the “top” number which is also the number of cases identified

•Denominator – the “bottom number” –(down below) is the total number of individuals studied

•Rate – the result of dividing the numerator by the denominator and multiplying by a factor

The “Factor”

•There is no established “factor” for most statistical math in epidemiology

•Generally report surgical and other similar infection as x/100 events

•Generally report device related infections by device day x/1000 device days

Measures of occurrence

•Incidence▫Measure of frequency with which an event

occurs in a population over a specified period of time New cases

•Prevalence ▫Proportion of persons in a population with

a particular disease at a specific point in time (point prevalence) or over a specified time period (period prevalence) Existing cases

Studies

•Case Control – two groups, identical, but one with the characteristic under study, and other without. General 1:3 (power)

•Cohort – all people in a group (enter together, and then observe for occurrence of disease/condition)

•Prospective – looking forward•Retrospective – looking backward

Bias

•Bias can be defined as “any systematic error in the design, conduct or analysis of a study that results in a mistaken estimate of an exposure’s effect on the risk of disease”

•Selection Bias•Information Bias

The monthly record of cases • Record demographic data for each case

▫ Use consistent methods Column A: Last Name Column B: First Name

• Column C: Medical Record #Physician▫ Physician name▫ Physician identification # (check, as often there are

two different numbers in the hospital)• Age – useful in stratification• Gender – equivocal data set• Admission date (critical!)• Onset date (used to calculate # hospital days

admission to onset)

Line Listing

Line List: A line list is an organized, detailed list of each record of a surgical site infection

Example Suppose you are interested in looking at all

CLABSIs in 2010 that occurred in the ICU and the Orthopedic Unit

You would like to produce a line list that includes basic patient demographics (patient ID, DOB, gender, and age at event), information on the event (date admitted, date of surgey, date of onset, location of patient when SSI developed

Line list heading – Depends on the HAI

• Infection site ▫ Use standard nomenclature - NHSN

SSI SST CAUTI

• Procedure codes• Procedure date• Surgeon code• Surgeon assistant and others in the room• Date of Admission• Date of Onset of Infection• Antibiotics• ASA score• Incision time• Closure time• Patient room number

Next columns

•Organism▫Use standard nomenclature!

CNS vs. Coag neg staph vs. S. epidermidis Spell the words correctly

•Culture site •Final attribution – Hosp Onset, Comm

Onset, Comm Acquired•Comment field– generally cannot sort by

anything except the first word but useful for keeping notes

Frequency Table

Frequency Table: A frequency table is an organized display of counts and percentages

The data are organized by a row variable and a column variable, and the frequency table provides a count of the number of observations in the data set that meet the specifications of both the row and column variables

Example Suppose you are interested in looking at the

distribution of each SSI across the different services in your facility, for all events that were identified in 2012

UHS HAI Dashboard

EXAMPLE OF HAI FREQUENCY TABLE IN EXCEL FILE

Descriptive Epidemiology

▫Cross tabulations: infections/organisms infections/nursing units infections/services infections/risk factors

▫Evaluate trends and clusters

▫Conduct studies and investigations Retrospective case reviews, Case-Control

Studies

Examples of Cross Tabulations

•CLABSI by ICUs•CLABSI by device type•CLABSI by organisms•SSIs by services•SSIs by surgeons•SSIs by nursing unit•Risk factors by SSIs•SSI rates over a time period

SSI by Service - 2012

SERVICE CABG TOTAL HIP

TOTAL KNEE

ABD HYSTEC

COLON

Gen Surgery

0 0 0 0 4

Cardiac Surgery

2 0 0 0 0

Orthopedic Surgery

0 2 3 0 0

Gynecology Surgery

0 0 0 3 0

Example CLABSI Analysis 2011-2012Nursing Unit 2011 (n=13) 2012 (n = 4)

SICU 34 24

NICU 3 1

PICU 2 1

MICU 42 34

4 WEST 1 0

5 SOUTH 16 23

What do these numerators mean?Next calculate rates by line days

CLABSI BY ORGANISMS - 2012

NURSUNIT

STAPH AUREUS

MRSA CNS ALPHA STREP

ECOLI PSEUDAERUG

CANDIDA

SICU 5 8 2 1 2 4 2

NICU 0 1 0 0 0 0 0

PICU 0 0 1 0 0 0 0

MICU 10 12 5 0 2 1 4

4 WEST 0 0 0 0 0 0 0

5 SOUTH

8 2 6 4 1 1 1

TOTALS 23 23 14 5 5 6 7

SSI RATESTYPE OF SURGERY

# SSIs # PROCEDURES

% RATE

THA 2 100 2%

TKA 3 75 4%

CABG 2 25 8%

COLON 4 15 27%

ABD HYSTERCTOMY

3 16 19%

SSIs BY SURGEONS - RATES

SURGEONCODE

CABG TKA THA COLON ABD HYSTER

A 1.2

B 1.0

C 0.9 1.0

D 0.4 0.8

E 0.0 0.0

F 5.6

G 4.8

H 0.0 (0/6 cases)

I 30.0 (3/10 cases)

Risk Factors for Infections

Surgery Diabetes Obese (BMI > 30)

Hema-toma

Drains Staples Smoking Steroids

THA 50% 75% 25% 90% 90% 20% 10%

TKA 60% 80% 35% 85% 95% 10% 5%

CABG 70% 70% 0% 0% 50% 60% 45%

COLON 50% 50% 0% 20% 80% 20% 10%

ABD HYSTER

70% 80% 0% 0% 90% 10% 10%

? What percentage of non-infected patients had risk factors? What percentage of Surgeon I patients had these risk factorsObesity diabetes risk factors at this institutionStaples are used often which may be increasing the riskDrains being used in orthopedic surgery – increase risk

Pie Chart

Pie Chart: A pie chart is a graphical representation of data. The different slices of the pie represent different values of a variable, with the relative size of the slice representing the amount of data included in the slice

Pie Chart Example

The top value for each slice is the value of the “chart variable” (e.g., location).

The second value is a count of the number of events included in each slice of the pie

Example: Distribution of HAIs

Bar Chart

Bar Chart: A bar chart is a graphical representation of data where the length or height of the bars represents counts of cases or rates

Number of Cases by Surgery Date

Days from Surgery to Infection- HPRO & KPRO

Orthopedic Surgical Site Infection Rates

OR Environmental controls:Traffic, Attire,Scrub, Air Handling

Antibacterial sutures

MRSA and Staph aureus Elimination Program

CHG/Alcohol Prep

Laminectomy outbreak due to locally administered steroids (depomedrol)7 x increase risk of infection if obese and diabetic

Increase in hematomas after use of Lovenox and Plavix

NEBH SSI Rates 2003 – 2010(outpatient and inpatient infections)

40

GENERAL SSI FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10

# Infections 6 1 3 4 2 2 1 0# Procedures 1073 920 780 692 567 467 425Infection Rate 0.6 0.1 0.4 0.5 0.3 0.3 0.2 0

ORTHOPEDIC SSI# Infections 63 60 49 46 39 37 28 32# Procedures 8837 9669 9216 8986 9027 8884 8890 9839Overall Infection Rate 0.7 0.6 0.5 0.5 0.4 0.4 0.31 0.33#Hip Infections 14 5 4 7 5 5 10 9 Hip Prosthesis Rate 1.0 0.3 0.2 0.4 0.3 0.3 0.49 0.41#Knee Infections 21 14 11 7 7 11 9 9 Knee Prosthesis Rate 1.6 1.0 0.7 0.4 0.3 0.5 0.39 0.35#Laminectomy Infec. 6 9 7 7 12 4 0 3 Laminectomy Rate 0.7 0.9 0.6 0.8 1.3 0.5 0.0 0.53#Spinal Fusions Infec. 5 15 12 12 5 5 3 3 Spinal Fusion Rate 0.8 2.0 1.4 1.1 0.4 0.4 0.31 0.34Other infections 17 15 13 12 10 6 8 Other infection rate 0.38 0.39 0.37 0.34 0.21 0.22

2009 - Total hip investigation – increase in post-op hematomas in infected patients being evaluated by a case-control study2008 – Total knee investigation – noticed increase rate in patients receiving toradol, marcaine and duromorph – needle on syringe was not being changed between each vial – changed practice2007 – Laminectomy rate increased – case control study revealed locally adminiistered steroids increased infection rate in obese/diabetic pts

Run Chart

Run Chart: A run chart (or control chart) is a line graph showing change in a variable over a selected time period

This is a useful output if you would like to view, for example, the change in rates over time and 2 standard deviation above the mean

Instituted AMD Gauze and Standardized dressing technique

MRSA/MSSA Eradication Program

Standardized Infection Ratio (SIR)• Standardized Infection Ratio (SIR), a statistic

used to measure relative difference in HAI occurrence during a reporting period compared to a common referent period (i.e., standard population).

• SIR compares the actual number of HAIs with the predicted number based on the baseline U.S. experience (i.e., standard population), adjusting for several risk factors that have been found to be most associated with differences in infection rates

Next Step: Calculate SIR by HAI by facility and compare to national data from NHSN

The “p” value

•The p value is the probability that an event will occur in a given set of trials

•A p of 1 means it will occur every time the trial occurs (if there were 100 “z” in a pile of 100 scrabble tiles, the probability of getting a “z” is 1 “by chance”

•Thus, a p of 0.05 means that 95% of the time or 95/100 you will not get a “z” if there were a random mix of tiles with only one z

Patient-associated risk factors identified by studies in Malaysia and Vietnam

Risk Factors for SSI

1. Praveen S et al. Asian J Surg 2009. 32(1):59-63. 2. Yong KS, et al. Med J Malays 2001. 56 Suppl C:57-60.3. Nguyen D et al. Infect Control Hosp Epidemiol 2001. 22(8):485-492. 4. Sohn AH et al. Infect Control Hosp Epidemiol 2002. 23(7):382-387.5. Thu LTA et al. J Hosp Infect 2005. 60(4):360-367.

Country Source Risk variable Surgical procedure Risk estimate (95% CI) P value

Malaysia

Praveen 20091

Intra-operative adhesions Inguinal hernioplasty

Not reported 0.013

Post-operation haematoma Not reported 0.001

Yong 20012

Type 2 diabetesTotal hip replacement

OR 21.4 (1.53, 300.2) 0.023

Obesity OR 20.2 (2.13, 191.5) 0.009

Vietnam

Nguyen 20013

Dirty wound Any surgical procedure OR 5.67 (1.92, 16.74) 0.002

Sohn 20024 Dirty wound Any surgical procedure OR 2.92 (1.35, 6.15) NR

Thu 20055

Dirty wound All orthopaedic surgery

OR 8.7 (4.55, 16.44) <0.001

ASA > 2 OR 3.9 (1.77, 8.82) 0.001

Surgical site infection

1. Duerink DO et al. J Hosp Infect 2006. 62(2):219-229. 2. Sohn AH et al. Infect Control Hosp Epidemiol 2002. 23(7):382-387.3. Praveen S et al. Asian J Surg 2009. 32(1):59-63. 4. Dhillon KS et al. Med J Malays 1995. 50(3):237-240.5. Syahrizal AB et al. Med J Malays 2001. 56 Suppl D:5-8. 6. Yang K et al. J Arthroplasty 2001. 16(1):102-106.7. Kehachindawat P et al. J Med Assoc Thai 2007;90(7):1356-62.8. Thu LTA et al. Infect Control Hosp Epidemiol 2006. 27(8):855-862.

1

2

SSI classification by surgical procedure

3

4

5

6

7

8

Gastrointestinal surgery Incidence of SSI: 4 – 56%

Incidence of ssi

1. Mahadeva S et al. Int J Clin Pract 2009. 63(5):760-765.2. Thambidorai CR et al. Singapore Med J 2008. 49(12):994-997.

Country Source Surgical procedure Incidence (%)

Malaysia

Mahadeva 20091 Percutaneous endoscopic gastrostomy 33/103 (32%)

Thambidorai 20082 Appendectomy in childrenOpen: 34/61(55.7%)Laparoscopic: 3/51 (5.9%)

Orthopaedic surgery Incidence of SSI: 4 – 15%

Incidence of ssi

1. Dhillon KS et al. Med J Malays 1995. 50(3):237-240.2. Syahrizal AB et al. Med J Malays 2001. 56 Suppl D:5-8.3. Tay BH et al. Med J Malays 2000. 55 Suppl C:74-85.

Country Source Surgical procedure Incidence (%)

Malaysia

Dhillon 19951 All orthopaedic surgery 48/703 (6.8%)

Syahrizal 20012 Total knee arthroplasty 11/100 (11.0%)

Tay 20003 Total hip arthroplasty 10/109 (9.2%)

Gynaecology & Obstetrics surgery Incidence of SSI: 2 – 26%

Incidence of ssi

1. Huam SH et al. Med J Malays 1997. 52(1):3-7.2. Ramli R et al. Int Med J 2009. 16(4):279-282.

Country Source Surgical procedure Incidence (%)

MalaysiaHuam 19971 Caesarean section

Antibiotic prophylaxis: 3/100 (3.0%)No prophylaxis: 13/100 (13.0%)

Ramli 20092 Laparoscopic ovarian cystectomy 2/37 (5.4%)

Other surgical procedures

Incidence of SSI

1. Ahmad TS et al. Ann Acad Med Singapore 1997. 26(6):840-843.2. Hisham AN et al. ANZ J Surg 2002. 72(4):287-289.3. Ng CY et al. Asian Cardiovasc Thorac Ann 2004. 12(3):218-223.4. Praveen S et al. Asian J Surg 2009. 32(1):59-63.

Country Source Surgical procedure Incidence (%)

Malaysia

Ahmad 19971 Free flap surgery 10/61 (16.4%)

Hisham 20012 Total thyroidectomy 3/98 (3.1%)

Ng 20043 CABG 34/1594 (2.1%)

Praveen 20094 Inguinal hernioplasty 15/202 (7.4%)

Patient Factors Surgeon Technique Work Environmental Factors

Pre-operative Factors Peri-operative Team Factors Organizational and Management Factors

Care Delivery problems (CDPs)

SSI Fishbone Diagram

Lack of hand hygiene

Patient body colonization

Lack of traffic control – too many in room

Improper surgical hand antisepsis

Improper surgical attire

MRSA or MSSA nasal colonization

Infection at another site

Obese

Diabetic

Smoker

Immunosuppressive agents

Unsterile instruments

Contaminated environment

Inadequate surgical prophylaxis

Poor surgical techniqueUse of Drains

Lack of re-dosing of antibiotic

Lack of pre-op shower

Financial constraints

Poor leadershipPoor communication among team

Poor staff levels

Workload and shift patterns

Design, availability and maintenance of equipment Environment and physical plant

problems (air handling system)

Surgical irrigation

Non-coated suturesUse of Staples or steri-strips

Contamination of incision post-op

Inadequate staffing for post-op care

Lack of discontinuation of antibiotics at 24 hrs

Lack of foley catheter removal within 48 hrs

Increase hospitalization days

Contaminated environment

Lack of hand hygiene

How Much Do These Infections Cost???

56

Relative Economic Burden Associated with HAIs

• SSISurgical Site Infections

• CLA-BSICentral-Line Associated Blood Stream Infections

• VAPVentilator Associated Pneumonia

• CA-UTICatheter-Associated Urinary Tract Infections

• Other / MDROs*Multi-Drug Resistant Organisms (e.g., MRSA, C. difficile, VRE, etc.)

Est. Annual # of Infections

Est. Annual # of Infections

Direct Cost per Patient (2007$)Direct Cost per Patient (2007$)

Avg. Increased Length of StayAvg. Increased Length of Stay

Attributable Mortality

Attributable Mortality

290,485(~17% of HAIs)

248,678(~14% of HAIs)

250,205(~15% of HAIs)

561,667(~32% of HAIs)

386,090(~22% of HAIs)

$34,670

$29,156

$28,508

$1,007

~$30,000

~12 days

~10-24 days

~9-13 days

1 day

~9.1 days

4%

26%

24%

1%

~4%

* NOTE: MDRO often cause other infection types (e.g., SSI, BSI, VAP, UTI); MDRO statistics reflect CDC estimates for methicillin-resistant Staphylococcus aureus (MRSA) only. SOURCES: Klevens, et al., “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002,” Public Health Review, 2007; CDC: “The Direct Medical Cost of HAIs in U.S. Hospitals and the Benefits of Prevention”, March 2009; Kirkland, et al., “The Impact of Surgical Site Infections”, Infect Control Hosp Epidemiol, 1999; Arch Internal Med, 1988; Arch Internal Med, 1974; Infect Control Hosp Epidemiol, 2002; CareFusion MedMined Analysis, 2009.

Extended hospital stay associated with SSI In Vietnam, SSI is associated with an increase in

hospital stay of 7-19 days

Economic burden of SSI

1. Nguyen D et al. Infect Control Hosp Epidemiol 2001. 22(8):485-492.2. Sohn AH et al. Infect Control Hosp Epidemiol 2002. 23(7):382-387.3. Thu LTA et al. J Hosp Infect 2005. 60(4):360-367. 4. Thu LTA et al. Infect Control Hosp Epidemiol 2006. 27(8):855-862.5. Thu LTA et al. Infect Control Hosp Epidemiol 2007. 28(5):583-588.

Country Source Surgical procedure Type of stayLength of stay (days)

SSI No SSI Difference P value

Vietnam

Nguyen 20011 Any surgical procedure Total stay 14 (SD: 10.8) 9.1 (SD: 7.1) 4.9 <0.001

Sohn 20022 Any surgical procedure Post-operative 26 10 16 <0.0001

Thu 20053 All orthopaedic surgery Post-operative 28.1 9 19.1 <0.001

Thu 20064

Orthopaedic surgery Post-operative 21 9 15 <0.001

Neurosurgery Post-operative 27 10 17 <0.001

Thu 20075 Neurosurgery Post-operative 16 9 7 NR

In Thailand, SSI is associated with an increase in hospital stay of 7-19 days

Economic cost of ssi

1. Danchaivijitr S et al. J Med Assoc of Thailand 2005;88 Suppl 10:S75-S82. 2. Kasatpibal N et al. J Med Assoc of Thailand 2005;88(8):1083-91.3. Lohsiriwat V et al. J Med Assoc of Thailand 2009;92(1):12-6.

Source Surgical procedure Type of stayLength of stay (days)

SSI no SSI Difference P value

Danchaivijitr 20051 Any surgical procedure Post-operative stay NS NS 12.6 NS

Kasatpibal 20052

Craniotomy

Post-operative stay

48.0 16.8 31.2 <0.0001

Colectomy 27.4 8.7 18.7 0.0001

Cholecystectomy 16.7 8.1 8.6 0.0147

Appendectomy 17.2 4.2 13.0 <0.0001

Mastectomy 20.5 9.8 10.7 0.0038

Herniorrhaphy 13.0 2.0 11.0 <0.0001

Lohsiriwat 20093 Colorectal surgery Hospital stay 15.9 8.3 7.6 <0.001

Hospitalization cost associated with SSI in Thailand

Economic cost of ssi

Source: Kasatpibal N et al. J Med Assoc of Thailand 2005;88(8):1083-91 .

Surgical procedureMean hospitalization cost (THB)

SSI no SSI Difference P value

Craniotomy 117,135 50,018 67,116 <0.0001

Colectomy 69,958 27,642 42,316 0.0170

Cholecystectomy 52,975 22,812 30,163 0.0341

Appendectomy 27,647 8,482 19,165 0.0004

Mastectomy 23,413 16,699 6,713 0.1449

Herniorrhaphy 17,801 6,882 10,919 0.0007

All 6 procedures 75,544 31,886 43,658 <0.0001

Edmiston, et al. APIC June 2012

Plus Antibacterial Sutures

• One year prospective study of 3789 total joints ▫ In July 2005, implemented a full-year evaluation of

antibacterial sutures usage in an orthopedic setting▫Changed product over July 4th holiday and did not tell

all surgeons (only those involved with study)• At the end of the year-long trial period:

▫45% reduction in SSIs caused by Staph aureus and MRSA

▫Reduction in total joint infections rate during trial period ▫ Infection rate dropped from 0.44% to 0.33% with

three less infections

61

Spencer M, et al: Reducing the Risk of Orthopedic Infections: The Role of Innovative Suture Technology

NAON Poster Presentation - 2010

Three Less Staph Aureus Infections•Incremental cost: $6000.00

•3 x $40,000 Sensitive Staph aureus = $120,000

•3 x $100,000 MRSA = $300,000

•UHS – to convert a 25 hospital system will increase the budget by 1% or $35,000

NEBH SSI Rates 2003 – 2010(outpatient and inpatient infections)

63

GENERAL SSI FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10

# Infections 6 1 3 4 2 2 1 0# Procedures 1073 920 780 692 567 467 425Infection Rate 0.6 0.1 0.4 0.5 0.3 0.3 0.2 0

ORTHOPEDIC SSI# Infections 63 60 49 46 39 37 28 32# Procedures 8837 9669 9216 8986 9027 8884 8890 9839Overall Infection Rate 0.7 0.6 0.5 0.5 0.4 0.4 0.31 0.33#Hip Infections 14 5 4 7 5 5 10 9 Hip Prosthesis Rate 1.0 0.3 0.2 0.4 0.3 0.3 0.49 0.41#Knee Infections 21 14 11 7 7 11 9 9 Knee Prosthesis Rate 1.6 1.0 0.7 0.4 0.3 0.5 0.39 0.35#Laminectomy Infec. 6 9 7 7 12 4 0 3 Laminectomy Rate 0.7 0.9 0.6 0.8 1.3 0.5 0.0 0.53#Spinal Fusions Infec. 5 15 12 12 5 5 3 3 Spinal Fusion Rate 0.8 2.0 1.4 1.1 0.4 0.4 0.31 0.34Other infections 17 15 13 12 10 6 8 Other infection rate 0.38 0.39 0.37 0.34 0.21 0.22

2009 - Total hip investigation – increase in post-op hematomas in infected patients being evaluated by a case-control study2008 – Total knee investigation – noticed increase rate in patients receiving toradol, marcaine and duromorph – needle on syringe was not being changed between each vial – changed practice2007 – Laminectomy rate increased – case control study revealed locally adminiistered steroids increased infection rate in obese/diabetic pts

64

Potential SavingsOrthopedic Surgical Site InfectionsCost: ~ $25,000/each

FY03 – 63/8837 cases (0.7%) 1.6 million

FY04 – 60/9669 cases (0.6%) 1.5 million

FY05 – 49/9216 cases (0.5%)  1.2 million

FY06 – 46/8986 cases (0.5%) 1.1 million

FY07 - 39/9027 cases (0.4%) $975,000

FY08 - 37/8884 cases (0.4%) $925,000

UHS Healthcare-Acquired Infections

2010 2011 (through October)

% Rate Reduction

UHS 2011 Benchmark Rate

# HAIsReduced

Potential Cost Savings

Catheter Associated UTI (rate per Foley days)

1.39 0.64 54% 0.2 97 $90,630

CLABSI rate by catheter days)

1.44 0.66 54% 0.0 59 $1,486,956

VAP (rate by ventilator days)

1.41 0.91 35% 0.0 47 $912,256

CABG SSI (overall rate by surgical procedures)

0.71 0.20 73% 0.0 4 $138,680

Total Hip (overall rate by surgical procedures)

0.73 0.53 27% 0.0 6 $208,020

Total Knee (overall rate by surgical procedures)

0.57 0.57 0% 0.0 12 $416,040

C.Difficile (rate per 10,000 patient days)

3.23 2.41 25% 7.0 150 $948,900

MRSA (rate per 1,000 patient days)

0.36 0.14 61% 0.4 252 $7,560,000

Total 627 $11,761,482

First Year Potential Cost Savings

Healthcare Acquired Infections

2011- 2012% Reduction

UHS 2012 Benchmark Rate

Infection Prevention Measures in Process

Catheter Associated UTI (rate per Foley days)

57% 0.0 Infection Control Foley Catheter Tray and Silver Foley Catheter, CHG washcloths

CLABSI (rate by catheter days)

54% 0.0 Central Line Insertion Kits, Alcohol Caps for Injection Hub Protection, CHG washcloths, Central Line Checklist

VAP (rate by ventilator days) 11% 0.0 CHG rinse with oral care kits, VAP bundle checklist, CHG washcloths, nebulizer cleaning procedures, VAP rounds

CABG SSI (overall rate by surgical procedures)

71% 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep

Total Hip (overall rate by surgical procedures)

15% 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep

Total Knee (overall rate by surgical procedures)

50% 0.0 MRSA screening before surgery, CHG preop showers/cloths , Incisional sealants, CHG/alcohol skin prep

C.Difficile (rate per 10,000 patient days)

12% 4.0/10,000 patient days

Bleach wipes and bleach disinfectant solution, Rapid PCR Diagnostics for Early Diagnosis and Precautions, Enhanced environmental cleaning, cubicle curtain changes, room decontamination units for high rates

MRSA (rate per 1,000 patient days)

62% 0.4 CHG Washcloths, Pre-admission and Pre-op Screening, Rapid PCR Diagnostics for Early Diagnosis and Precautions

The overall incidence of SSI in South East Asia varies between 1-20%. SSI account for approximately 20% of all HAI.

Variability in SSI incidence related to surgical procedure and risk factors (eg, diabetes, wound classification).

SSI have a substantial economic impact through increased hospital stay, additional treatment and consequently loss of productivity

Clinical studies in patients undergoing abdominal, spinal and cardiac surgery show that VICRYL Plus sutures significantly reduce the incidence of SSI

Conclusions