Table 4.
Characteristics of SSI investigations generated by traditional surveillance signals versus optimised SPC signals.
| Traditional surveillance (n=24 SSI investigations) | Optimised SPC surveillance (n=74 SSI investigations) | |||
|---|---|---|---|---|
| Procedure type investigated | ||||
| Abdominal hysterectomy | 4 | (16.7%) | 8 | (10.8%) |
| Cardiac surgerya | 0 | (0%) | 0 | (0%) |
| Coronary artery bypass graft | 4 | (16.7%) | 0 | (0%) |
| Carotid endarterectomy | 0 | (0%) | 0 | (0%) |
| Cesarean section | 0 | (0%) | 11 | (14.9%) |
| Colon surgery | 0 | (0%) | 20 | (27.0%) |
| Herniorrhaphy | 0 | (0%) | 7 | (9.5%) |
| Hip prosthesis | 5 | (20.8%) | 8 | (10.8%) |
| Knee prosthesis | 5 | (20.8%) | 9 | (12.2%) |
| Laminectomy | 2 | (8.3%) | 3 | (4.1%) |
| Peripheral vascular bypass surgery | 0 | (0%) | 2 | (2.7%) |
| Spinal fusion | 2 | (8.3%) | 6 | (8.1%) |
| Vaginal hysterectomy | 2 | (8.3%) | 0 | (0%) |
| Primary reason for investigation | ||||
| Persistent SSI rate elevation | 4 | (16.7%) | 16 | (21.6%) |
| Rapid SSI rate elevation | 8 | (33.3%) | 37 | (50.0%) |
| Elevated surgeon-specific SSI rates | 10 | (41.7%) | 15 | (20.3%) |
| Pathogen profile | 2 | (8.3%) | 6 | (8.1%) |
| Investigation actions taken by study teamb | ||||
| Phone call or meeting with hospital infection prevention teams | 14 | (58.3%) | 62 | (83.8%) |
| Phone call or meeting with operating room staff | 10 | (41.7%) | 10 | (13.5%) |
| Phone call or meeting with surgeon(s) | 7 | (29.2%) | 9 | (12.2%) |
| Detailed line listing | 24 | (100%) | 72 | (97.3%) |
| Step-by-step perioperative practice review | 8 | (33.3%) | 35 | (47.3%) |
| In-person hospital visit | 9 | (37.5%) | 26 | (35.1%) |
| In-person operative room observation | 5 | (20.8%) | 7 | (9.5%) |
| Written recommendations provided | 24 | (100%) | 73 | (98.6%) |
| Type of recommendations | ||||
| Perioperative process improvement | 22/24 | (91.7%) | 72/73 | (98.6%) |
| Ongoing surveillance and feedback | 16/24 | (66.7%) | 45/73 | (61.6%) |
| Education of operating room staff | 1/24 | (4.2%) | 13/73 | (17.8%) |
| Patient-specific intervention | 3/24 | (12.5%) | 14/73 | (19.2%) |
| Groups targeted by recommendations | ||||
| Infection prevention committee | 17/24 | (70.8%) | 65/73 | (89.0%) |
| Operating room leadership | 15/24 | (62.5%) | 43/73 | (58.9%) |
| Surgeons | 11/24 | (45.8%) | 31/73 | (42.5%) |
| Hospital leadership | 11/24 | (45.8%) | 29/73 | (39.7%) |
| Infectious diseases clinicians | 3/24 | (12.5%) | 3/73 | (4.1%) |
| Pharmacy committee | 0/24 | (0%) | 3/73 | (4.1%) |
| Other committeec | 0/24 | (0%) | 2/73 | (2.7%) |
| Implementation of recommendations | ||||
| All recommendations implemented | 6/24 | (25.0%) | 15/73 | (20.5%) |
| Some recommendations implemented | 18/24 | (75%) | 55/73 | (75.3%) |
| No recommendations implemented | 0/24 | (0%) | 3/73 | (4.1%) |
| Days from signal identification to completion of investigation | 185 | (122–242) | 163 | (97–262) |
Data are n (%), n/N (%), or median (IQR). SPC = statistical process control; SSI = surgical site infection.
a
Cardiac surgery included open chest procedures on the valves or septum of the heart.
b
Investigation actions included steps that occurred after initial SSI data review and discussions with network and hospital infection preventionists, which occurred in all investigations.
c
Other committees targeted by recommendations included a performance improvement committee (n=1) and a colon SSI prevention team (n=1).