Tham N, Fazio T, Johnson D, et al. World J Surg. 2022;46:1249-1258.
The COVID-19 pandemic led to changes in infection control and prevention measures to limit nosocomial spread. This retrospective cohort study found that escalations in infection prevention and control practices due to the COVID-19 pandemic did not affect the incidence of other hospital-acquired infections among surgical patients at one Australian hospital. The authors posit that this may be due to high compliance with existing infection prevention and control practices pre-pandemic.
Forrester JD, Maggio PM, Tennakoon L. J Patient Saf. 2022;18:e477-e479.
Healthcare-associated infections (HAIs) result in poorer patient outcomes and increased costs. The 2016 national data set of five common HAIs (surgical site infections, catheter- and line-associated bloodstream infections, catheter-associate urinary tract infections, ventilator-associated pneumonia, and Clostridioides difficile) was analyzed to create an estimated national cost. Clostridioides difficile was the most frequently reported; Clostridioides difficile and surgical site infections accounted for 79% of costs.
Gillespie BM, Harbeck EL, Rattray M, et al. Int J Surg. 2021;95:106136.
Surgical site infections (SSI) are a common, yet largely preventable, complication of surgery which can result in increased length of stay and hospital readmission. In this review of 57 studies, the cumulative incidence of SSI was 11% in adult general surgical patients and was associated with increased length of stay (with variation by types of surgery).
This article describes the development and validation of a decision support model to support healthcare leadership when prioritizing quality improvement initiatives related to four common healthcare-associated infections.
Sood N, Lee RE, To JK, et al. Birth. 2022;49:141-146.
Cesarean delivery can contribute to increased maternal morbidity. This retrospective study found that the introduction of a hospital-wide perioperative bundle significantly reduced surgical site infection rates. The perioperative bundle consisted of five elements (1) an antibiotic protocol, (2) preoperative warming and intraoperative maintenance of normal temperature, (3) standardized surgical preparation for each patient, (4) use of standardized fascial closure trays, and (5) standardized intraoperative application of wound dressing.
Weiner-Lastinger LM, Pattabiraman V, Konnor RY, et al. Infect Control Hosp Epidemiol. 2022;43:12-25.
Using data reported to the National Healthcare Safety Network, this study identified significant increases in the incidence of healthcare-associated infections from 2019 to 2020. The authors conclude that these findings suggest a need to return to conventional infection control and prevention practices and prepare for future pandemics.
Velmahos CS, Kokoroskos N, Tarabanis C, et al. World J Surg. 2021;45:690-696.
The authors retrospectively reviewed records for 150 patients undergoing emergency surgery who experienced a preventable complication and/or death. The most common preventable complication was surgical site infections. The majority of complications were attributed to personal performance (technical or judgement issues) and a small proportion (3%) were attributed to systemic issues, such as poor communication or inadequate protocols.
Sweet W, Snyder D, Raymond M. J Healthc Risk Manage. 2020.
This article describes one health system’s experience implementing an infection prevention program into risk management in an outpatient setting. Over a two-year period post-implementation, the system identified and corrected high-risk practices, increased compliance to device guidance, increased efficiency with the use of central sterile processing departments, and developed a staff competency training structure.
Dieplinger B, Egger M, Jezek C, et al. Am J Infect Control. 2020;48:386-390.
This observational study enrolled 2,576 women undergoing cesarean delivery at a single tertiary care hospital over a five-year period to evaluate the impact of an evidence-based bundle on surgical site infections. The comprehensive and multidisciplinary bundle included preoperative, intraoperative and postoperative actions. Implementation of the bundle resulted in a 60% reduction in the risk of surgical site infections, from 1.5% in the preintervention period to 0.56% after implementation.
Health Care-Associated Infections. APSF Newsletter. October 2019;34:29-56.
Surgical patients are at increased risk for harm due to healthcare associated infection. This special issue explores the anesthesiologist's role in infection prevention and the importance of emphasizing hand hygiene and disinfection efforts in the perioperative environment.
Infections after surgery are common and frequently lead to hospital readmission and other adverse consequences for patients. Recent programs, including several led by the Agency for Healthcare Research and Quality, have demonstrated how hospitals can successfully prevent these infections.
Chang BH, Hsu Y-J, Rosen MA, et al. Am J Med Qual. 2020;35:37-45.
Preventing health care–associated infections remains a patient safety priority. This multisite study compared rates of central line–associated bloodstream infections, surgical site infections, and ventilator-associated pneumonia before and after implementation of a multifaceted intervention. Investigators adopted the comprehensive unit-based safety program, which emphasizes safety culture and includes staff education, identification of safety risks, leadership engagement, and team training. Central line–associated bloodstream infections and surgical site infections initially declined, but rates returned to baseline in the third year. They were unable to measure differences in ventilator-associated pneumonia rates due to a change in the definition. These results demonstrate the challenge of implementing and sustaining evidence-based safety practices in real-world clinical settings. A past PSNet interview discussed infection prevention and patient safety.
Failure to adhere to evidenced-based practices can result in patient harm. This article explores how high reliability concepts can support the reliable use of best practices to prevent surgical site infections. The authors suggest a framework focused on team engagement, education, implementation, and evaluation to encourage the use of evidence-based practice on the front line.
Mohajer MA, Joiner KA, Nix DE. Acad Med. 2018;93:1827-1832.
The Hospital-Acquired Condition Reduction Program (HACRP) was established by the Centers for Medicare and Medicaid Services (CMS) and withholds payment to hospitals for several hospital-acquired conditions deemed to be preventable sources of patient harm. Prior research has shown that teaching hospitals, hospitals caring for more complicated and high-risk patients, and safety-net hospitals may be more likely to experience financial penalties under HACRP compared to nonteaching hospitals caring for less sick patients. These findings raised concerns regarding the possible unintended consequences related to pay-for-performance. Researchers sought to identify factors associated with HACRP performance and penalties. They found that teaching institutions and hospitals with higher case-mix index, length of stay, and those located in the Northeast or Western United States were more likely to receive penalties under the CMS program. A previous WebM&M commentary discussed the unintended consequences associated with publicly reported health care quality measures.
Broman KK, Gaskill CE, Faqih A, et al. JAMA Surg. 2019;154:117-124.
This prospective study examined the impact of wound photography on surgeons' remote diagnosis and suggestions for management of surgical site infections (SSIs). When wound photographs were provided along with clinical scenarios, researchers found no change in diagnostic accuracy, a decrease in sensitivity, and an increase in specificity. The inclusion of images led to changes in surgeons' assessments in 27% of cases, both from correct to incorrect and incorrect to correct in almost equal numbers. Surgeons did report improved confidence in diagnosis of SSIs when photographs were included, whether or not their assessment was correct.
Anand P, Kranker K, Chen AY. Health Serv Res. 2019;54:86-96.
Pressure ulcers, surgical site infections, and other hospital-acquired conditions are common preventable harms in hospitals. In 2008, the Centers for Medicare and Medicaid Services stopped paying for care related to preventable hospital-acquired conditions. Investigators estimated the financial cost of those conditions using a national database. Added cost varied from $32,000 for a surgical site infection to $9000 for a hospital-acquired urinary tract infection. Certain conditions increased the total cost of the hospital stay by more than 50%. Patients with preventable hospital-acquired conditions were more likely to be readmitted within 90 days. A WebM&M commentary explored the cascade of events that can lead to a hospital-acquired bloodstream infection and how to prevent them.
Lin DM, Carson KA, Lubomski LH, et al. J Am Coll Surg. 2018;227:189-197.e1.
This pre–post study applied an evidence-based approach—the AHRQ Safety Program for Surgery—to colorectal cancer surgeries. The program was associated with a significant reduction in surgical site infections and an improvement in safety culture.
Anderson KT, Appelbaum R, Bartz-Kurycki MA, et al. Semin Pediatr Surg. 2018;27:92-101.
Clinical skill development in surgery is evolving beyond technical expertise as focus has shifted to how teamwork and human factors affect safety. This commentary describes three key activities associated with surgical safety efforts, including monitoring surgical quality through national data analysis, bundling field-tested processes to prevent surgical site infections, and utilizing surgical checklists.
Rockville, MD: Agency for Healthcare Research and Quality. December 2017. AHRQ Publication No. 16(18)-0004-1-EF.
Large-scale collaboratives have achieved success in implementing patient safety improvements. This report describes the work and outcomes of a 3-year surgical safety program funded by AHRQ that involved more than 200 hospitals in the United States. The project employed models and tools to implement surgical site infection prevention strategies. Participants reported substantial reductions of surgical site infections in their facilities.
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