Preventing surgical site infection

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Surgical site infections (SSIs) are infections at the site of an operation (usually an incision) and are caused by the operation. SSIs are the second most common type of adverse event occurring in hospitalised patients. This intervention aims to prevent SSIs through the application of the SSI components of care. The care components can drastically reduce the incidence of SSI and virtually eliminate instances of preventable SSI.

Toolkit

Preventing surgical site infections toolkit (447kb, pdf)

Tools

SSI audit summary (65kb, MS Word)
SSI audit tool (61kb, MS Word)

FAQs

Safer Systems Saving Lives FAQs - February 2006 (327kb, pdf)

Where a surgical patient has two wounds and both are infected, how do we represent this in our data collection?

The emphasis in the toolkits is on the ‘number of patients’ not the ‘number of wound infections’. Therefore, regardless of how may infections a patient may have, for the SSSL outcome measure the patient is only counted once.

Why are we not categorising surgical site infection as superficial, deep, and organ space?

The aim of the SSSL project is to prevent surgical site infections (SSIs) generally. The scope of the project is the collection of general data relating to SSIs. Therefore, the outcome measure for the SSSL project is the number of patients with wound infections, with no emphasis on category. Though infection control surveillance may require sites to categorise surgical site infections, reporting to SSSL will only be aggregated SSIs for the chosen surgical procedure.

Is the denominator for the surgical site infection outcome measure ALL patients in the hospital with surgical wounds?

No! The toolkit suggests that sites choose a specific procedure for review. It may be that smaller sites choose a group of procedures (for example, all laparotomies or all joint replacements). For the outcome measure, the numerator will be the number of audited patients (in the chosen procedure) with a wound infection, and the denominator will be the number of patients audited during the collection period.

For example, during May your site performs 40 laparotomies and you audit 20 of the patients. You find that 2 have wound infections. The outcome measure for May is:

Post discharge surveillance is very resource intensive. The scope of the SSSL does not extend to this degree, however sites that are engaged in post discharged surveillance may wish to share their results with other sites during the course of the project.

References

• Brennan, TA, Leape, LL, Laird, NM, Hebert, L, Localio, AR, Lawthers, AG, Newhouse, JP, Weiler, PC, and Hiatt, HH, 1991, ‘Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I’, New England Journal of Medicine, Volume 324, Number 6, pp 370-376.
  
  Incidence of adverse events and negligence in hospitalized patients (External link)
  http://content.nejm.org/cgi/content/short/324/6/370

• Australian Council for Safety and Quality in Health Care, 2003, National Strategy to Address health care associated infections, Fourth Report to the Australian Health Ministers’ Conference, 31 July.
  
  National Strategy to Address health care associated infections (436kb, pdf)

• Van den Berghe, G, Wouters, P, Weekers, F, Verwaest, C. Bruyninckx, F, Schetz, M, Vlasselears, D, Ferdinande, P, Lauwers, P, Bouillon, R, 2001, ‘Intensive Insulin therapy in critically ill patients’, New England Journal of Medicine, Volume 345,pp 1359-1367.
  
  Intensive Insulin therapy in critically ill patients (External link)
  http://content.nejm.org/cgi/content/short/345/19/1359

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