Becker's Clinical Quality & Infection Control

83 Executive Briefing Sponsored by: R educing hospital-acquired infections is a top priority for CMS, the CDC and healthcare providers. While significant progress has been made over the past decade to decrease certain types of hospital acquired infections (HAIs), progress on surgical site infection (SSI) reduction has been mostly stagnant. Overall, SSIs occur in 2 to 5 percent of all inpatient surgeries and affect as many as 300,000 patients every year. The estimated annual cost of treating SSIs ranges from $3.5 billion to $10 billion, according to research compiled by the American College of Surgeons. While the overall SSI rate is alarming — especially since many SSIs are preventable — even more concerning is the rate of SSIs for high-risk surgeries. For example, colorectal surgery is associated with SSI rates that are 5 percent to 45 percent higher than other forms of surgery. Becker's Hospital Review recently spoke with three leading surgeons about SSIs and what actions can be taken to help protect high-risk surgery patients from these infections. The surgeons discussed why SSI rates remain so high for abdominal surgeries and what their organizations are doing to help reduce SSIs. Participants included: • J. Augusto Bastidas, MD, surgical director of Los Gatos, Calif.-based National Surgical Associates • Kevin Chan, MD, associate clinical professor in the division of urology and urologic oncology in the department of surgery at Duarte, Calif.-based City of Hope • Ran Kim, MD, colon and rectal surgeon with Concord, Calif.-based John Muir Hospital Dr. Bastidas' practice focuses on gastrointestinal surgery, including patients with gastrointestinal cancers. His patients represent a high-risk population as they tend to be older and frail. Dr. Chan specializes in bladder reconstruction for patients with bladder cancer. Dr. Kim performs several types of complex abdominal surgeries. Note: Responses have been edited for length and clarity Question: Why do SSIs remain such a significant problem, especially for abdominal surgery? Dr. J. Augusto Bastidas: No part of the human body is sterile. There are bacteria on the skin and in the gut. Wound infection will occur in any environment. Because I have a high-risk patient population, I expect a soft tissue infection rate in the 10 percent to 20 percent range. Dr. Ran Kim: Abdominal surgeries deal with cutting and perforating the intestine, and exposure of intestinal contents. These surgeries often involve a big incision, often around 10 inches. The bigger the wound, the greater the risk of contamination from bacteria. Dr. Kevin Chan: The surgeries I perform involve making a new bladder, which is very complex. The bowel is open for a long period, typically over an hour. It's messy, and complications, infections and readmissions are common. It is part of the nature of the surgery. Q: Is the SSI problem being overlooked or taken for granted? Do some surgeons believe their SSIs rates aren't a problem? Chan: I certainly don't overlook or take SSIs for granted. Radical cystectomy with urinary diversion has an expected 60 to 80 percent complication rate and about 30 percent of major complications are infections. My mission in life is to lower complication rates. Working to further lower SSI rates is essential because SSIs have costs to the hospital and to patients. There is morbidity, there is pain for patients, there are readmissions and additional procedures and there are a lot of downstream consequences. Kim: When I did my residency training, which was before 2000, there was no talk about SSIs. But about seven or eight years ago that changed. It was driven by hospitals, which realized that SSIs and readmissions are very costly. Most hospitals and health systems have now made surgeons aware of the problem. Bastidas: I think many surgeons are unaware of their actual complication rates. There are not always systems in place to track infections and provide data to the surgeon. That's a big problem because if you are not aware of the data, you can't address it. Surgeons Find New Ways to Prevent Infection in High-Risk Surgeries

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