Surgical site infections (SSIs) occur in an estimated 2 percent to 5 percent of patients undergoing inpatient operations. Each year, approximately 300,000 SSIs occur in the U.S.1 Because SSI remains a serious complication for surgical patients, Joint Commission Resources (JCR) has participated in a new initiative designed to help reduce this type of infection.
Hospital Engagement Networks
As part of the federal Partnership for Patients, JCR was one of 26 Hospital Engagement Networks (HENs) formed in 2012 to work at the national, regional, state, or institutional level to reduce harm to patients and to improve the safety and quality of health care.
New preliminary data from the U.S. Department of Health and Human Services (HHS) showed a 9 percent decrease in patient injuries in hospitals in 2012 compared with a 2010 baseline, and an 8 percent decrease in Medicare fee-for-service 30-day readmissions.2 The data also showed improvement on a range of measures for health care-associated infections (HAIs) and conditions, including for SSIs. HENs with other partners, including quality improvement organizations, the hospital Value-Based Purchasing program, the Centers for Disease Control and Prevention, and other groups and agencies, have worked intensively to achieve these reductions.
Effectiveness of JCR HEN
Over the last two years, the JCR HEN, which currently comprises 46 hospitals, has made addressing SSIs a top priority. In aggregate, the JCR HEN rate for SSIs continues to decline. As of September 8, 2014, 17 hospitals have shown a significant reduction from baseline (or have consistently had a rate of zero), and 13 of those institutions have achieved a 40 percent reduction or better. The 40 percent reduction reflects the relative percent change between the hospitals’ performance for the first half of 2014 compared with their performance from January of 2010 through April of 2012.
Hospitals in the JCR HEN were able to select the outcome measure they wanted to collect. Of the 17 improving hospitals, 14 collected a measure focused on surgical patients with an uninfected operative wound and the remaining four selected a measure that addressed SSIs for colorectal surgery.
According to HHS, several other HENs also were successful in tackling SSIs. For example, the Healthcare Association of New York State has shown a 28 percent reduction in SSI rates for hip prosthesis.2 In addition, the Hospital & Healthsystem Association of Pennsylvania has shown a decrease in SSI rates for several procedures—cardiac artery bypass graft, hip replacement, knee replacement, and abdominal hysterectomy—with a combined reduction of 47 percent.3
The JCR HEN began its efforts to reduce SSIs by leading an all-day workshop that included JCR consultants and an interdisciplinary team of individuals from surgical nursing, infection control, pre-anesthesia testing, and the post-anesthesia care unit. Together, they completed a strengths, weaknesses, opportunities, and threats analysis of its suppliers, inputs, processes, outputs, and customers to identify next steps and strategies for reducing and preventing SSIs.
In addition, the JCR HEN provided support for an SSI educational program in Illinois. It also encouraged hospitals to be part of reducing SSI rates for colorectal surgery and abdominal hysterectomy patients by involving surgeons, sharing case-specific data with surgeons, and using standardized skin antiseptic preparation across all surgical settings and in the patient’s home before admission to the hospital.
Best practices revealed
As a result of these combined efforts, the JCR HEN identified and recommended the following best practices and strategies to target SSIs:
- Consistently provide case-specific feedback to surgeons through continuous surgical quality improvement meetings, surgical governance, and one-on-one meetings
- Have senior leadership and physicians participate in steering operating room SSI reduction team meetings
- Involve the chief financial officer in cost-per-case analysis and instrument purchase justification
JCR’s work with its HEN hospitals continues to expand. The project has grown from an original cohort of 32 hospitals in 2012 to 46 in 2014. In addition, the project’s focus has expanded from the 10 original HAIs (including SSIs) to include clostridium difficile, worker safety, sepsis, health care disparities, and pediatric safety.4 To sustain improvement, JCR will remain committed to its SSI-related efforts even after the Partnership for Patients project ends.
- Centers for Disease Control and Prevention. Surgical Site Infection (SSI) Toolkit. Activity C: ELC prevention collaboratives. December 21, 2009. Available at: http://www.cdc.gov/HAI/pdfs/toolkits/SSI_toolkit021710SIBT_revised.pdf. Accessed September 12, 2014.
- U.S. Department of Health & Human Services. New HHS data shows major strides in patient safety, leading to improved care and savings. May 7, 2014. Available at: http://innovation.cms.gov/Files/reports/patient-safety-results.pdf. Accessed August 28, 2014.
- The Hospital & Healthsystem Association of Pennsylvania. Pennsylvania hospitals achieve significant results in reducing surgical-site infections. June 6, 2014. Available at: https://www.haponline.org/Newsroom/News/ID/352/Pennsylvania-Hospitals-Achieve-Significant-Results-in-Reducing-Surgical-Site-Infections. Accessed September 12, 2014.
- Joint Commission Resources. Hospital Engagement Network. Available at: http://www.jcrinc.com/about-jcr/hospital-engagement-network/. Accessed September 9, 2014.