THURSDAY, June 23, 2005 (HealthDay News) -- A collaborative project involving hospitals from every state and U.S. territory managed to cut the rate of surgical site infections by 27 percent over the course of a year.
"The decrease of almost a quarter across a wide range of hospitals was something we thought was a very favorable result," Dr. Jonathan Sugarman, president of the American Health Quality Association (AHQA) and a clinical professor of family medicine at the University of Washington School of Medicine in Seattle, said at a teleconference Thursday.
Sugarman is co-author of an article appearing in the current issue of the American Journal of Surgery that details the findings of the National Surgical Infection Prevention Collaborative.
Between 2 percent and 5 percent of people undergoing major surgery in the United States will develop a surgical-site infection, said Dr. Dale Bratzler, another co-author and principal clinical coordinator of the Oklahoma Foundation for Medical Quality. With 30 million major operations performed each year, such infections are a major public health problem.
"The patient who does develop a postoperative wound infection is two to three times more likely to die, and five to six times more likely to be readmitted to the hospital," Bratzler said. Such patients also have longer hospital stays and higher costs of care.
At the same time, the medical profession has known for close to 40 years that properly administered antibiotics can reduce the risk of such infections.
But many hospitals have not been following three relatively simple rules, Bratzler said. In the United States in 2001, 44 percent of hospitals did not have antibiotics initiated within one hour before the incision; 7 percent didn't give antibiotics as recommended by published guidelines; and 59 percent of patients were kept on antibiotics longer than the recommended 24 hours after surgery, increasing the risk for infection with resistant organisms.
The National Surgical Infection Prevention Collaborative was conducted in 2002-2003 and involved 43 Quality Improvement Organizations (QIOs) or organizations that are contracted to maintain quality assurance in hospitals that serve Medicare patients. The AHQA, of which Sugarman is president, is an organization that represents QIOs nationwide.
Interestingly, a recent Journal of the American Medical Association report found that hospitals linked with QIOs did not improve their performance beyond hospitals not participating in the effort. That report, however, looked at a different constellation of patient problems and, according to AHQA, did not use complete data.
For the current collaboration, hospital personnel attended meetings, heard lectures from experts and shared information with other professionals over the course of a year. In general, the institutions involved were already performing better than the national average at the start of the project, said Dr. Patchen Dellinger, another co-author and vice chairman of the department of surgery at the University of Washington School of Medicine.
The participating hospitals worked on the three key antibiotic measures: choosing the correct antibiotics, delivering them at the correct time, and stopping them in a timely fashion after the operation.
In addition, hospitals were encouraged to pay attention to other areas known to reduce infection: controlling body temperature and blood sugar levels, using supplemental oxygen during the operation, and clipping, rather than shaving, the operative site.
Of the 56 hospitals that voluntarily participated, 44 provided monthly reports and 43 reported their infection rates. All told, more than 35,000 operations were performed by these institutions during the project.
There were improvements.
At the outset of the project, about 70 percent of patients were receiving antibiotics within the ideal beginning timeframe. This number increased to 92 percent at the conclusion of the project, with many hospitals going into the high 90s, Sugarman said.
Timely discontinuation of antibiotics rose from about 67 percent to 85 percent.
Adherence to body temperature guidelines increased by about 12 percent, not shaving the surgical site showed a 27 percent improvement, and maintaining high oxygen levels and controlling blood glucose improved by about 18 percent.
Perhaps most important, the overall rate of surgical site infections fell 27 percent from 2.28 percent in the first three months of the project to 1.65 percent in the last three months.
Many of the hospitals also implemented additional measures to improve infection control, Bratzler said.
"The collaboration showed that teams of medical professionals could rise to the challenge of achieving rapid and substantial improvements in care," Sugarman said.
Similar QIO collaboratives are now underway in 30 states. Final results are not yet ready, but 26 California hospitals improved the proportion of surgical patients receiving antibiotics within one hour of incision from 73.8 percent to 84.3 percent. In Colorado, 16 hospitals increased that proportion from 62 percent to 88 percent; in Maryland 16 hospitals went from 72 percent to 91.9 percent; in New Mexico, the rate rose from 47.6 percent to 68 percent; and in Texas it went from 61 percent to 84 percent.
More information
For more on health-care quality, visit the American Health Quality Association.
