The AHRQ Safety Program for Surgery used the CUSP model and implementation science approaches to improve adherence to evidence-based SSI prevention practices in 197 hospitals. ![]() CUSP emphasizes improving safety culture through a continuous process of identifying and learning from errors, improving teamwork, and engaging staff at all levels in safety efforts. The comprehensive unit-based safety program (CUSP) has been demonstrated to be an instrumental approach to driving reductions in SSI. ![]() Key elements of organizational interventions to prevent SSIs (and HAIs in general) include improving safety culture, the use of robust data tracking and feedback mechanisms, and utilizing checklists or evidence-based bundles. Many organizations have been able to achieve sustained reductions in SSIs, and AHRQ has led notable efforts to encourage dissemination and implementation of SSI prevention strategies. However, as with many other quality problems, implementing the recommended methods as standard practice and sustaining the use of preventive interventions has been challenging. Adherence to these clinical standards (for example, administration of appropriate antimicrobial prophylaxis) is routinely tracked in the form of process measures that, if adhered to, should reduce the incidence of SSI. The CDC has also developed guidelines (last updated in 2017) summarizing the evidence for clinical interventions to prevent SSI the World Health Organization also issued SSI prevention guidelines in 2016. Both the NHSN and NSQIP definitions are widely used for both quality improvement and research purposes. These definitions are also used by the National Surgical Quality Improvement Program (NSQIP), although NSQIP uses slightly different methods of surveillance for infections. The CDC's National Healthcare Safety Network (NHSN) has developed standards for SSI measurement. Prevention of Surgical Site InfectionsĪccurate measurement can be a challenge in patient safety, but prevention of SSIs (and HAIs in general) has benefited from the development of standard metrics that allow for tracking of infection rates over time and comparison of infection rates between facilities. Information on other types of health care–associated infections (HAIs) may be found in the Health Care–Associated Infections Primer. This Primer will provide an overview of the prevention of SSI, with a focus on system-level interventions. While many of these risk factors are not modifiable, the majority of SSIs are considered preventable, and recent advances have improved our insights as to how hospitals can systematically prevent these infections. Risk factors for SSI include patient factors (such as age, tobacco use, diabetes, and malnutrition) and procedure-specific risk factors (including emergency surgery and the degree of bacterial contamination of the surgical wound at the time of the procedure). Although SSIs are less common following ambulatory surgery than after inpatient procedures, they are a frequent source of morbidity in these patients as well. They are the leading cause of readmissions to the hospital following surgery, and approximately 3% of patients who contract an SSI will die as a consequence. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery. SSIs occur in 2% to 4% of all patients undergoing inpatient surgical procedures. Surgical site infection (SSI)-defined by the Centers for Disease Control and Prevention (CDC) as infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure, or within 90 days if prosthetic material is implanted at surgery-is among the most common preventable complication after surgery. Increasing numbers of patients also undergo surgery at ambulatory surgery centers (facilities specifically designed for certain types of surgery after which the patient can be discharged home directly). ![]() The most common types of inpatient surgical procedures include cesarean section, orthopedic procedures (hip and knee replacement, hip fracture repair), neurosurgical procedures (spinal fusion and laminectomy), and intraabdominal procedures (cholecystectomy and colorectal resections). According to data from AHRQ, more than 10 million patients undergo surgical procedures as inpatients each year, accounting for over one-fourth of all hospital stays.
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