Healthcare News & Insights

Study: Hospitals reduce colorectal surgical site infections risk

Did you know that across all types of hospitals, surgical site infections (SSIs) are disproportionately higher among patients following colorectal surgeries? And with the focus nowadays being on providing quality care for less money, addressing such a common place procedure that has costly issues tied to it is one of the main reasons why it was chosen as the focus of a new study. 

In addition, there was a high variability in performance across hospitals and significant opportunities for improvement. So the Joint Commission Center for Transforming Healthcare, in collaboration with the American College of Surgeons, headed up a two-and-a half year project.

The project studied all three types of colorectal SSIs:

  • superficial incisional SSI – the infection involves only skin or subcutaneous tissue of the incision
  • deep incisional SSI – the infection appears to be related to the operation and involves deep soft tissues (for example, fascial and muscle layers) of the incision, and
  • organ/space SSI – the infection appears to be related to the operation and involves any part of the anatomy other than the incision (for example, organs or spaces), which was opened or manipulated during an operation.

Extensive data collection

The project addressed preadmission, preoperative, intraoperative, postoperative and post discharge follow-up processes for surgical patients who underwent emergency and elective colorectal surgery.

The teams collected data on colorectal surgical patients, whether the patient had an infection or not. By doing this the project teams could detect risk points and identify if the care provided to patients:

  • deviated from the intended practice, which was defined by the organization’s policy, protocol or evidence-based recommendations
  • indicated the absence of a process step considered to be critical in delivering intended care, or
  • showed significant variation in care delivery and inconsistency in the care approach by different care providers.

They also identified 34 unique factors/attributes that are strongly associated with the 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.

 Challenges and targeted solutions

Robust Process Improvement (RPI) methods and tools –fact-based, systematic and data-driven problem-solving methodology — was used to measure the size of the problem, identify contributing causes, develop specific solution targeted and test the solution in real-life situations.

The targeted solutions included standardizing the preoperative instructions to patients and caregivers applying the preoperative skin cleaning product, and establishing specific criteria for the management of specific types of wounds to promote healing and decrease the risk of colorectal SSIs.

Throughout the study what the hospitals found was that a one-size-fits-all approach did not work in measuring and reducing all three types of colorectal SSIs, especially organ/space SSIs. More in-depth studies need to be done in surgical techniques and protocols for these more challenging SSIs.

Good news

The good news is the hospitals that participated in the study were able to reduce:

  • superficial incisional SSIs, which affect skin and underlying tissue, by 45%
  • all types of colorectal SSIs by 32%, and
  • the average length of stay for hospital patients with any type of colorectal SSI from an average of 15 days to 13 days.

And, overall, the study saved more than $3.7 million in costs for 135 avoided SSIs.

“This vital project has rendered measurable results in reducing surgical site infections – a major source of preventable patient harm and greater healthcare costs,” says Dr. David Hoyt, FACS, executive director, American College of Surgeons, in a news release. “Our partnership with the Joint Commission Center for Transforming Healthcare to reduce surgical site infections is helping participating hospitals save millions of dollars annually, and it is engaging surgical teams to become more effective in promoting a culture of surgical patient safety, which is our foremost priority.”

The seven hospitals that participated in the study were:

  • Cedars-Sinai Medical Center
  • Cleveland Clinic
  • Mayo Clinic-Rochester Methodist Hospital
  • North Shore-Long Island Jewish Health System
  • Northwestern Memorial Hospital
  • OSF Saint Francis Medical Center and
  • Stanford Hospital & Clinics.

For more information on the study, click here.

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