Studies have shown that compared to similar risk patients undergoing the same surgery, a patient who gets a surgical site infection is twice as likely to die, 5-6 times more likely to require re-admission, and likely to stay in the hospital twice as long.

Over the past two years, local Medicare Quality Improvement Organizations (QIOs) have been working closely with many hospitals to redesign procedures and protocols, so that surgical patients are given antibiotics within sixty minutes before incision.

Several hundred U.S. hospitals report successfully implementing clinical processes that effectively prevent surgical site infections, one of the leading causes of hospital-associated infections. Still, many others lag.

Use of Antibiotics 'Suboptimal'

“The effectiveness of antimicrobials administered shortly before skin incision for the prevention of Surgical Site Infections was established in the 1960s and has been repeatedly demonstrated since. However, despite evidence of effectiveness ... use is often suboptimal,” researchers say in the study.

“Our study reveals a huge opportunity for hospitals to reduce the human and financial costs of surgical infections,” says Dale Bratzler, DO, MPH, lead author of the study and Principal Clinical Coordinator at Oklahoma Foundation for Medical Quality. Dr. Bratzler is president of the American Health Quality Association, which represents the national network of QIOs that work under contract to Medicare to improve care in hospitals, nursing homes, physicians’ offices and in home health care.

Recommended Timeframe Often Missed

Researchers collected data for the study in 2001 as a baseline for the launch of the Surgical Infection Prevention Project (SIP), which is jointly sponsored by the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention.

In the article, researchers report the results of their analysis of medical records from 2,965 acute care hospitals throughout the United States, involving a random sample of 34,133 Medicare inpatients undergoing major surgeries during 2001.

Surgical procedures studied for this project included Coronary Artery Bypass Graft (CABG), cardiac, colon, hip and knee arthroplasty, abdominal and vaginal hysterectomy, and selected vascular surgery procedures.

The research team found that 55.7% of these patients received antibiotics in the recommended timeframe of one hour before incision, 92.6% received the correct antibiotic, and 40.7% of patients had antibiotics discontinued within 24 hours following surgery to limit resistance to antibiotics.

High Cost of Surgical Infections

Surgical site infections are the second most common cause of hospital-associated infections, according to the CDC. There are about 15 million in-patient surgeries performed each year in US hospitals. Of these, about 300,000 patients develop surgical site infections at an estimated cost of $1.5 billion.

Surgical site infections are a major cause of mortality and morbidity among hospitalized patients. Studies have shown that compared to similar risk patients undergoing the same surgery, a patient who gets a surgical site infection is twice as likely to die, 5-6 times more likely to require re-admission, and likely to stay in the hospital twice as long. For major orthopedic or cardiac surgery, the costs of these complications may range from $30,000-$50,000.

Significant Improvements Noted

In late 2002, as part of the SIP project, QIOs skilled in helping medical institutions redesign systems of care began providing technical assistance to hospitals in every state. Typically, QIOs bring together surgical teams from a number of hospitals for a series of training sessions aimed at incorporating infection prevention into treatment protocols.

Already, QIOs in 32 states report hospitals taking part in this training have shown significant improvement. For example:

• 26 hospitals participating in California increased the proportion of surgical patients receiving antibiotics within one hour of incision from 73.8% to 84.3%. In Colorado, 16 hospitals increased the proportion receiving antibiotics within one hour of incision from 62% to 88%. In Maryland, 16 hospitals went from 72% to 91.9%. In New Mexico, 19 hospitals went from 47.6% to 68%. In Texas, 42 hospitals went from 61% to 84%.

• Individual hospitals often had striking results. Leesburg Regional Medical Center in Florida, for example, went from 19.3% to 92% in administration of antibiotics in the hour before incision. Glen Cove Hospital in New York went from 43% in July 2003 to 100% in early 2004. By improving antibiotic administration and timing, Mercy Health Center in Oklahoma performed 400 surgeries without infections, four times its rate before participating in a QIO-led training.

“The Surgical Infection Prevention Project (SIP) shows what hospitals can accomplish if they work with QIOs or learn from other institutions that have succeeded,” says Dr. Bratzler. “Reducing surgical infections is often not expensive: costs are usually recovered through shorter hospital stays. What it takes is commitment to change and to provide the right care.”