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Enhanced Surgical Site Infection Surveillance Following Hysterectomy, Vascular, and Colorectal Surgery

Published online by Cambridge University Press:  02 January 2015

Deborah S. Yokoe ,
Yosef Khan ,
Margaret A. Olsen ,
David C. Hooper ,
Maurice Greenbaum ,
Johanna Vostok ,
Julie Lankiewicz ,
Victoria J. Fraser ,
Kurt B. Stevenson  and
Centers for Disease Control and Prevention Epicenters Program
Deborah S. Yokoe*
Affiliation:
Channing Laboratory and Infectious Diseases Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Yosef Khan
Affiliation:
Division of Infectious Diseases, College of Medicine and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
David C. Hooper
Affiliation:
Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Maurice Greenbaum
Affiliation:
Division of Infectious Diseases, North Shore Medical Center, Salem, Massachusetts
Johanna Vostok
Affiliation:
Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Julie Lankiewicz
Affiliation:
Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri Barnes-Jewish Hospital, St. Louis, Missouri
Kurt B. Stevenson
Affiliation:
Division of Infectious Diseases, College of Medicine and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio Department of Clinical Epidemiology, Ohio State University Medical Center, Columbus, Ohio
*
Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115 ([email protected])
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Abstract

Objective.

To evaluate the use of inpatient pharmacy and administrative data to detect surgical site infections (SSIs) following hysterectomy and colorectal and vascular surgery.

Design.

Retrospective cohort study.

Setting.

Five hospitals affiliated with academic medical centers.

Patients.

Adults who underwent abdominal or vaginal hysterectomy, colorectal surgery, or vascular surgery procedures between July 1, 2003, and June 30, 2005.

Methods.

We reviewed the medical records of weighted, random samples drawn from 3,079 abdominal and vaginal hysterectomy, 4,748 colorectal surgery, and 3,332 vascular surgery procedures. We compared routine surveillance with screening of inpatient pharmacy data and diagnosis codes and then performed medical record review to confirm SSI status.

Results.

Medical records from 823 hysterectomy, 736 colorectal surgery, and 680 vascular surgery procedures were reviewed. SSI rates determined by antimicrobial- and/or diagnosis code-based screening followed by medical record review (enhanced surveillance) were substantially higher than rates determined by routine surveillance (4.3% [95% confidence interval, 3.6%—5.1%] vs 2.7% for hysterectomies, 7.1% [95% confidence interval, 6.7%–8.2%] vs 2.0% for colorectal procedures, and 2.3% [95% confidence interval, 1.9%–2.9%] vs 1.4% for vascular procedures). Enhanced surveillance had substantially higher sensitivity than did routine surveillance to detect SSI (92% vs 59% for hysterectomies, 88% vs 22% for colorectal procedures, and 72% vs 43% for vascular procedures). A review of medical records confirmed SSI for 31% of hysterectomies, 20% of colorectal procedures, and 31% of vascular procedures that met the enhanced screening criteria.

Conclusion.

Antimicrobial- and diagnosis code-based screening may be a useful method for enhancing and streamlining SSI surveillance for a variety of surgical procedures, including those procedures targeted by the Centers for Medicare and Medicaid Services.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 8 , August 2012 , pp. 768 - 773
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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