New York Hospitals Take Aim at Surgical Infections; New National Guidelines Point the Way

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,

visit http://www.medqic.org/sip.

Source:  IPRO