LAKE SUCCESS, N.Y. -- New York hospitals are expected to take a leading role in adopting new national guidelines that address the prevention of surgery-related infections. The guidelines, which represent unprecedented consensus among 20 of the nation's largest surgical, medical and hospital associations, are the result of a year-long effort by these groups to identify best practices for preventing surgical site
infections. Approximately 780,000 operations are complicated by surgical site
infections each year in the United States, causing a significant amount of
patient injury, mortality and often-avoidable costs.
"We believe this consensus statement will lead to greater clarity for
health professionals on proper antibiotic use, and will help in our quality
improvement efforts," says Charles E. Stimler, MD, MPH, Medical Officer for IPRO.
"We will leverage this consensus as we continue to work with the New York
Surgical Infection Prevention Collaborative and the state's hospitals to save
lives and reduce unnecessary hospitalizations."
Stimler and the IPRO quality improvement team are leading the
Collaborative as part of Medicare's National Surgical Infection Prevention
(SIP) Project, an ongoing, three-year-old initiative co-sponsored by the
Centers for Medicare & Medicaid Services (CMS) and the Center for Disease
Control and Prevention (CDC). The SIP Project's goal is to reduce the
occurrence of post-operative infection by improving the selection and timing
of preventative antibiotic administration. Twenty-two New York hospitals
recently completed an initial year-long SIP project, and now IPRO is about to
begin a larger statewide initiative to improve infection prevention in such
widely performed procedures as hip replacement, hysterectomy and coronary
artery bypass graft (CABG) surgery.
In its initial infection prevention project, IPRO collected self-reported
discharge data for surgeries conducted between April 2003 and March 2004 at 22
hospitals in New York. The effort focused on surgical procedures among the
Medicare population, including coronary artery bypass graft, colon surgery,
hip and knee replacement (arthroplasty), abdominal and vaginal hysterectomy,
and selected vascular procedures, such as arterial bypass. Once IPRO
identified areas for improvement, the hospitals and IPRO worked cooperatively
to establish and implement procedures to improve care.
To further reduce the incidence of surgical infection and foster quality
improvement in a range of other clinical areas, IPRO will launch a New York
State hospital collaborative beginning in August 2004. The expanded effort
will incorporate aspects of the Institute for Health Care Improvement's (IHI)
Breakthrough Series Collaborative, a model used in IPRO's initial infection
prevention collaborative. Throughout the year, IPRO will host monthly
conference calls highlighting program development models, clinical updates and
intervention strategies. IPRO will provide assistance to New York hospitals
to effectively use learnings from the project, and will create a Web-based
information exchange tool.
In 2003, the National SIP Project brought together the authors of all
current major American surgical infection prevention guidelines and the
leadership of 20 professional organizations involved in surgical care to
develop and adopt new surgical infection prevention guidelines.
Among these 20 groups were the American Academy of Orthopaedic Surgeons,
American College of Surgeons and Society of Thoracic Surgeons -- three of the
largest surgical specialty societies and academies. The result was a joint
advisory statement on infection prevention entitled, "Antimicrobial
Prophylaxis for Surgery: An Advisory Statement from the National Surgical
Infection Prevention Project." The statement, published earlier this summer
in the journal Clinical Infectious Diseases, recommends that prophylactic
antibiotics be used for no more than 24 hours after surgery, that the initial
dose of a prophylactic antibiotic be infused within the hour before surgery,
and that specific antibiotics be used in certain situations.
According to the medical literature, each surgical infection increases a
patient's hospital stay by an average of seven days. Patients who develop
surgical site infections are 60 percent more likely to spend time in the Intensive
Care Unit, five times more likely to be readmitted to the hospital and twice
as likely to die. In addition, surgical site infection complications add more
than $1 billion annually to the nation's healthcare bill.
With nearly 20 years of experience in healthcare quality evaluation, IPRO
holds major contracts with state and federal governments to review the cost
and quality of services provided to Medicaid recipients, Medicare
beneficiaries, and patients enrolled in managed care organizations. Based in
Lake Success, New York, IPRO also holds contracts with private-sector clients
to improve the quality of privately financed services.
For information on the New York Surgical Infection Prevention
Collaborative, log on to http://www.ipro.org/sip. For more on the
National Surgical Infection Prevention Project and the advisory statement,