Study: Surveillance May Miss Many Outpatient Surgical Site Infections

The results of a new study show that surgical site infection (SSI) surveillance systems may omit numerous outpatient surgeries with an expected increased likelihood of an adverse event.

As the study, which was published in the Society for Healthcare Epidemiology of America (SHEA) journal Infection Control & Hospital Epidemiology, notes, surveillance was based on Veterans Affairs Surgical Quality Improvement Program (VASQIP) eligibility criteria, which is defined by clinician determination of invasiveness.

Data for the study came from 31 Veterans Affairs (VA) organizations —  20 freestanding ambulatory surgery centers and 11 inpatient facilities — reports Infectious Disease News. Researchers conducted a retrospective study examining outpatient surgeries performed at these facilities between October 2011 and September 2015.

Researcher Dr. Katherine Linsenmeyer of the VA Boston Healthcare System told Infectious Disease News that the researchers' analysis indicated that more than half of the adverse events identified occurred in low-risk surgeries that did not meet criteria for review under the current VASQIP surveillance processes. These include nearly all skin and soft tissue procedures and nearly half of urologic procedures.

She told the publication, "Our study demonstrates the need to re-evaluate surveillance, particularly for SSIs, in this outpatient setting and to re-think how we classify 'low'- and 'high'-risk procedures — infections are a risk following any invasive procedure and it is important that we think about ways to implement effective inpatient prevention programs in outpatient settings."

This is yet another study raising concerns about effective SSI identification. Duke researchers recently determined that inconsistent methods for calculating SSI rates of some procedures are contributing to underestimates of the rates.

Data Analysis: Some Surgical Site Infection Rates Underestimated

Researchers have found that inconsistent methods for calculating surgical site infections (SSIs) of some procedures are contributing to underestimates of their SSI rates.

The research was published in Infection Control & Hospital Epidemiology and performed by members of the Duke infection Control Outreach Network (DICON). They conducted a retrospective analysis of SSI surveillance data from 11 DICON hospitals over a three-year period (January 2015 through December 2017). The analysis looked at SSI rates of laminectomies and rectal procedures using two different denominators: the current National Health Safety Network (NHSN) definition or only when the laminectomy or rectal procedure was the primary procedure.

Researchers hypothesized that since laminectomies and rectal procedures are commonly performed with "higher-ranking" procedures (fusion procedures and colon procedures, respectively), SSI rates would greatly differ when calculated using the different denominators. More specifically, "… SSIs occurring after combined laminectomy and fusion procedures would be counted as spinal fusion SSIs (but not laminectomy SSIs) and SSIs occurring after combined colon and rectal procedures would be counted as colon surgery SSIs (but not rectal surgery SSIs)," they wrote.

Their hypothesis was correct: The analysis showed significant underestimates of SSI rates for laminectomies and rectal procedures. The researchers wrote, "This analysis showed that the current NHSN method of calculating SSI rates underestimates the SSI rate of procedures, such as laminectomies and rectal surgeries, which are commonly performed alongside higher-ranking procedures."

Dr. Jessica Seidelman, who led the team of researchers, told Infectious Disease News, "If we want to have clinicians and hospitals make informed decisions for their patients, then we need to ensure that the data they use to make those decisions are accurate."

NHSN recently announced it is considering a requirement for hospitals to report ICD-10 or CPT codes when they report SSI denominators. The researchers wrote, "Requiring ICD-10 or CPT codes when reporting SSI data may pave the way for NHSN to further risk-adjust SSI rates based on specific procedure(s) performed. We recommend that the NHSN consider revising their current method for counting SSI denominators by including only primary surgical procedures in denominators when calculating SSI rates and standardized infection ratios."

Sepsis Awareness Month Shines Spotlight on Infection Complication That Kills Thousands

September is Sepsis Awareness Month, which provides an opportunity to share some information and best practices concerning this life-threatening condition.

Sepsis occurs when an infection triggers a chain reaction in a patient's body, resulting in tissue damage, organ failure and even death. The Centers for Disease Control and Prevention (CDC) reports that more than 1.7 million people develop sepsis every year, with about 270,000 Americans dying from it. One in three patients who die in a hospital have sepsis, CDC states.

Some key facts to know about sepsis:

• Almost any infection can lead to sepsis. Certain people are at higher risk: adults 65 or older, people with chronic medical conditions (e.g., diabetes, lung disease, cancer, kidney disease), people with weakened immune systems and children younger than one.

• The most frequently identified pathogens that cause infections turning into sepsis include Staphylococcus aureus, Escherichia coli and some types of Streptococcus.

• The four types of infections most often linked with sepsis: infections of the lungs, urinary track, skin and gut.

• To help patients avoid sepsis, healthcare professionals should follow best practices, including practicing good hand hygiene and proper catheter removal.

• Signs to watch for that may indicate an infection has developed into sepsis include confusion or disorientation; shortness of breath; high heart rate; fever, shivering and/or feeling very cold; extreme pain or discomfort; and clammy or sweaty skin.

• Healthcare professionals need to know their facilities' guidelines for diagnosing and managing sepsis. Any delays in recognition and treatment can cause significant harm.

Here are a few, free resources from the CDC that can help you raise awareness of sepsis:

• Protect Your Patients from Sepsis: Infographic

• Protect Your Patients from Sepsis: Poster

• Protect Your Patients from Sepsis: Fact Sheet

• Stay Healthy. Protect Yourself from Sepsis (patient poster)

Learn more about Sepsis Awareness Month.

Joint Commission Infection Control Standards Challenge Home Care Providers, Nursing Care Centers

As we recently reported, ambulatory healthcare organizations and office-based surgery practices accredited by The Joint Commission have struggled mightily to comply with some infection control standards. This is apparent from The Joint Commission's release of its most challenging requirements for the first half of 2019.

These organizations are not alone. Home care providers and nursing care centers also had infection control requirements identified most frequently as "not compliant" during Joint Commission surveys and reviews from January through June.

For home care providers, IC.02.01.01 (The organization implements the infection prevention and control activities it has planned.) had the second highest non-compliance percentage at 43%. It only trailed PC.01.03.01 (The organization plans the patient's care.), which had a reported 58% non-compliance.

For nursing care centers, IC.02.01.01 (The organization implements its infection prevention and control plan.) came in third at 29% non-compliance. It only trailed HR.02.01.04 (The organization permits licensed independent practitioners to provide care, treatment and services.) at 36% and MM.03.01.01 (The organization safely stores medications.) at 30% non-compliance.

If your organization requires assistance with CMS and/or accreditation survey preparation, call on the expert consultants at Infection Control Consulting Services (ICCS). If your organization recently underwent a survey that revealed deficiencies, contact ICCS to learn about our services for developing a plan of correction.

Study: Surgical Masks Match Respirators for Respiratory Virus Protection

The results of a new study indicate that surgical masks are as effective as respirator-type masks in protecting healthcare workers from influenza and other respiratory viruses.

The randomized clinical trial involving more than 2,800 healthcare personnel at 137 outpatient sites compared the use of surgical/medical masks to N95 respirators.

The results, which were published in JAMA, revealed no significant difference in the incidence of laboratory-confirmed flu between the pieces of protection.

Dr. Trish Perl, chief of the Division of Infectious Diseases and Geographic Medicine at UT Southwestern Medical Center and the report's senior author stated in a news release, "This finding is important from a public policy standpoint because it informs about what should be recommended and what kind of protective apparel should be kept available for outbreaks.”

Furthermore, as the news release noted, the mask only costs about a dime while N95 costs around $1. 

The study was performed at multiple medical settings in several U.S. cities, including Houston, Denver, Washington and New York. Participating researchers came from the University of Texas, the Centers for Disease Control and Prevention (CDC), Johns Hopkins University, the University of Colorado, Children's Hospital Colorado, the University of Massachusetts, the University of Florida and several Department of Veterans Affairs hospitals.

Researchers collected data during four flu seasons between 2011 and 2015.