Seven institutions participating in a Joint Commission and American College of Surgeons quality-improvement project to reduce colorectal surgical-site infection rates
saved more than $3.7 million by avoiding 135 infections over a 2½-year period.
This included superficial incisional infections, affecting skin and underlying tissue, which were lowered 45%; and all types of colorectal surgical-site infections by 32%. The average length of stay for surgical-site infection patients was reduced to 13 days from 15.
Joint Commission President Dr. Mark Chassin said during a news conference that “there is no simple, one-size-fits-all solution,” but he explained that the key to reducing these infections lies in pinpointing causes and then using and testing targeted solutions to solve those problems. Thirty-four variables were identified that affect rates for colorectal surgical-site infections, or SSIs, and Chassin said each institution has to identify which ones are causing problems in their facilities and use the interventions that have been found to work against each one of these variables.
The Mayo Clinic, Rochester, Minn., was able to reduce its colorectal SSI rate to 4% from 9.8% during this project, and Cedars-Sinai Medical Center, Los Angeles, went to 5.5% from a 15.5% infection rate during the project. Dr. Shirin Towfigh, a Cedars-Sinai attending surgeon and medical student education program director, said during the news conference that the rate has been below 5% since July.
She said some of the simple Cedars-Sinai interventions included having the patient shower the night before or the day of surgery, administering antibiotics before the incision, administering them again in surgeries lasting beyond four hours, and requiring a complete changing of surgical gowns gloves and instruments before closing of the skin.
The other participating institutions were: Cleveland Clinic; North Shore-Long Island Jewish Health System, New York; Northwestern Memorial Hospital, Chicago; OSF St. Francis Medical Center, Peoria, Ill.; and Stanford Hospital & Clinics, Palo Alto, Calif.
Chassin, Towfigh and Dr. Clifford Ko, director of the ACS National Surgical Quality Improvement Program, said that—while the participating institutions have advanced quality-improvement and data-collection systems—the findings of the project can be reproduced at hospitals across the country.
Chassin added that the Joint Commission is “working on the most appropriate way” to estimate the number of colorectal SSIs that can be avoided and the financial savings that can be accumulated if hospitals across the country adopt the principles of the program.