Washington Hospitals Reduce Rates of Surgical Infection

SEATTLE -- Eleven Washington state hospitals have

worked for the last year as part of the Surgical Infection Prevention

Collaborative Northwest (SIP NW) to reduce their rates of surgical infections,

which are recognized as a major preventable form of patient injury, mortality

and healthcare costs.

The federal Institute of Medicine reports that between 44,000 and 98,000

Americans die each year from adverse medical events, as compared to about

45,000 deaths each year from auto accidents. Sixty-nine percent of adverse

events and deaths are considered by experts to be preventable.

Perioperative infections complicate an estimated 2.6 percent of nearly 30

million operations each year, resulting in roughly 780,000 surgical site

infections. An estimated 40 to 60 percent of surgical infections are

preventable with the appropriate use of prophylactic antibiotics.

It's estimated that if a hospital with an annual surgical volume of 10,000

operations could reduce its 300 surgical infections by half, this would result

in an annual cost savings of about $450,000.

Proper administration of antibiotics has been a major goal of the SIP NW,

along with other measures such as clipping, rather than shaving, the surgical

site and maintenance of proper body temperature before, during and after

surgery (normothermia).

Qualis Health of Seattle, a nonprofit healthcare quality improvement

organization, managed and provided technical and professional assistance to

SIP NW participating Washington hospitals under a contract with Medicare.

Participating Washington hospitals will convene with other hospitals from

Oregon and Idaho to share their results at an "outcomes congress" April 2, 2004 in

Seattle.

Of the 11 participating Washington hospitals, the achievements of two facilities exemplify progress made in the SIP NW:

Overlake Hospital Medical Center, Bellevue, Wash. (240 beds)

-- 100 percent of all surgical cases received the appropriate selection of

prophylactic antibiotic,

-- 75 percent of patients with prophylactic antibiotics were begun in the

appropriate one-hour period before surgical incision,

-- 97 percent of surgery patients who received prophylactic antibiotics

had those medicines discontinued within the appropriate 24-hour period

after surgery,

-- 72 percent of surgical patients had a temperature greater than 36

degrees C,

-- 88 percent had hair removed at the surgical site without shaving,

-- The number of cases between surgical infections has more than doubled

from 40 to 91 cases.

"This project demonstrated how our hospital staff can study, test, and

implement the latest knowledge available to produce rapid improvements

in our hospital. We have made significant changes that will improve

clinical outcomes and reduce costs associated with surgical site

infections. In our baseline population, patients with infections had,

on average, $5,590 in additional direct costs for days/visits other

than the day of surgery. Each of these patients also had a net loss

that averaged $828 more than the average net loss for these types of

cases. In 2002 we had 12 surgical site infections and in 2003 we

reduced the number to five. This equates roughly to a cost savings of

$39,000 and seven patients that were saved of an infection, for our

pilot population alone." - from the summary report for SIP NW Outcomes

Congress.

St. Mary Medical Center, Walla Walla, Wash. (142 beds)

-- Administered appropriate prophylactic antibiotics to 100 percent of the

eligible patients in the pilot group,

-- Increased the proportion of patients who received prophylactic

antibiotics within one hour before the surgical incision time from 74

to 100 percent,

-- Increased the proportion of patients with prophylactic antibiotics

discontinued within 24 hours after surgery from 70 to 92 percent,

-- Increased the proportion of patients demonstrating minimal heat loss

from 25 to 92 percent,

-- Increased the proportion of patients who received appropriate hair

removal at the operative site from 10 to 80 percent.

"Changes in the perception of 'acceptable rates' of infection have

shifted to 0. There are no acceptable rates of health care associated

infections. Surgical site infections are evaluated as being potentially

preventable or not potentially preventable based on compliance with the

measures of the [SIP NW] collaborative and other basic prevention

measures. Opportunities to continuously improve the surgical system are

identified from potentially preventable cases." - from the summary report for

SIP NW Outcomes Congress.

The physician leader for SIP NW is E. Patchen ("Patch") Dellinger, MD,

professor of surgery at the University of Washington School of Medicine, where

he is vice chairman of the department of surgery and chief of the division of

general surgery at the University of Washington Medical Center.

Qualis Health is a private, nonprofit organization that offers programs

and services to generate, apply and disseminate knowledge to improve the

quality of healthcare delivery and health outcomes. In operation since 1974,

the firm has headquarters in Seattle with offices in Boise and Anchorage.

Source: Qualis Health