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Surgical Site Infections

In a 2002 study of US hospitals, the estimated number of healthcare-associated infections (HAIs) was approximately 1.7 million. Surgical site infections (SSIs) were the second most common HAI, accounting for 22 percent of all HAIs among hospital patients. The estimated deaths associated with HAIs were 98,987, of which 8,205 (8 percent) were associated with SSIs.

The SSI project began in August 2010 and was launched in collaboration with the American College of Surgeons (ACS) and seven participating organizations. The project uses SSI outcomes data derived from ACS’s National Surgical Quality Improvement Program (NSQIP) to guide the improvement effort. NSQIP data on outcomes of surgery are highly regarded by physicians as clinically valid, using detailed medical information on severity of illness and comorbidity to produce data on risk-adjusted outcomes.

Colorectal surgery was identified as the focus of the project because it is a common procedure across different types of hospitals, can have significant complications, presents substantial opportunities for improvement, and has high variability in performance across hospitals. Project participants studied the potential factors that contribute to colorectal SSIs.

Project Team

The Joint Commission Center for Transforming Healthcare uses Robust Process Improvement® (RPI®) methods and tools in the development of its solutions. RPI is a fact-based, systematic, and data-driven problem-solving methodology. It incorporates Lean Six Sigma and change management methodologies. Using RPI, project teams measure the magnitude of the problem, pinpoint the contributing causes, develop specific solutions that are targeted to each cause, and thoroughly test the solutions in real life situations.

Utilizing RPI, the project participants identified 34 unique correlating variables for risk of colorectal SSIs that may be related to patient characteristics; the surgical procedure; antibiotic administration; preoperative, intra-operative and postoperative processes; and measurement challenges. 

Project Team 
Cedars-Sinai Medical Center, California 
Cleveland Clinic, Ohio 
Mayo Clinic-Rochester Methodist Hospital, Minnesota 
North Shore-Long Island Jewish Health System, New York 
Northwestern Memorial Hospital, Illinois 
OSF Saint Francis Medical Center, Illinois 
Stanford Hospital & Clinics, California 
In collaboration with the American College of Surgeons 

Pilot Team
Barnes-Jewish West County Hospital, Missouri

Project Results

The project team aimed to identify the root causes of surgical site infections and to find effective and targeted solutions for overcoming them.

Project participants identified 34 unique contributing factors for risk of colorectal SSIs related to patient characteristics; the surgical procedure; antibiotic administration; preoperative, intra-operative and postoperative processes; and measurement challenges — and then developed ideas and targeted solutions to address each one.

Examples of some of the targeted solutions to reduce superficial incisional colorectal SSIs include:

  • Standardizing the preoperative instruction to patients and caregivers for applying the preoperative skin-cleaning product.
  • Establishing specific criteria for the correct management of specific types of wounds, which promotes healing and decreases the risk of developing colorectal SSIs.

Examples of some of the targeted solutions to reduce all types of colorectal SSIs include:

  • Warming interventions to ensure that the patient’s temperature is consistently maintained at the recommended range for optimal wound healing and infection prevention.
  • Establishing solutions such as a weight-based antibiotic dosing protocol in order to address the inadequate administration of antibiotics.

Working together, the participating hospitals:

  • Reduced superficial incisional colorectal SSIs by 45%.
  • Reduced all types of colorectal SSIs by 32%.
  • Attained an estimated cost savings of more than $3.7 million for the 135 estimated colorectal SSIs that were avoided.
  • Decreased the average length of stay for hospital patients with any type of colorectal SSI from 15 days to 13 days. In comparison, patients with no colorectal SSI had an average length of stay of eight days. 

Additional Resources

The following additional resources are available for the Surgical Site Infections project:

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