New draft guideline to prevent SSI

Surgical site infections (SSIs) are the third most common health care-associated infection (HAI), according to the Centers for Disease Control and Prevention (CDC), occurring in more than 500,000 patients annually.^1,2 The Joint Commission has long been committed to developing the highest standards aimed at the prevention of HAIs and SSIs in an effort to improve patient safety and quality of care.

Earlier this year, The Joint Commission submitted public comments to the CDC regarding its “Draft Guideline for the Prevention of SSIs,” which were published in the Federal Register in January.^3,4 The draft guideline addresses new and updated strategies for the prevention of SSIs in health care settings by health care administrators and epidemiologists, as well as health care professionals including nurses, surgeons, and other staff responsible for the development, implementation, and evaluation of infection prevention and control programs.

The recommendations in the draft guideline are based on a systematic review of the best available evidence on the prevention of SSIs. The document covers new topics related to antimicrobial prophylaxis parenteral, antimicrobial prophylaxis topical, and skin preparation, as well as updates on glycemic control, normothermia, and oxygenation. The guideline also comprises new pending recommendations on anthroplasty-related topics, such as transfusion, anticoagulation, and exhaust suits.

The CDC previously issued recommendations on the prevention of SSIs in 1999. Since then, SSIs have decreased significantly. According to the CDC, as of 2012, SSIs were down nationally by 20 percent since 2008.⁵ The Joint Commission, health care providers, and practitioners have looked to the CDC’s guideline over the last 15 years to attain a better understanding of the latest science and interpretation of empirical evidence related to SSIs to inform their patient care decisions.

Whereas the current CDC protocol for the prevention of SSIs has been extremely helpful to the health care community, The Joint Commission supports any updates with as many clear and concrete recommendations as the science will allow. The Joint Commission would further assert that, in some instances, practice recommendations that stem from the inclusion of controlled observation studies or other information from solid methodological evaluations and industry standards may provide an even greater benefit.

Joint Commission use of current guideline

The Joint Commission and its affiliates use the current CDC guideline as an example of evidence-based guideline use in many of its accreditation, educational, and consulting activities. For example, The Joint Commission asks ambulatory care centers, critical access facilities, hospitals, and office-based surgery practices to comply with professional guidelines, such as those from the CDC, to demonstrate adherence to The Joint Commission’s National Patient Safety Goal (NPSG) 7: Reduce the Risk of HAIs.

A section of NPSG 7 (NPSG.07.05.01) specifically focuses on the implementation of evidence-based practices for preventing SSIs and includes eight elements of performance (EPs). The EPs highlight the following:

• Educating of staff, patients, and families about the prevention of SSIs
• Implementing policies and practices aimed at reducing SSIs
• Measuring SSI rates for the first 30 or 90 days following surgical procedures
• Providing process and outcome measure results to key stakeholders

Additional SSI resources

In addition to use of the current CDC guideline, The Joint Commission has undertaken several other efforts to help reduce SSIs. In November 2012, the Joint Commission Center for Transforming Healthcare announced findings from its SSIs project on reducing the risk of colorectal SSIs.⁶ Seven hospitals participated in the project and identified 34 unique correlating variables for the risk of colorectal SSIs that may be related to patient characteristics, including the surgical procedure; antibiotic administration; preoperative, intraoperative, and postoperative processes; and measurement challenges. The Joint Commission also has made several SSI resources available through its online HAIs portal.

For more information on SSIs, go to www.jointcommission.org.

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References

1. Centers for Disease Control and Prevention. Healthcare-associated infections. Available at: www.cdc.gov/hai/surveillance/index.html?mobile=nocontent. Accessed June 9, 2014.
2. Meeks DW, Lally KP, Carrick MM, et al. Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3? Amer J of Surg. 2011;201(1):76-83.
3. The eRulemaking Program Management Office. Regulations.gov. Comment from The Joint Commission: TJC comments on CDC draft guidelines SSIs. Available at: www.regulations.gov/#!documentDetail;D=CDC-2014-0003-0062. Accessed June 19, 2014.
4. Office of the Federal Register. Draft guideline—Centers for Disease Control and Prevention draft guideline for the prevention of surgical site infections. January 29, 2014. Available at: www.federalregister.gov/articles/2014/01/29/2014-01674/draft-guideline-centers-for-disease-control-and-prevention-draft-guideline-for-the-prevention-of. Accessed June 19, 2014.
5. The Centers for Disease Control and Prevention. CDC’s Healthcare-Associated Infection Progress Report: Questions and answers. Available at: www.cdc.gov/hai/surveillance/QA_stateSummary.html. Accessed June 10, 2014.
6. Joint Commission Center for Transforming Healthcare. Project detail: Surgical site infections. Available at: www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=4. Accessed June 19, 2014.