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Surgical Site Infection Prevention

How Do We Compare?

What is surgical site infection prevention?

Surgical Site Infection Prevention - Quality Measures
MEASURE: MEMORIAL
RESULTS
Jan-Dec 2011
(Actual/Total Procedures)
COLORADO
AVERAGE RATE‡
NATIONAL
AVERAGE RATE
Jan-Dec 2010‡‡
Chest & leg - Coronary artery bypass graft (CABG) rate of infection

 

For CABG risk level 0

Achieved the best possible results
0.00
(0/13)
No data available 0.35

For CABG risk level 1

At or near national average performance
2.93
(6/205)
No data available 2.55

For CABG risk level 2, 3

Achieved the best possible results
0.00
(0/20)
No data available 4.26
Hip - Total hip replacement (THR) rate of infection
(Memorial Hospital Central)

For THR risk Level 0

Achieved the best possible results
0.00
(0/89)
No data available 0.67

For THR risk level 1

Above national average performance
0.56
(1/178)
No data available 1.44

For THR risk level 2, 3

Above national average performance
1.19
(1/84)
No data available 2.40
Hip - Total hip replacement (THR) rate of infection
(Memorial Hospital North)

For THR risk Level 0

Achieved the best possible results
0.0
(0/50)
No data available 0.67

For THR risk level 1

Achieved the best possible results
0.0
(0/49)
No data available 1.44

For THR risk level 2, 3

Achieved the best possible results
0.0
(0/27)
No data available 2.40
Knee - Total knee arthroplasty/replacement (TKA) rate of infection
(Memorial Hospital Central)

For TKA risk level 0

Achieved the best possible results
0.0
(0/196)
No data available 0.58

For TKA risk level 1

Achieved the best possible results
0.0
(0/273)
No data available 0.99

For TKA risk level 2, 3

Above national average performance
0.8
(1/125)
No data available 1.60
Knee - Total knee arthroplasty/replacement (TKA) rate of infection
(Memorial Hospital North)

For TKA risk level 0

At or near national average performance
0.89
(2/223)
No data available 0.58

For TKA risk level 1

Achieved the best possible results
0.0
(0/133)
No data available 0.99

For TKA risk level 2, 3

Below national average performance
4.0
(2/50)
No data available 1.60
C-section - rate of infection (Memorial Hospital North)

 

For risk level 0

Above national average performance
1.15
(3/260)
No date available 1.46

For risk level 1, 2, 3

Above national average performance
1.37
(1/73)
No data available 3.16

KEY:

(‡) This is the most current data available for average Colorado hospital quality performance.
(‡‡) This is the most current data available for average national hospital quality performance according to the National Healthcare Safety Network (NHSN).

NOTE: Memorial results are highlighted in the blue column of data and annotated with one of the following quality indicators:

Achieved the best possible results = Achieved the best possible results
Above national average performance = Above national average performance
At or near national average performance = At or near national average performance
Below national average performance = Below national average performance

 

What is surgical site infection prevention?

Surgical site infection prevention for chests & legs, hips and knees is measured by the number of infections per one hundred procedures. The lowest possible infection rate is desired with a rate of 0.00 being perfect.

Preventing infection promotes better healing, decreases length of stay and cost of care due to infection. Patients who smoke or have chronic health issues are at higher risk of infection. Patients who stop smoking, lose weight and manage their chronic disease conditions can improve their patient outcomes. Examples of chronic disease or conditions include, but are not limited to, diabetes, hypertension, asthma, liver or kidney failure. A patient with a risk factor of zero has a lesser chance of acquiring an infection than a patient with a higher risk factor.

IMPORTANT: most infections come from organisms already found on or in the patient’s system. Proper body hygiene is important and care of incisions or medical devices with appropriate products and supplies will reduce the risk of infection.

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What is a coronary artery bypass graft (CBCG), why is it important to prevent infections and what are the levels of risk?

Coronary artery bypass graft surgery (CABG) is a procedure used to treat coronary artery disease in certain circumstances. Coronary artery disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a buildup of fatty material within the walls of the arteries. This buildup causes the inside of the arteries to become rough and narrowed, limiting the supply of oxygen-rich blood to the heart muscle.

One way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with another piece of blood vessel. Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein taken from the legs or an artery in the chest. One end of the graft is attached above the blockage and the other end is attached below the blockage. Thus, the blood is rerouted around, or bypasses, the blockage through the new graft to reach the heart muscle. This bypass of the blocked coronary artery can be done by performing coronary artery bypass surgery.

Preventing infection promotes better healing, decreases length of stay and cost of care due to infection. Patients who smoke or have chronic health issues are at higher risk of infection. Patients who stop smoking, lose weight and manage their chronic disease conditions can improve their patient outcomes. Examples of chronic disease or conditions include, but are not limited to, diabetes, hypertension, asthma, liver or kidney failure. A patient with a risk factor of zero has a lesser chance of acquiring an infection than a patient with a higher risk factor.

IMPORTANT: most infections come from organisms already found on or in the patient’s system. Proper body hygiene is important and care of incisions or medical devices with appropriate products and supplies will reduce the risk of infection.

The risk index of 0, 1, 2 or 3 is used to categorize surgical procedures. This number is representative of co-morbidity and duration of operation. Co-morbidity includes the various disease conditions that a person could have such as diabetes, liver, kidney or lung disease or more. The more of these conditions a person has, the higher the risk number. Longer surgical procedures increase the risk number. Both are considered when assigning a risk index to the patient for the specific procedure.

Risk index = 0 when neither risk factor is present

Risk index = 1 when either one of the risk factors is present

Risk index = 2, 3 when multiple risk factors are present.

To determine which risk index applies to your condition, consult with your physician.

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What is a hip replacement (total hip replacement or THR), why is it important to prevent infections and what are the levels of risk?

Total hip replacement (THR) is an elective surgery. The goals for THR are to relieve pain and improve function.

There are two types of total hip replacements performed: primary total hip replacement and revision total hip replacement. The expected rate of adverse outcomes depends in part on the age of the patient, severity of the disease and co-morbid conditions. Post-operative complications, such as infections and deep venous thrombosis, have been significantly reduced because of the use of prophylactic antibiotics, anticoagulants and early mobilization.

Preventing infection promotes better healing, decreases length of stay and cost of care due to infection. Patients who smoke or have chronic health issues are at higher risk of infection. Patients who stop smoking, lose weight and manage their chronic disease conditions can improve their patient outcomes. Examples of chronic disease or conditions include, but are not limited to, diabetes, hypertension, asthma, liver or kidney failure. A patient with a risk factor of zero has a lesser chance of acquiring an infection than a patient with a higher risk factor.

IMPORTANT: most infections come from organisms already found on or in the patient’s system. Proper body hygiene is important and care of incisions or medical devices with appropriate products and supplies will reduce the risk of infection.

The risk index of 0, 1, 2 or 3 is used to categorize surgical procedures. This number is representative of co-morbidity and duration of operation. Co-morbidity includes the various disease conditions that a person could have such as diabetes, liver, kidney or lung disease or more. The more of these conditions a person has, the higher the risk number. Longer surgical procedures increase the risk number. Both are considered when assigning a risk index to the patient for the specific procedure.

Risk index = 0 when neither risk factor is present

Risk index = 1 when either one of the risk factors is present

Risk index = 2, 3 when multiple risk factors are present.

To determine which risk index applies to your condition, consult with your physician.

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What is a knee replacement (total knee arthroplasty or TKA), why is it important to prevent infections and what are the levels of risk?

PLEASE NOTE: The term total knee arthroplasty (TKA) may be used instead of total knee replacement because the abbreviation for total knee replacement (TKR) can be confused with total knee revision.

Primary total knee replacement is most commonly performed for knee joint failure caused by osteoarthritis (OA). Other indications may include rheumatoid arthritis (RA), juvenile RA, osteonecrosis and other types of inflammatory arthritis.

The goals of total knee replacement are to relieve pain and improve function. According to the National Institutes of Health (NIH) Consensus Statement on Total Knee Replacement 2003, candidates for elective total knee replacement should have radiographic evidence of joint damage, moderate to severe persistent pain that is not relieved by nonsurgical management and significant functional limitation.

Indications for knee replacement are variable within the medical community.

The most commonly used pre- and post-total knee replacement functional measures are the Knee Society score (KS), the Hospital for Special Surgery Scale (HSS), the WOMAC (Western Ontario and McMaster Universities) Arthritis Scale and SF-36.

There are very few contraindications to this procedure and the mortality rate is low.

Complications following total knee replacement may include: wound and deep-tissue infection, deep vein thrombosis, pulmonary thrombosis, pneumonia, patellar fracture, myocardial infarction, joint instability, stiffness, and/or malalignment and nerve/vascular injuries. The rate of complications in some studies was inversely related to both surgeon and hospital volume of procedures per year.

The support for the use of specific preoperative or postoperative rehabilitation intervention is questionable. Further research is needed. However, there is consensus that the following perioperative interventions improve total knee replacement outcomes: antibiotic prophylaxis, postoperative pain management, perioperative assessment and management of other medical conditions and preoperative education.

Preventing infection promotes better healing, decreases length of stay and cost of care due to infection. Patients who smoke or have chronic health issues are at higher risk of infection. Patients who stop smoking, lose weight and manage their chronic disease conditions can improve their patient outcomes. Examples of chronic diseases or conditions include, but are not limited to, diabetes, hypertension, asthma, liver or kidney failure. A patient with a risk factor of zero has a lesser chance of acquiring an infection than a patient with a higher risk factor.

IMPORTANT: most infections come from organisms already found on or in the patient’s system. Proper body hygiene is important and care of incisions or medical devices with appropriate products and supplies will reduce the risk of infection.

The risk index of 0, 1, 2 or 3 is used to categorize surgical procedures. This number is representative of co-morbidity and duration of operation. Co-morbidity includes the various disease conditions that a person could have such as diabetes, liver, kidney or lung disease or more. The more of these conditions a person has, the higher the risk number. Longer surgical procedures increase the risk number. Both are considered when assigning a risk index to the patient for the specific procedure.

Risk index = 0 when neither risk factor is present

Risk index = 1 when either one of the risk factors is present

Risk index = 2, 3 when multiple risk factors are present.

To determine which risk index applies to your condition, consult with your physician.

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What is a c-section (cesarean section), why is it important to prevent infections and what are the levels of risk?

A cesarean section also known as a c-section, is a method used to surgically deliver a baby. It is considered a major surgical procedure. A cesarean section can either be a planned procedure or it may be an emergency procedure when complications present during a vaginal birth. A cesarean section involves a surgeon making a horizontal incision in the stomach and uterus, and the baby is then lifted out through the incision.

Once the baby is delivered the uterus will be sewn shut with dissolvable stitches and the stomach will be closed with either stitches or staples. Sterile procedure and aseptic parameters are always in place.

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RELATED INFORMATION:

Agency for Healthcare Research and Quality (AHRQ)
www.ahrq.gov/qual

American Academy of Orthopaedic Surgeons (AAOS)
www.aaos.org

American Board of Medical Specialties
www.abms.org

American Board of Orthopaedic Surgery
https://www.abos.org

Centers for Disease Control and Prevention
https://www.cdc.gov

Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample
http://hcup.ahrq.gov/HcupNet.asp

The Joint Commission
www.jointcommission.org

Medicare Quality Improvement Community (MedQIC)
www.medqic.org

National Institutes of Health
www.nih.gov

Institute for Healthcare Improvement
www.ihi.org

National Healthcare Safety Network (NHSN)
www.cdc.gov/ncidod/dhqp/nhsn.html

Center for Medicare/Medicaid Services
www.cms.hhs.gov

Association for Professionals in Infection Control and Epidemiology
www.apic.org

Society for Healthcare Epidemiology of America
www.shea-online.org

 

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