A SSI-siphian Task: Tracking Surgical-site Infections
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Each year, an estimated 1.7 million patients contract a hospital-acquired infection (HAI), according to the Centers for Disease Control and Prevention (CDC). Surgical-site infections (SSIs) account for 22 percent, or 290,485, of these HAIs. SSIs increase hospital readmissions and patient length of stay, equating to higher overall medical costs—many of which cannot be recouped through Medicare because SSIs are considered preventable.
A report from HospitalConnect.com in 2009 found that patients who contract an SSI in-hospital can expect, on average, to spend 6.5 more days in the hospital. Patients who experience an SSI are five times more likely to be readmitted after discharge and are twice as likely to die, according to the report.
Although the CDC and various state initiatives are requiring hospitals to report their HAI rates, most organizations are reluctant to do so for fear of reduced reimbursements and bad publicity if they don’t measure up to others. Now some hospitals are enlisting IT systems to track, measure and report patterns associated with HAIs in general and SSIs in particular.
“We have the ability to eliminate at least 40 and almost 50 percent of surgical-site infections today, which is tremendous reduction, if we follow certain programs,” says Richard P. Wenzel, MD, professor of internal medicine and former chairman of the internal medicine department at Virginia Commonwealth University, in Richmond.
The IT connection
While incorporating best practices into care plans can prevent SSIs, monitoring, tracking and finding patterns of infection is also critical to lowering SSI rates and associated costs. The 209-bed Methodist Richardson Medical Center, in Richardson, Texas, adopted CareFusion’s MedMined data mining surveillance software to help prevent infection and cut its HAI rates.“I don’t have to enter data objectively or manually anymore—it’s done automatically,” says Nancy Viamonte, RN, MBA, MSN, director of infection control at the facility. “We take our admission, discharge, transfer data, our pharmacy data and our lab data at our hospital, and I can get real-time data.”
The software includes benchmarking patterns, a virtual surveillance interface (VSI) and nosocomial infection markers. “These data we enter are objective and consistent, and I can benchmark [them] against other hospital systems using the MedMined solution throughout the state and country,” Viamonte says.
The software issues a monthly report that outlines SSI trends and patterns. Information related to infection-causing organisms including the organism and its profile, characteristics, incubation period, and steps to prevent it are included.
The detailed trends save hours of time each month that Viamonte and colleagues previously spent on research and analysis. “I can get this information in a push of a button and then can educate staff with it,” she says. “We analyze data and go through each action item to see if hospital policies need to be changed and evaluate whether the correct, most preventable actions are being carried out.”
Viamonte says it’s often difficult to pinpoint infection patterns, but “the MedMined solution has really helped us keep our HAIs rate low.” The detailed data allow the facility to take immediate action to prevent infection, whereas paper-based methods took three to four months to gather that information, she says. As a result, overall rates of infection at the facility have dropped by more than 50 percent since the system was implemented in January 2007, Viamonte estimates. “Our rates of HAIs are so low that when you get this low, it’s even harder to get lower because our goal is zero.”
At Oakwood Health System, a four-hospital system based in Dearborn, Mich., staff adopted RL Solutions’ Infection Monitor Pro (IMPro) in 2004 to better track and log SSI incidence, and to drive infection rates down
“As a patient is admitted, we are able to integrate lab, microbiology, surgery and pharmacy results to manage an individual patient based on lab outcomes and surgical outcomes, then prioritize opportunities for potential infection and have more efficient management of real-time infections,” says Sara Atwell, RN, MHA, chief quality and patient safety officer at Oakwood Health System.
“Our infection prevention specialists can now spend much more time and education on the reduction of infections with staff, as opposed to managing an infection after it occurs,” says Atwell.
IMPro allows the facility to report “essential levels of information” and integrate them into the EMR. In addition, data can be uploaded to CDC’s National Healthcare Safety Network (NHSN), fulfilling reporting requirements with the click of a mouse, Atwell says.
The application allows Oakwood to track and trend multi-drug resistant organisms unit by unit to get a better grip on where the infection originated and steps that have been taken to monitor and cure it. Atwell estimates that the overall savings from use of IMPro will be $1.2 million.
Building a better mousetrap
The 700-bed Case Western Reserve University School of Medicine, in Cleveland, implemented a home-grown system called Surgical Intensive Care-Infection Registry (SIC-IR) in March 2007 to provide a better research mechanism for spotting infection in the ICU.Although data show that 1.3 million of the 1.7 million HAIs annually occur outside the ICU, both HAIs and SSIs in the ICU are an ongoing problem, says Jeffrey A. Claridge, MD, trauma surgeon and intensivist at Case Western.
“The ICU is a place where that intensivist can be faced with 200 different data points at any different time of day for each patient. To try to process them and try to remember what the trends were from the day before can be a little bit overwhelming,” he says.
SIC-IR alleviates this by providing better documentation and using real-time data to compare infection trends within the hospital. “The solution can basically archive 100 variables a day per patient and a lot of them are targeted around collecting risk factors for infection,” says Claridge.
The web-based application consists of a graphical user interface and a relational database on the back end that has already helped to accurately measure a number of cultures and patient parameters including vital signs, ventilator settings and antibiotics, among others.
Claridge says the technology enables the staff to not only monitor the quality of infection data, but also to “look into what variables are predictive of patients who develop infections while they are in the ICU.”
Is transparency the key to reducing infections?
Federal agencies including the CDC and state initiatives are mandating facilities to report HAI data to registries, in an effort to make the data public and thus encourage hospitals to lower their HAI rates.Methodist Richardson plans to work with the NHSN and the Texas Infectious Diseases Society to report data beginning in January 2011, says Viamonte.
Claridge supports that accurate reporting of infections should be done, but “the first thing is realistic expectations for the public,” he says. “It’s very hard, with electronic systems, to actually even capture what the true rates of infection are. [Some SSIs] develop after a patient goes home, and to me that’s probably the most important aspect,” he says. “One of the key [challenges for] healthcare IT is to really make sure that you are capturing accurate data, and healthcare is behind in that.”
In addition, due to current federal standards, “systems are being put into place to discourage accurate reporting,” Claridge says. These systems discourage reporting because they can pinpoint SSIs, and when an SSI is reported to CMS, the provider will not be reimbursed for the procedure or associated costs. Therefore, he says, “setting goals of zero for infections is impossible.”
As with many aspects of U.S. healthcare, the solution to the problem of SSIs will involve administrative fixes beyond the scope of healthcare IT. But infection surveillance and analysis software can offer the ounce of prevention so many facilities need.