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Effect of National Healthcare Safety Network (NHSN) Definition Changes on Colon Surgical Site Infection (SSI) Rates
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Oral Abstracts / American Journal of Infection Control 42 (2014) S3-S28
RESULTS: 417 colon procedures were identified. The SSI rate was 3.1% (13/417) by current case finding Methods. Six procedures were identified as non-colon or duplicate procedures and excluded from review. Chart review identified 34 SSI. Applying the 2012 NHSN definitions Results in an SSI rate of 5.5% (19/343); 68 (16.5%) procedures were not primarily closed including 3 (8.8%) SSI; and 12 (35.3%) of the infections identified were excluded based on the POP table. Using 2013 NHSN definitions, 45 (10.9%) procedures were not primarily closed and 34 infections were included for a 9.3% (34/ 366) SSI rate. See Table 1 for additional results.
LESSON LEARNED: A systematic, multidisciplinary approach is needed to effectively reduce the frequency of IUSS and to achieve sustainable outcomes. Although great success has been achieved, it is important to remember that quality improvement is an ongoing process. Staff involvement is crucial to promote sustainability and to increase the likelihood of success.
Surveillance Publication Number 412 Effect of National Healthcare Safety Network (NHSN) Definition Changes on Colon Surgical Site Infection (SSI) Rates Jeanne A. Yegge RN, BSN, MPH, CIC, Infection Prevention Specialist, Missouri Baptist Medical Center; Kathleen Gase MPH, CIC, Manager Infection Prevention and Quality Patient Care, BJC HealthCare System; Melinda Hohrein, Data Analyst, BJC HealthCare; Raya Khoury MPH, Epidemiologist/Analyst, BJC HealthCare; Hilary Babcock MD, MPH, Associate Professor of Medicine, Infectious Diseases, Washington University School of Medicine BACKGROUND/OBJECTIVES: Current case finding Methods for identifying colon SSI involve Infection Preventionists (IP) assessing candidate infections flagged by an electronic algorithm without a systematic process to identify all procedures that are not primarily closed. In 2013, NHSN broadened the primarily closed definition and updated the principal operative procedure (POP) Table. The objectives of this study are to assess the effect of these definition changes on colon SSI rates and validate the use of electronic algorithms. METHODS: All colon procedures (identified by ICD-9 code) performed in 4th quarter 2012 at 10 adult hospitals were included. A single clinical abstractor screened the medical records and flagged those that were potentially left open and/or infected. A single IP reviewed those flagged procedures to confirm closure and infection status. This review was compared to current case finding Methods as well as to the 2013 NHSN definitions. SSI rates were calculated by dividing the number of colon SSIs by the number of colon procedures and multiplying by 100. A chi-square statistic was used to compare the rates.
CONCLUSIONS: NHSN’s POP table change significantly impacts colon SSI rates. Changes to the primary closure definition and manual review for SSI do not significantly change the overall rate. These findings validate the use of electronic algorithms to decrease IP surveillance workload, and have been used to communicate with leadership regarding the differences between 2012 and 2013 SSI rates. This review will be utilized to develop electronic mechanisms to meet the 2014 open procedure requirement.
Publication Number 413 The Burden of Mucosal Barrier Injury Laboratory-confirmed Bloodstream Infection Among Hematology, Oncology and Stem Cell Transplant Patients Kristen Metzger MPH, CIC, Infection Preventionist, Northwestern Memorial Hospital; Yvonne Rucker MSN, RN, NE-BC, OCN, Performance Manager, Oncology, Northwestern Memorial Hospital; Mary Callaghan MN, RN, AOCNS, APN, Clinical Nurse Specialist, Northwestern Memorial Hospital; Michelle Churchill MSN, ANP-BC, OCN, Palliative Care Nurse Practitioner, Northshore University Health System, Highland Park Hospital; Maureen Bolon MD, MS, Medical Director, Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital Northwestern University Feinberg School of Medicine BACKGROUND: In 2013, Centers for Disease Control and Prevention released a revised central line-associated bloodstream infection (CLABSI) surveillance protocol which differentiates laboratoryconfirmed bloodstream infection (LCBI) from mucosal barrier injury LCBI (MBI-LCBI). The objectives of this study were to determine the
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014
Oral Abstracts / American Journal of Infection Control 42 (2014) S3-S28
RESULTS: 417 colon procedures were identified. The SSI rate was 3.1% (13/417) by current case finding Methods. Six procedures were identified as non-colon or duplicate procedures and excluded from review. Chart review identified 34 SSI. Applying the 2012 NHSN definitions Results in an SSI rate of 5.5% (19/343); 68 (16.5%) procedures were not primarily closed including 3 (8.8%) SSI; and 12 (35.3%) of the infections identified were excluded based on the POP table. Using 2013 NHSN definitions, 45 (10.9%) procedures were not primarily closed and 34 infections were included for a 9.3% (34/ 366) SSI rate. See Table 1 for additional results.
LESSON LEARNED: A systematic, multidisciplinary approach is needed to effectively reduce the frequency of IUSS and to achieve sustainable outcomes. Although great success has been achieved, it is important to remember that quality improvement is an ongoing process. Staff involvement is crucial to promote sustainability and to increase the likelihood of success.
Surveillance Publication Number 412 Effect of National Healthcare Safety Network (NHSN) Definition Changes on Colon Surgical Site Infection (SSI) Rates Jeanne A. Yegge RN, BSN, MPH, CIC, Infection Prevention Specialist, Missouri Baptist Medical Center; Kathleen Gase MPH, CIC, Manager Infection Prevention and Quality Patient Care, BJC HealthCare System; Melinda Hohrein, Data Analyst, BJC HealthCare; Raya Khoury MPH, Epidemiologist/Analyst, BJC HealthCare; Hilary Babcock MD, MPH, Associate Professor of Medicine, Infectious Diseases, Washington University School of Medicine BACKGROUND/OBJECTIVES: Current case finding Methods for identifying colon SSI involve Infection Preventionists (IP) assessing candidate infections flagged by an electronic algorithm without a systematic process to identify all procedures that are not primarily closed. In 2013, NHSN broadened the primarily closed definition and updated the principal operative procedure (POP) Table. The objectives of this study are to assess the effect of these definition changes on colon SSI rates and validate the use of electronic algorithms. METHODS: All colon procedures (identified by ICD-9 code) performed in 4th quarter 2012 at 10 adult hospitals were included. A single clinical abstractor screened the medical records and flagged those that were potentially left open and/or infected. A single IP reviewed those flagged procedures to confirm closure and infection status. This review was compared to current case finding Methods as well as to the 2013 NHSN definitions. SSI rates were calculated by dividing the number of colon SSIs by the number of colon procedures and multiplying by 100. A chi-square statistic was used to compare the rates.
CONCLUSIONS: NHSN’s POP table change significantly impacts colon SSI rates. Changes to the primary closure definition and manual review for SSI do not significantly change the overall rate. These findings validate the use of electronic algorithms to decrease IP surveillance workload, and have been used to communicate with leadership regarding the differences between 2012 and 2013 SSI rates. This review will be utilized to develop electronic mechanisms to meet the 2014 open procedure requirement.
Publication Number 413 The Burden of Mucosal Barrier Injury Laboratory-confirmed Bloodstream Infection Among Hematology, Oncology and Stem Cell Transplant Patients Kristen Metzger MPH, CIC, Infection Preventionist, Northwestern Memorial Hospital; Yvonne Rucker MSN, RN, NE-BC, OCN, Performance Manager, Oncology, Northwestern Memorial Hospital; Mary Callaghan MN, RN, AOCNS, APN, Clinical Nurse Specialist, Northwestern Memorial Hospital; Michelle Churchill MSN, ANP-BC, OCN, Palliative Care Nurse Practitioner, Northshore University Health System, Highland Park Hospital; Maureen Bolon MD, MS, Medical Director, Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital Northwestern University Feinberg School of Medicine BACKGROUND: In 2013, Centers for Disease Control and Prevention released a revised central line-associated bloodstream infection (CLABSI) surveillance protocol which differentiates laboratoryconfirmed bloodstream infection (LCBI) from mucosal barrier injury LCBI (MBI-LCBI). The objectives of this study were to determine the
APIC 41st Annual Educational Conference & International Meeting j Anaheim, CA j June 7-9, 2014