Comparison of an algorithm, and coding data, with traditional surveillance to identify surgical site infections in Australia: a retrospective multi-centred cohort study

BACKGROUND

Surveillance of healthcare-associated infections (HAIs) in Australia is disparate, resource intensive, unsustainable, and provides limited information. Traditional HAI surveillance is time intensive and agreement levels between clinicians have been shown to be variable.

AIM

To compare two methods: a semi-automated algorithm, and coding data, against traditional surgical site infection (SSI) surveillance methods.

METHODS

This retrospective multi-centre cohort study included all patients undergoing a hip (HPRO) or knee (KPRO) prosthesis and coronary artery bypass graft (CABG) surgery during a two-year period at two large metropolitan hospitals. Routine SSI data were obtained via the infection prevention and control (IPC) team, a previously developed algorithm was applied to all patient records, and the ICD-10-AM data were searched for those categorized as having an SSI.

FINDINGS

Overall, 1447, 1416, and 1026 patients who underwent HPRO, KPRO, and CABG, respectively, were included. The highest sensitivity values were generated by the algorithm: HPRO deep or organ-space (D/O) 0.87 (95% confidence interval: 0.66-0.96), CABG 0.86 (0.64-0.96), and HPRO all SSI 0.77 (0.57-89); the lowest sensitivity was Code CABG D/O 0.03 (0.00-0.21). The highest PPV values were generated by the algorithm: HPRO D/O 0.97 (0.77-0.99), CABG D/O 0.97 (0.76-0.99), and the Code HPRO D/O 0.9 (0.66-0.99). Both the algorithm and coding data resulted in a substantial reduction in the number of medical records required to review.

CONCLUSION

The application of algorithms to enhance SSI surveillance demonstrates high accuracy in identifying patient records that require review by IPC teams to determine the presence of an SSI. Coding data alone should not be used to identify SSIs.

Service improvement study to improve care for patients who developed a surgical site infection after discharge

Background:

many patients develop surgical site infection (SSI) after they have been discharged from hospital. SSI rate is a quality measure intended to support healthcare providers with useful information to improve service and patient outcomes.

Aim:

the purpose of the study was to gain some local insight into current practice and to inform and improve clinical practice for patients who develop SSIs after they have been discharged.

Method:

a quantitative approach was taken, using retrospective data collection and analysis of patient records, of patients reviewed by the tissue viability service after discharge over a 1-year period.

Findings:

a total of 112 patients were included in the study. Of these, 59 were assessed as having developed an SSI, of whom 39 patients presented after discharge. Most of these patients had shorter inpatient stays and many were under the care of community nurses, but referral to the specialist tissue viability service to seek expert advice was often delayed.

Conclusion:

the study has highlighted the potential value of post-discharge surveillance in contributing to more accurate SSI rates, and the importance of patients and community nurses being provided with clear, understandable information to ensure patients receive timely and effective management, which could reduce the severity of, and duration of treatment for, SSIs.

The OneTogether collaborative approach to reduce the risk of surgical site infection: identifying the challenges to assuring best practice

BACKGROUND

Surgical site infections (SSI) account for 16% of healthcare associated infections, and are associated with considerable morbidity, mortality and increased costs of care. Ensuring evidence-based practice to prevent SSI is incorporated across the patient's surgical journey is complex. OneTogether is a quality improvement collaborative of infection prevention and operating department specialists, formed to support the spread and adoption of best practice to prevent SSI. This paper describes the findings of an expert workshop on infection prevention in operating departments.

METHODS

A total of 84 delegates from 75 hospitals attended the workshop, comprising 46 (55%) theatre nurses/operating department practitioners; 16 (19%) infection control practitioners and 22 (26%) other healthcare practitioners. Discussion focused on evidence, policy implementation and barriers to best practice. Responses were synthesised into a narrative review.

RESULTS

Delegates reported significant problems in translating evidence-based guidance into everyday practice, lack of local polices and poor compliance. Major barriers were lack of leadership, poorly defined responsibilities, and lack of knowledge/training.

CONCLUSIONS

This workshop has provided important insights into major challenges in assuring compliance with best practice in relation to the prevention of SSI. The OneTogether partnership aims to support healthcare practitioners to improve the outcomes of patients undergoing surgery by reducing the risk of SSI.