Surgical Procedures Presented by Audrey Adams RN MPH CIC Director of I nfection P revention amp C ontrol Background of Hospital Acquired Infections HAI Significant economic consequences ID: 907827
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Slide1
Surveillance of Abdominal Hysterectomy Surgical Procedures
Presented by: Audrey Adams, RN, MPH, CIC
Director of
I
nfection
P
revention &
C
ontrol
Slide2Background of Hospital Acquired Infections (HAI)Significant economic consequences:Estimated cost of $4.5 billion.Fifth leading cause of death in hospitals.
Slide3Four leading categories of infection: Catheter-associated urinary tract infections (CAUTIs)Surgical site infections (SSIs)Central line associated bloodstream infections (CLABSIs)
And
ventilator-associated pneumonia (
VAP
).
Slide4Incidence of HAIs has increased by 36% in the last 20 yearsA major public health problem worldwideAffect >10% of hospitalized patients annually with over 2 million infections and >90,000 deaths.Background of Hospital Acquired Infections (HAI)
Slide5Burden of HAIMajor Site of InfectionTotalInfections
Hospital
Cost Per
Infection
Total Annual
Hospital Cost
(
in millions
)
Deaths
Per YearSurgical Site Infections290,485$25,546$7,42113,088Central Line-Associated Bloodstream Infections248,678$36,441$9, 06230,665Ventilator-Associated Pneumonia (lung infection)250,205$9,969$2,49435,967Catheter-Associated UrinaryTract Infection561,667$1,006$5658,205
Source: U.S. Department of Health & Human Services 2009
Slide6Background of Hospital Acquired Infections (HAI)It has been demonstrated that many HAIs are preventable by implementing evidence base prevention strategies.To ensure that hospitals recognize their role in preventing HAIs, State and national regulatory agencies have required reporting of specific HAIs.
Slide7Affordable Care Act Hospital Acquired ConditionsSec. 3008. PAYMENT ADJUSTMENT FOR CONDITIONS ACQUIRED IN HOSPITALSPenalizes hospitals for hospital-acquired conditions (HACs) Beginning in 2015 CMS subtracts 1% of payments from hospitals with the highest rates of HACs (bottom quartile performers when compared to the national average). Results in system-wide reduction of $1.5 billion over 10 years.
Slide8CMS Mandated HAI Reporting to NHSNYEARHAI REPORTING2011CLABSI – Acute Care ICUs (Jan)2012
CAUTI – Acute
Care ICUs (except NICUs) (Jan)
CAUTI – LTCH, IRF, Cancer Hospitals (Oct)
SSI – Colon and Abdominal Hysterectomy Surgeries – Acute Care (Jan)
Dialysis Events – ESRD (Jan)CLABSIs – LTCH, Cancer Hospitals (Oct)
2013
C. Difficile
LabID Events –
Acute Care (Jan)
MRSA Bacteremia LabID Events – Acute Care (Jan)HCP Influenza Vaccination – Acute Care (Jan)HCP Influenza Vaccination – LTCH (Jan)2014HCP Influenza Vaccination – ASCs (Oct)SSI – Cancer Hospitals (Jan)HCP Influenza Vaccination – IRF (Oct)2015CLABSI – Acute Care Med, Surg, Med/Surg Units (Jan)CAUTI – Acute Care Med, Surg, Med/Surg Units (Jan)MRSA Bacteremia LabID Events – LTCH (Jan)C. Difficile LabID Events – LTCH (Jan)
Slide9ObjectivesTo perform an overall analysis of SSIs related to total abdominal hysterectomies (TAH) in 2012.Investigation of indicators for TAH and associated infection risk.
Slide10MethodsThe NHSN Patient Safety Component was used to perform surveillance of TAH.Using inpatient procedure codes, each procedure was classified into 1 of 9 procedure codes.The NHSN data base was used to identify specific SSI events, along with the mode of detection and organisms associated with the SSIs.The use of prophylactic antibiotics for SSIs was determined by chart review.
Slide11Slide12Slide13Slide14Slide15NHSN - Surgical Site Infections (SSIs) DefinedSIP - Super incisional primary surgical site infectionSIS - Superficial incisional secondary surgical site infectionDIP
- Deep incisional primary surgical site
infection
DIS
- Deep incisional secondary surgical site infectionIAB
- Intraabdominal surgical site infection
Slide16Slide17SSI DetectionTable 3Detection of SSIs Number
of SSIs
Total
SSIs
Percent
Of
Total
During Admission
2
30
7Post Discharge Surveillance103020Readmission163053Readmission to Another Facility2307
Slide18ConclusionsForty percent (40%) of the SSIs were superficial.Electronic medical records, which extend to ambulatory sites, facilitated the identification of 10 (33%) SSIs via post discharge surveillance.Enterococcus (30%) and S. aureus (14%) were the highest proportion of organisms identified.Of the 29 prophylactic antibiotic agents given for those with SSIs, 69% were appropriate.
Slide19Conclusions (cont.)Of the 30 SSIs identified, 29 received prophylactic antibiotics. Thirty-one percent (31%) of these did not receive required re-dosing after 4 hours of surgery.Although TAH are performed for a variety of indications, it appears that no one indication carries a higher infection risk than others. However, this conclusion should be tempered by the small sample sizes.There may be risk factors for TAH SSIs as yet to be determined. Further investigation is required for risk stratification of TAH with larger sample size.
Slide20Hysterectomy Surgical Site Infection RatesEinstein CampusMoses Campus
Wakefield Campus
2.6
2.1
3.3
1.4
1.8
0.5
Slide21Infection Prevention & Control is in YOUR hands!