Jeanne Yegge

Risk Factors for Craniotomy or Spinal Fusion Surgical Site Infection.

Background: Surgical site infections (SSIs) occur in approximately 700 pediatric patients annually and are associated with increased morbidity, mortality and cost. The aim of this study is to determine risk factors for SSI among pediatric patients undergoing craniotomy and spinal fusion. Methods: This is a retrospective case-control study. Cases were craniotomy or spinal fusion patients with SSI as defined by Centers for Disease Control and Prevention criteria with surgery performed from January 1, 2008 to July 31, 2009. For each case patient, 3 uninfected controls were randomly selected among patients who underwent the same procedure as the case patient within 1 month. We performed analyses of risk factors for craniotomy and spinal fusion SSI separately and as a combined outcome variable. Results: Underweight body mass index, increased time at lowest body temperature, increased interval to antibiotic redosing, the combination of vancomycin and cefazolin for prophylaxis, longer preoperative and postoperative intensive care unit stay and anticoagulant use at 2 weeks postoperatively were associated with an increased risk of SSI in the combined analysis of craniotomy and spinal fusion. Forty-seven percent of cases and 27% of controls received preoperative antibiotic doses that were inappropriately low because of their weight. Conclusions: We identified modifiable risk factors for SSI including antibiotic dosing and body temperature during surgery. Preoperative antibiotic administration is likely to benefit from standard processes. Further studies of risk benefit for prolonged low body temperature during procedures are needed to determine the optimal balance between neuroprotection and potential immunosuppression associated with low body temperature.

Development of a standardized process improvement protocol to address elevated health care-associated infection rates on an incented quality scorecard.

This practice forum report details a standardized improvement process that was created both to improve patient outcomes related to various hospital-acquired infections and to address leadership concerns related to incented quality metrics. A 3-year retrospective review identified common issues to guide future interventions and confirmed that this methodology reduced the rate of recurrent infections across the health care system. Process tool samples are provided.

Inter-rater Reliability of Infection Preventionists’ Colon Surgical Site Infection Determination Utilizing a User Assisted Electronic Surveillance System

ISSUE: Our 28 bed Hematology Oncology (Heme-Onc) unit has had an unacceptably high central line assosciated bloodstream infection (CLABSI) rate. This patient population with various hematologic malignancies, including stem cell transplants, is at high risk for neutropenia, mucositis and graft-versus-host disease. Despite aggressive prevention efforts with implementation of multiple evidence-based CLABSI interventions over a 3 year period, no significant reduction in the CLABSI rate was achieved. PROJECT: Applying the new January 2013 National Healthcare Safety Network (NHSN) mucosal barrier injury laboratoryconfirmed bloodstream infection (MBI-LCBSI) definition, we identified that 80% of the CLABSIs on our Heme-Onc unit met the MBI-LCBSI definition for the first quarter of 2013. To determine if this finding was new, all CLABSIs from 2012 on this Heme-Onc unit were retrospectively reviewed applying the 2013 NSHN MBILCBI definition. Tracking of the CLABSI rate excluding the MBI-LCBSIs continued in 2013. Chi square tests were performed to determine if the overall CLABSI rate was significantly different than the CLABSI rate excluding MBI-LCBIs for both 2012 and 2013. RESULTS: The overall CLABSI rate in 2012 was 4.07 BSI/1,000 device days. 67.6% of the CLABSIs in 2012met the definition for MBI-LCBSI. The CLABSI rate, excluding MBI-LCBSIs, was 1.32 BSI/1,000 device days. For the first eleven months of 2013, the overall CLABSI rate was 3.6 BSI/1,000 device days. 77.8 % of the CLABSIs met the MBI-LCBSI definition in 2013. The CLABSI rate, excluding the MBI-LCBIs, was 0.8 BSI/1,000 device days. There was a significant difference between the rates in 2012, (c2 (1) 1⁄4 11.72, p < .01) as well as in 2013, (c2 (1) 1⁄4 13.33, p < .01).