Hostname: page-component-77c89778f8-gq7q9 Total loading time: 0 Render date: 2024-07-22T10:14:01.828Z Has data issue: false hasContentIssue false

Surgical site infection trends in community hospitals from 2013 to 2018

Published online by Cambridge University Press:  18 July 2022

Jessica L. Seidelman*
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina
Arthur W. Baker
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina
Sarah S. Lewis
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina
Sonali D. Advani
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina
Becky Smith
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina
Deverick Anderson
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina
*
Author for correspondence: Jessica L. Seidelman, E-mail: Jessica.seidelman@duke.edu

Abstract

Objective:

Sparse recent data are available on the epidemiology of surgical site infections (SSIs) in community hospitals. Our objective was to provide updated epidemiology data on complex SSIs in community hospitals and to characterize trends of SSI prevalence rates over time.

Design:

Retrospective cohort study.

Methods:

SSI data were collected from patients undergoing 26 commonly performed surgical procedures at 32 community hospitals in the southeastern United States from 2013 to 2018. SSI prevalence rates were calculated for each year and were stratified by procedure and causative pathogen.

Results:

Over the 6-year study period, 3,561 complex (deep incisional or organ-space) SSIs occurred following 669,467 total surgeries (prevalence rate, 0.53 infections per 100 procedures). The overall complex SSI prevalence rate did not change significantly during the study period: 0.58 of 100 procedures in 2013 versus 0.53 of 100 procedures in 2018 (prevalence rate ratio [PRR], 0.84; 95% CI, 0.66–1.08; P = .16). Methicillin-sensitive Staphylococcus aureus (MSSA) complex SSIs (n = 480, 13.5%) were more common than complex SSIs caused by methicillin-resistant S. aureus (MRSA; n = 363, 10.2%).

Conclusions:

The complex SSI rate did not decrease in our cohort of community hospitals from 2013 to 2018, which is a change from prior comparisons. The reason for this stagnation is unclear. Additional research is needed to determine the proportion of or remaining SSIs that are preventable and what measures would be effective to further reduce SSI rates.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. The data from this manuscript were presented as an abstract at ID Week 2020 on October 23, 2020, held virtually.

References

Burke, JP. Infection control—a problem for patient safety. N Engl J Med 2003;348:651656.CrossRefGoogle ScholarPubMed
Lewis, SS, Moehring, RW, Chen, LF, Sexton, DJ, Anderson, DJ. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 2013;34:12291230.CrossRefGoogle Scholar
Zimlichman, E, Henderson, D, Tamir, O, et al. Healthcare-associated infections: a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med 2013;173:20392046.CrossRefGoogle Scholar
McDermott, K, Liang, Lan. Overview of operating room procedures during inpatient stays in US hospitals, 2018. Agency for Healthcare Research and Quality website. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb281-Operating-Room-Procedures-During-Hospitalization-2018.pdf. Published August 2021. Accessed October 27, 2021.Google Scholar
Karaca, Z, McDermott, K. High-volume invasive, therapeuticambulatory surgeries performed in hospital-owned facilities, 2016. Agency for Healthcare Research and Quality website. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb252-Invasive-Ambulatory-Surgeries-2016.pdf. Published 2019. Accessed October 27, 2021.Google Scholar
Scott, RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Published 2009. Accessed May 31, 2022.Google Scholar
Healthcare cost and utilization project—statistics on hospital stays. Agency for Healthcare Research and Quality website. http://hcupnet.ahrq.gov/. Published 2013. Accessed November 17, 2020.Google Scholar
Berrios-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784791.Google Scholar
Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of healthcare-associated infections in US Hospitals. N Engl J Med 2018;379:17321744.CrossRefGoogle Scholar
National data for acute-care hospitals, year 2017 HAI data. Centers for Disease Control and Prevention website. https://gis.cdc.gov/grasp/PSA/HAIreport.html. Accessed October 20, 2019.Google Scholar
Anderson, DJ, Sexton, DJ, Kanafani, ZA, Auten, G, Kaye, KS. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2007;28:10471053.CrossRefGoogle ScholarPubMed
Baker, AW, Dicks, KV, Durkin, MJ, et al. Epidemiology of surgical site infection in a community hospital network. Infect Control Hosp Epidemiol 2016;37:519526.Google Scholar
Fagernes, M, Lingaas, E. Factors interfering with the microflora on hands: a regression analysis of samples from 465 healthcare workers. J Adv Nurs 2011;67:297307.CrossRefGoogle Scholar
Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315322.CrossRefGoogle Scholar
Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute-care setting. Am J Infect Control 2008;36:309332.Google ScholarPubMed
Seidelman, JL, Smith, B, Shoff, C, et al. Serious superficial incisional surgical site infections (SSISSIs): a proposed surveillance definition. Infect Control Hosp Epidemiol 2019;40:12581259.Google ScholarPubMed
Harris, JE. Smoke yields of tobacco-specific nitrosamines in relation to FTC tar level and cigarette manufacturer: analysis of the Massachusetts Benchmark Study. Public Health Rep 2001;116:336343.Google ScholarPubMed
Badia, JM, Casey, AL, Petrosillo, N, Hudson, PM, Mitchell, SA, Crosby, C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 2017;96:115.CrossRefGoogle ScholarPubMed
Surgical site infection (SSI) event. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Updated January 2021. Accessed July 22, 2021.Google Scholar
Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101114.Google ScholarPubMed
Andersson, AE, Bergh, I, Karlsson, J, Nilsson, K. Patients’ experiences of acquiring a deep surgical site infection: an interview study. Am J Infect Control 2010;38:711717.CrossRefGoogle ScholarPubMed
de Lissovoy, G, Fraeman, K, Hutchins, V, Murphy, D, Song, D, Vaughn, BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387397.CrossRefGoogle ScholarPubMed
Baker, AW, Dicks, KV, Durkin, MJ, et al. Epidemiology of surgical site infection in a community hospital network. Infect Control Hosp Epidemiol 2016;37:519526.CrossRefGoogle Scholar
Centers for Medicare and Medicaid Services. Hospital quality initiative overview. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/downloads/hospitaloverview.pdf. Published 2008. Accessed May 31, 2022.Google Scholar
Centers for Medicare and Medicaid Services. Medicare program; hospital inpatient value-based purchasing program. Final rule. Fed Regist 2011;76:2649026547.Google Scholar
Centers for Medicare and Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute-care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals’ resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. Final rule. Fed Regist 2012;77:5325753750.Google Scholar
Tanner, J, Dumville, JC, Norman, G, Fortnam, M. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev 2016:CD004288.Google Scholar
Diab-Elschahawi, M, Berger, J, Blacky, A, et al. Impact of different-sized laminar air flow versus no laminar air flow on bacterial counts in the operating room during orthopedic surgery. Am J Infect Control 2011;39:e25e29.Google ScholarPubMed
Baker, A, Ilies, I, Benneyan, J, et al. Early recognition and response to increases in surgical site infections (SSI) using optimized statistical process control (SPC) charts— the early 2RIS trial: a multicenter stepped wedge cluster randomized controlled trial (RCT). Presented at IDWeek 2021, September 29–October 3, 2021, held virtually.Google Scholar
Wenzel, RP. Surgical site infections and the microbiome: an updated perspective. Infect Control Hosp Epidemiol 2019;40:590596.CrossRefGoogle ScholarPubMed
Fields, AC, Pradarelli, JC, Itani, KM. Preventing surgical site infections: looking beyond the current guidelines. JAMA 2020;323:10871088.CrossRefGoogle ScholarPubMed
Anderson, DJ, Ilieş, I, Foy, K, et al. Early recognition and response to increases in surgical site infections using optimized statistical process control charts—the early 2RIS trial: a multicenter cluster randomized controlled trial with stepped wedge design. Trials 2020;21:894.Google Scholar