Becker's Clinical Quality & Infection Control

18 Infection Prevention & Control SSI Risk Factors: 3 Main Categories By Heather Punke A report from the Centers for Disease Control and Preven- tion deemed surgical site infections as the most common healthcare-associated infection, accounting for 31 percent of all HAIs among hospitalized patients. "The prevention of SSIs is of critical importance and can only be achieved through implementation of an consistent and rigid adher- ence to infection prevention standards," a report in the May issue of AORN Journal reads, and those standards must address all potential risk factors for developing SSIs. According to the report, risk factors for SSIs fall into three main cat- egories: 1. Patient characteristics, like age, obesity, malnutrition or diabetes 2. Surgery and surgeon characteristics, like the wound classifica- tion, length of procedure, skill of the surgeon, appropriate use of antibiotic prophylaxis and maintenance of normothermia throughout the perioperative experience 3. The operating room environment, including cleanliness, tem- perature and humidity levels and ventilation n As Temperatures Rise in the Summer, So Do Common SSIs By Shannon Barnet C ommon surgical site infections increase in frequency during the summer months, according to recent research published in Infec- tion Control & Hospital Epidemiology. Researchers analyzed six years of data from the 15 most commonly per- formed procedures in 20 hospitals in the Duke Infection Control Outreach Network between Jan. 1, 2007 and Dec. 31, 2012. They performed regression and sensitivity analyses on the data and stratified the results to obtain esti- mates based on procedure type and organism type. All total, they identified 4,543 SSIs following 441,428 surgical procedures. The study revealed the rate of SSIs was significantly higher during the summer compared with the remainder of the year (1.11 per 100 proce- dures versus 1 per 100 procedures, respectively). Additionally, calcula- tions revealed higher SSI rates during the summer for spinal procedures, non-spinal procedures and infections due to either gram-positive cocci or gram-negative bacilli. n to assure that everyone saw the importance of their role at Einstein Medical Center Montgomery and to celebrate the ongoing success. This enhanced the feeling that everyone makes a difference in the lives of our patients every day, every time, and helped to enhance job performance." For the patients and the triple aim Clinically, infection prevention and environmental services are critical to helping ensure patient stays are as effective and efficient as possible, without the threat of infectious diseases. However, the two departments play an im- portant nonclinical role as well. "You may not know or see what infection prevention is doing when you walk in to get your care," Dr. Anand says. "But cleanliness is something you pick up on immediately. It gives [patients] a very tangible part of their experience that the system is keeping things clean and preventing infection." To take it one step further, a strong relationship between the two departments, and an ultimate lowering of HAIs, also feeds directly into healthcare's triple aim. "If you truly have low infection rates and clean facilities, it does move the system toward better outcomes and lower costs on HAIs and a better patient and staff experience," Dr. Anand says. n A presurgical intervention that includes screening for Staphylococcus aureus and administering antibiotics based on those screening results was associated with a reduction in S. aureus surgical site infections, according to a study published in JAMA. Twenty hospitals in nine states participated in the study, which involved implementing an evidence- based bundle for patients undergoing cardiac operations or hip or knee replacement or recon- struction. Data was collected for a median of 39 months pre-intervention, and for a median of 21 months during the intervention period. Clinicians would swab patients for methicillin- resistant and methicillin-susceptible S. aureus and have patients who tested positive apply an antibiotic in their nose twice daily for up to five days and also bathe daily with chlorhexidine-glu- conate for up to five days before their operations. Overall, the pre-intervention period had an aver- age rate of 36 complex S. aureus SSIs per 10,000 operations, and the intervention period had an average rate of 21 per 10,000 operations. Com- plex S. aureus rates decreased for both hip or knee arthroplasties and cardiac operations. "Given that approximately 400,000 cardiac op- erations and 1 million total join arthroplasties are performed in the United States each year, numer- ous S. aureus SSIs, which can have catastrophic consequences, may be preventable," the research- ers wrote. "Moreover, one SSI adds from $13,000 to $100,000 to the cost of healthcare. Thus, im- plementation of this bundle might reduce patient morbidity and the costs of care substantially." In an accompanying editorial in JAMA, however, one researcher noted that decolonizing MRSA pa- tients should just be one precaution among many when it comes to preventing SSIs. "Although S. aureus remains the principal patho- gen in terms of prevalence and associated mor- bidity, many other organisms also cause SSIs," wrote Preeti Malani, MD, of the University of Michigan Health System in Ann Arbor. "As such, decolonization of MSSA and MRSA can be only one aspect of SSI prevention." n Presurgical MRSA Screening Can Help Decrease SSIs, Study Finds By Heather Punke

• Cover