Prevention of Surgical Site Infection
- Indicators for Monitoring
To ensure the appropriate prevention of surgical site infections in hospitals and reduce the risk of readmission, specific indicators should be monitored regularly. These are some indicators which focus on measuring and improving the prevention and management of infections occurring at surgical sites. These key performance indicators (KPIs) help track the effectiveness of infection control measures and identify areas for improvement, ultimately aiming to reduce SSIs and enhance patient outcomes. Here are some key indicators that can be included in hospital guidelines for prevention of SSI.
1) Process indicators for SSI prevention
The selected KPIs can be categorized into three groups: 1) Perioperative antibiotic prophylaxis (PAP) indicators, 2) Preoperative skin preparation indicators, and 3) other SSI prevention indicators.
a. Perioperative antibiotic prophylaxis
Two PAP indicators have been added to the SSI protocol:
For the first PAP indicator, the compliance with the administration appropriateness includes (1) correct antibiotic for specific surgery, (2) correct antibiotic dose, (3) administration start time within 1 hour of incision (2 hours allowed for vancomycin and fluoroquinolones) will be assessed for all surgical procedures where PAP was indicated (according to the local protocol) and administered
● Numerator: Number of patients who appropriately received PAP
● Denominator: Total number of all selected operations performed
● Multiply by 100 so that measure is expressed as a percentage.
- For the second PAP indicator the compliance with the discontinuation of PAP within 24 hours after initiation of surgery will be assessed for all surgical procedures where PAP was indicated (according to the local protocol) and administered
● Numerator: Number of patients who discontinued PAP within 24 hours after initiation of surgery
● Denominator: Total number of all selected operations performed
● Multiply by 100 so that measure is expressed as a percentage
b. Preoperative skin preparation
The following preoperative skin preparation indicators have been added to the protocol:
o No hair removal, or if hair removal was necessary, only clipping.
o Use of alcohol-based antiseptic solutions based on CHG for surgical site skin preparation in the operating room (OR) (if no patient contraindication exists)
- The compliance with no hair removal (or if hair removal was necessary, only clipping) will be assessed for all surgeries in the selected operation type
● Numerator: Number of surgical procedures with no hair removal, or only clipping
● Denominator: Number of all surgical procedures in the procedure type
c. Other prevention indicators
The last group of indicators that are collected aggregated per operation type include two indicators:
- Ensuring the patient's normothermia in the perioperative period (within one hour of the end of operation) (36-38°C (rectal measurement) or 35,5-37,5 °C (non-rectal measurement)), if no contraindication.
● Numerator: Number of all surgical procedures where patient normothermic within one hour after surgery
● Denominator: Number of all surgical procedures in the procedure type where no contraindication
* Normothermia should NOT be assessed for surgical procedures where normothermia is contraindicated, as for example in the case of induced hypothermia for Coronary Artery Bypass Grafting (CABG).
- Using a protocol for intensive perioperative blood glucose control and blood glucose levels monitored for adult patients undergoing surgical procedures
o Numerator: Number of all surgical procedures where a protocol for intensive blood glucose control is used and the blood glucose levels monitored
o Denominator: Number of all surgical procedures in the procedure type
2) Outcome Measures:
a. Percentage of SSIs by category
The percentage of patients who develop SSIs using center of disease control and prevention / national healthcare safety network (CDC/NHSN) case definitions after a surgical procedure. The first indicator (% SSIs) gives the most complete picture for a given operative procedure but is highly dependent on the intensity of post-discharge surveillance, which varies considerably between hospitals and between countries.
● Numerator: All first SSI* in that category
● Denominator: Total number of operations in that category
● Standardization factor: Multiply by 100 so that the measure is expressed as percentage
*SSIs are included, if {Date of Onset} − {Date of Operation} +1 ≤31 or ≤91 days if implant is in place