Utilization of a Dual Surveillance Program to Reduce Surgical-site Infections

BACKGROUND: Surveillance plays a pivotal role in the surgical-site infections (SSIs) prevention through identifying infections, monitoring changes in infection rates, and evaluating the effectiveness of intervention strategies. METHODS: This retrospective study reviewed SSI surveillance systems implemented at the Children’s National Health System in 3 phases between 2007 and 2016 including all surgical procedures. The targeted surveillance was conducted in cardiovascular, spinal fusion, and ventricular shunt surgeries and required an infection preventionist (IP) to review all procedures, to identify SSIs that meet the CDC’s National Healthcare Safety Network definition. SSIs in the remaining surgical procedures were identified through the review of positive microbiology reports daily and followed by full chart review if the specimen type and/or patient location were suggestive of a surgical history. Timely feedback of SSI to stakeholders was the primary mode of intervention, with additional interventions implemented for the 3 targeted surveillance procedures. Data collected between 2013 and 2016 were analyzed to account for a definition change in 2013. RESULTS: For the 3 targeted surveillance procedures, IP reviewed 2,255 procedures and identified 43 SSIs. For the remaining procedures, IPs identified 123 SSIs confirmed by one or more pathogens. The overall SSI rate had a 31% decrease. The cardiovascular and spinal fusion SSI rate had a 61% and 84% decrease, respectively. The ventricular shunt SSI rate increased 29% due to 2 episodes of recurrent infections in 2 patients. CONCLUSIONS: It is prudent for hospitals to continue monitoring SSI by establishing surveillance programs with optimal approaches.