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Surveillance of  Abdominal Hysterectomy Surveillance of  Abdominal Hysterectomy

Surveillance of Abdominal Hysterectomy - PowerPoint Presentation

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Surveillance of Abdominal Hysterectomy - PPT Presentation

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

jan ssis infection site ssis jan site infection surgical care infections acute hospitals hospital acquired events tah ltch med

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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

Slide2

Background of Hospital Acquired Infections (HAI)Significant economic consequences:Estimated cost of $4.5 billion.Fifth leading cause of death in hospitals.

Slide3

Four 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

).

Slide4

Incidence 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)

Slide5

Burden 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

Slide6

Background 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.

Slide7

Affordable 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.

Slide8

CMS 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)

Slide9

ObjectivesTo perform an overall analysis of SSIs related to total abdominal hysterectomies (TAH) in 2012.Investigation of indicators for TAH and associated infection risk.

Slide10

MethodsThe 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.

Slide11

Slide12

Slide13

Slide14

Slide15

NHSN - 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

Slide16

Slide17

SSI DetectionTable 3Detection of SSIs  Number

of SSIs

Total

SSIs

Percent

Of

Total

During Admission

2

30

7Post Discharge Surveillance103020Readmission163053Readmission to Another Facility2307

Slide18

ConclusionsForty 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.

Slide19

Conclusions (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.

Slide20

Hysterectomy Surgical Site Infection RatesEinstein CampusMoses Campus

Wakefield Campus

2.6

2.1

3.3

1.4

1.8

0.5

Slide21

Infection Prevention & Control is in YOUR hands!