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Search results for "United States of America"

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Journal Article > Study

Proactive risk assessment of surgical site infections in ambulatory surgery centers.

Bish EK, Azadeh-Fard N, Steighner LA, Hall KK, Slonim AD. J Patient Saf. 2017;13:69-75.

This study reports on the use of a prospective risk assessment tool to identify risks for surgical site infection in an ambulatory surgery center. A safety intervention was developed that specifically targeted the vulnerabilities identified by the risk assessment. Other methods of prospective error detection are discussed in the Detection of Safety Hazards Patient Safety Primer.

Clinical Guideline

Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.

Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. JAMA Surg. 2017 May 3; [Epub ahead of print].

Surgical site infections are a common hospital-acquired condition. This clinical guideline reviews the literature and gathers expert opinion to identify generalizable evidence-based strategies to reduce surgical site infections. The authors highlight antimicrobial, preoperative hygiene, glycemic control, and skin preparation procedures to prevent infection.

Tools/Toolkit > Government Resource

Toolkit To Improve Safety in Ambulatory Surgery Centers.

Agency for Healthcare Research and Quality: Rockville, MD.

Ambulatory surgery centers provide care to growing numbers of patients. This toolkit draws from AHRQ's Comprehensive Unit-based Safety Program to help ambulatory surgical center teams develop communication and teamwork skills to reduce infections and other iatrogenic harms.

Journal Article > Organizational Policy/Guidelines

American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update.

Ban KA, Minei JP, Laronga C, et al. J Am Coll Surg. 2017;224:59-74.

Surgical site infections are a persistent and costly challenge to patient safety. These guidelines provide recommendations to reduce this common hospital-acquired condition, including policies for surgeon attire, hand hygiene, and equipment sterilization.

Journal Article > Commentary

Consensus bundle on prevention of surgical site infections after major gynecologic surgery.

Pellegrini JE, Toledo P, Soper DE, et al. Obstet Gynecol. 2017;129:50-61.

Surgical site infections are a common complication, and they can have serious consequences. This consensus statement provides a set of recommendations to prevent surgical site infections in gynecologic surgical care that focus on readiness, recognition and prevention, response, and reporting and systems learning. The authors highlight the importance of teamwork and communication to achieving success and suggest that components of the bundle are applicable across a variety of surgical settings.

Newspaper/Magazine Article

More than half a million heart surgery patients at risk of a dangerous infection.

Sun LH. The Washington Post. October 13, 2016.

Medical devices can contribute to the spread of health care–associated infections. This news article discusses a government report that raises concerns that patients may have been exposed to a deadly bacterial infection related to an essential piece of equipment used in cardiac surgery worldwide. The resulting infection can be difficult to diagnosis as symptoms may remain dormant for months after the initial exposure.

Journal Article > Study

Operating room traffic as a modifiable risk factor for surgical site infection.

Wanta BT, Glasgow AE, Habermann EB, et al. Surg Infect (Larchmt). 2016;17:755-760.

Surgical site infections are an important type of health care–associated infection that safety efforts aim to prevent. This case-control study compared patients matched on age, gender, and elective procedure who developed surgical site infections with those who did not. Although investigators hypothesized that having additional personnel in the operating room would lead to higher likelihood of infection, after adjusting for patient- and procedure-related factors, they found this was not the case.

Journal Article > Study

Impact of hospital-acquired conditions on financial liabilities for Medicare patients.

Coomer NM, Kandilov AMG. Am J Infect Control. 2016;44:1326-1334.

Hospital-acquired conditions (HACs) are a costly source of patient harms. Prior analyses have suggested that HACs lead to nearly $150 million per year in excess Medicare costs. Examining the financial burdens placed on Medicare patients who develop an HAC, this study found that these patients are liable for increased deductibles, copayments, and coinsurance, resulting in approximately $20.5 million per year in added cost burdens.

Journal Article > Study

Association of safety culture with surgical site infection outcomes.

  • Classic

Fan CJ, Pawlik TM, Daniels T, et al. J Am Coll Surg. 2016;222:122-128.

Safety culture is widely measured and discussed, but its link to patient outcomes has not been consistently demonstrated. Surgical site infections are considered preventable adverse events. In this cross-sectional study, investigators found that better safety culture was associated with lower rates of surgical site infections after colon surgery. Specifically, aspects of safety culture associated with teamwork, communication, engaged leadership, and nonpunitive response to error were linked to fewer infections. Although this work does not establish a clear cause-and-effect relationship between safety culture and patient outcomes, it suggests that efforts to enhance safety culture could improve patient outcomes.

Journal Article > Study

The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings.

Keenan JE, Speicher PJ, Thacker JKM, Walter M, Kuchibhatla M, Mantyh CR. JAMA Surg. 2014;149:1045-1052.

Surgical site infections are a major contributor to the overall burden of health care–associated infections. In this study, implementation of a formal bundle for preventing surgical site infections resulted in a significant decrease in both superficial infections and postoperative sepsis.

Journal Article > Study

Costs associated with surgical site infections in Veterans Affairs hospitals.

Schweizer ML, Cullen JJ, Perencevich EN, Vaughan Sarrazin MS. JAMA Surg. 2014;149:575-581.

This analysis found that excess hospital costs are significant for patients who experience surgical site infections in the Veterans Affairs system. The authors highlight how adhering to proven practices to reduce postoperative infections provides an opportunity to enhance safety while decreasing costs.

Journal Article > Commentary

Back to basics: preventing surgical site infections.

Spruce L. AORN J. 2014;99:600-611.

Surgical site infections are a common yet preventable unintended consequence of surgery. This commentary describes strategies to reduce such infections, including hand hygiene adherence, checklist use, and speaking up when team members display poor compliance with best practices.

Journal Article > Commentary

Standardization in patient safety: the WHO High 5s project.

Leotsakos A, Zheng H, Croteau R, et al. Int J Qual Health Care. 2014;26:109-116.

This commentary describes a World Health Organization effort to design and apply standardized care processes to address safety concerns. Three standards (surgical site identification, medication reconciliation, and concentrated injectable medicines) have been developed and implemented in multiple countries in the past 5 years.

Journal Article > Study

Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program.

Gibson A, Tevis S, Kennedy G. Am J Surg. 2014;207:832-839.

The National Surgical Quality Improvement Program (NSQIP) was developed to monitor and enhance the quality of surgical care. This retrospective study used the NSQIP indicators to identify cases of surgical site infections. Researchers found that nearly 50% of patients were diagnosed following hospital discharge, and many of these infections led to readmissions. Patients who presented with a surgical site infection after discharge were less likely to smoke or have chronic cardiopulmonary illness. The authors suggest that closer postdischarge follow-up might have prevented some readmissions they identified. However, prior studies did not show a benefit to early follow-up. A past AHRQ WebM&M commentary discussed environmental safety in the operating room and its relationship to surgical site infections.

Audiovisual

Reducing Colorectal Surgical Site Infections.

Oakbrook Terrace, IL: Joint Commission Center for Transforming Health Care. Chicago, IL: American College of Surgeons. November 2012.

Some of the most prominent successes in the patient safety field have been achieved in preventing health care–associated infections. Sponsored by The Joint Commission Center for Transforming Healthcare and the American College of Surgeons, this effort used rigorous quality improvement methodology and a collaborative approach across seven participating hospitals to tackle the problem of surgical site infections (SSIs) in patients undergoing colorectal surgery. The project was a remarkable success, achieving a 32% reduction in SSIs during the study period. The Center for Transforming Healthcare is also sponsoring efforts to prevent wrong-site surgery and improve hand hygiene and handoff communications.

Book/Report

Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection: Final Contract Report.

Price CS, Savitz LA. Rockville, MD: Agency for Healthcare Research and Quality; March 2012. AHRQ Publication No. 12-0046-EF.

This report explores techniques to detect and monitor surgical site infections (SSIs), evaluates a computer-assisted algorithm to identify patients at risk for SSIs, and makes recommendations to investigate surgery-specific risk factors.

Journal Article > Study

Implementation of a surgical comprehensive unit-based safety program to reduce surgical site infections.

Wick EC, Hobson DB, Bennett JL, et al. J Am Coll Surg. 2012;215;193-200.

Implementation of a comprehensive unit-based safety program was associated with a reduction in surgical site infection rates at a tertiary care hospital.

Journal Article > Study

Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period.

Haynes K, Linkin DR, Fishman NO, et al. J Am Med Inform Assoc. 2011;18:164-168.

A standardized order set within a computerized provider order entry system improved appropriateness of antibiotics to prevent surgical site infections.

Journal Article > Study

Evaluating an evidence-based bundle for preventing surgical site infection.

Anthony T, Murray BW, Sum-Ping JT, et al. Arch Surg. 2011;146:263-269.

Checklists of evidence-based interventions have resulted in notable successes in patient safety, particularly in preventing central line–associated bloodstream infections. This randomized controlled trial attempted to extend the checklist approach to prevention of surgical site infection. However, despite implementing five evidence-based practices in a bundled approach, the incidence of postoperative infections was actually higher in the intervention group compared with patients receiving standard infection prophylaxis. A commentary by the developers of the Keystone ICU checklist discusses the utility and limitations of checklists in improving safety.

Journal Article > Study

Hospital process compliance and surgical outcomes in Medicare beneficiaries.

Nicholas LH, Osborne NH, Birkmeyer JD, Dimick JB. Arch Surg. 2010;145:999-1004.

Hospitals are now required to report adherence to measures intended to prevent post-surgical complications, including surgical site infections. These measures are being publicly reported by groups including the Centers for Medicare and Medicaid Services. However, this analysis found that high levels of adherence to these accountability measures were not correlated with postoperative mortality, surgical site infection rate, or other complications, calling into question the value of public reporting of such measures.

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