scholarly journals Making a Case for Adjusting NHSN SSI Risk Stratification Classification for Use of Enhanced Electronic Infection Surveillance

2020 ◽  
Vol 41 (S1) ◽  
pp. s18-s18
Author(s):  
Meri Pearson ◽  
Krista Doline
Keyword(s):  
Healthcare System ◽  
Surveillance System ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Detection Methods ◽  
Surveillance Systems ◽  
Electronic Surveillance ◽  
Healthcare Associated Infection ◽  
Infection Surveillance

Background: A large healthcare system in Georgia went live with an enhanced electronic infection surveillance system in August of 2018. The system was employed at its facilities using a staggered approach. Prior to the implementation of this infection surveillance platform, the healthcare system performed healthcare-associated infection (HAI) surveillance using an in-house culture-based system. The NHSN estimates that culture-based surveillance misses 50%–60% of true surgical site infections (SSIs). Due to the lack of clinical-based detection methods (eg, radiologic imaging), we were unable to appropriately detect all patient harm using the old surveillance system. Method: A retrospective analysis was performed to assess the change in HAI for colon (COLO), abdominal hysterectomy (HYST), hip prosthesis (HPRO), and knee prosthesis (KPRO). SSI cases that met NHSN surveillance criteria were reviewed to determine whether they would have been identified prior to launching the new enhanced electronic surveillance system. Results: Systemwide, 8 of 26 COLO SSIs (31%) and 9 of 18 HYST SSIs (50%) would have not been detected using our old surveillance system. HPRO SSIs and KPRO SSIs identified by our new surveillance system were detected using our old surveillance system, and no change was observed. Conclusion: This analysis showed an increase in COLO SSIs and HYST SSIs from enhanced surveillance. Electronic surveillance systems are not considered as a risk factor in the NHSN annual facility survey that aids in calculating a facility’s standardized infection ratio (SIR). These data help support NHSN consideration of modifying the logistic regression calculation used for the complex SSI models. This revision would allow facilities to compare themselves equitably to those using electronic infection surveillance.Funding: NoneDisclosures: None

Laminar Airflow Ceiling Size: No Impact on Infection Rates Following Hip and Knee Prosthesis

2011 ◽  
Vol 32 (11) ◽  
pp. 1097-1102 ◽  
Author(s):  
Ann-Christin Breier ◽  
Christian Brandt ◽  
Dorit Sohr ◽  
Christine Geffers ◽  
Petra Gastmeier
Keyword(s):  
Orthopedic Surgery ◽  
Surveillance System ◽  
Generalized Estimating Equations ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Infection Risk ◽  
National Nosocomial Infection Surveillance ◽  
Infection Rates ◽  
Infection Surveillance ◽  
Lower Infection

Objective.Laminar airflow (LAF) systems are widely used, at least in orthopedic surgery. However, there is still controversial discussion about the influence of LAF on surgical site infection (SSI) rates. The size of the LAF ceiling is also often a question of debate. Our objective is to determine the effect of this technique under conditions of actual rather than ideal use.Design.Cohort study using multivariate analysis with generalized estimating equations method.Setting.Data for hip and knee prosthesis procedures from hospitals participating in the German national nosocomial infection surveillance system (KISS) from July 2004 to June 2009 were used for analysis.Patients.A total of 33,463 elective hip prosthesis procedures due to arthrosis (HIP-A) from 48 hospitals, 7,749 urgent hip prosthesis procedures due to fracture (HIP-F) from 41 hospitals, and 20,554 knee prosthesis (KPRO) procedures from 38 hospitals were included.Methods.The data were analyzed for hospitals with and without LAF in the operating rooms and by the size of the LAF ceiling. The endpoints were severe SSI rates.Results.The overall severe SSI rate was 0.74 per 100 procedures for HIP-A, 2.39 for HIP-F, and 0.63 for KPRO. For all 3 prosthesis types, neither LAF nor the size of the LAF ceiling was associated with lower infection risk.Conclusions.The data demonstrate consistency and reproducibility with the results from earlier registry studies. Neither LAF nor ceiling size had an impact on severe SSI rates.

Complex Surgical Site Infections and the Devilish Details of Risk Adjustment: Important Implications for Public Reporting

2008 ◽  
Vol 29 (10) ◽  
pp. 941-946 ◽  
Author(s):  
Deverick J. Anderson ◽  
Luke F. Chen ◽  
Daniel J. Sexton ◽  
Keith S. Kaye
Keyword(s):  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Abdominal Hysterectomy ◽  
Index Score ◽  
Case Mix ◽  
Infection Surveillance ◽  
Reporting Rates ◽  
Risk Index Score

Objective.To validate the National Nosocomial Infection Surveillance (NNIS) risk index as a tool to account for differences in case mix when reporting rates of complex surgical site infection (SSI).Design.Prospective cohort study.Setting.Twenty-four community hospitals in the southeastern United States.Methods.We identified surgical procedures performed between January 1, 2005, and June 30, 2007. The Goodman-Kruskal gamma or G statistic was used to determine the correlation between the NNIS risk index score and the rates of complex SSI (not including superficial incisional SSI). Procedure-specific analyses were performed for SSI after abdominal hysterectomy, cardiothoracic procedures, colon procedures, insertion of a hip prosthesis, insertion of a knee prosthesis, and vascular procedures.Results.A total of 2,257 SSIs were identified during the study period (overall rate, 1.19 SSIs per 100 procedures), of which 1,093 (48.4%) were complex (0.58 complex SSIs per 100 procedures). There were 45 complex SSIs identified following 7,032 abdominal hysterectomies (rate, 0.64 SSIs per 100 procedures); 63 following 5,318 cardiothoracic procedures (1.18 SSIs per 100 procedures); 139 following 5,144 colon procedures (2.70 SSIs per 100 procedures); 63 following 6,639 hip prosthesis insertions (0.94 SSIs per 100 procedures); 73 following 9,658 knee prosthesis insertions (0.76 SSIs per 100 procedures); and 55 following 6,575 vascular procedures (0.84 SSIs per 100 procedures). All 6 procedure-specific rates of complex SSI were significantly correlated with increasing NNIS risk index score (P< .05).Conclusions.Some experts recommend reporting rates of complex SSI to overcome the widely acknowledged detection bias associated with superficial incisional infection. Furthermore, it is necessary to compensate for case-mix differences in patient populations, to ensure that intrahospital comparisons are meaningful. Our results indicate that the NNIS risk index is a reasonable method for the risk stratification of complex SSIs for several commonly performed procedures.

scholarly journals Administrative Coding Methods Impact Surgical Site Infection Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s111-s112
Author(s):  
Mohammed Alsuhaibani ◽  
Mohammed Alzunitan ◽  
Kyle Jenn ◽  
Daniel Diekema ◽  
Michael Edmond ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Surgical Procedures ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
Abdominal Hysterectomy ◽  
Absolute Difference ◽  
Coding Method ◽  
The Impact

Background: Surveillance for surgical site infections (SSI) is recommended by the CDC. Currently, colon and abdominal hysterectomy SSI rates are publicly available and impact hospital reimbursement. However, the CDC NHSN allows surgical procedures to be abstracted based on International Classification of Diseases, Tenth Revision (ICD-10) or current procedural terminology (CPT) codes. We assessed the impact of using ICD and/or CPT codes on the number of cases abstracted and SSI rates. Methods: We retrieved administrative codes (ICD and/or CPT) for procedures performed at the University of Iowa Hospitals & Clinics over 1 year: October 2018–September 2019. We included 10 procedure types: colon, hysterectomy, cesarean section, breast, cardiac, craniotomy, spinal fusion, laminectomy, hip prosthesis, and knee prosthesis surgeries. We then calculated the number of procedures that would be abstracted if we used different permutations in administration codes: (1) ICD codes only, (2) CPT codes only, (3) both ICD and CPT codes, and (4) at least 1 code from either ICD or CPT. We then calculated the impact on SSI rates based on any of the 4 coding permutations. Results: In total, 9,583 surgical procedures and 180 SSIs were detected during the study period using the fourth method (ICD or CPT codes). Denominators varied according to procedure type and coding method used. The number of procedures abstracted for breast surgery had a >10-fold difference if reported based on ICD only versus ICD or CPT codes (104 vs 1,109). Hip prosthesis had the lowest variation (638 vs 767). For SSI rates, cesarean section showed almost a 3-fold increment (2.6% when using ICD only to 7.32% with both ICD & CPT), whereas abdominal hysterectomy showed nearly a 2-fold increase (1.14% when using CPT only to 2.22% with both ICD & CPT codes). However, SSI rates remained fairly similar for craniotomy (0.14% absolute difference), hip prosthesis (0.24% absolute difference), and colon (0.09% absolute difference) despite differences in the number of abstracted procedures and coding methods. Conclusions: Denominators and SSI rates vary depending on the coding method used. Variations in the number of procedures abstracted and their subsequent impact on SSI rates were not predictable. Variations in coding methods used by hospitals could impact interhospital comparisons and benchmarking, potentially leading to disparities in public reporting and hospital penalties.Funding: NoneDisclosures: None

scholarly journals Governmental surveillance system of healthcare-associated infection in Brazil

2014 ◽  
Vol 48 (4) ◽  
pp. 657-662 ◽  
Author(s):  
Cassimiro Nogueira Junior ◽  
Maria Clara Padoveze ◽  
Rúbia Aparecida Lacerda
Keyword(s):  
Surveillance System ◽  
Surveillance Systems ◽  
Healthcare Associated Infection ◽  
Cross Sectional ◽  
Southern States ◽  
Governmental Surveillance ◽  
Minimum Requirements ◽  
Two Phases ◽  
Healthcare Associated ◽  
And Control


Objective: This study aimed to describe the structure of governmental surveillance systems for Healthcare Associated Infection (HAI) in the Brazilian Southeastern and Southern States. Method: A cross-sectional, descriptive and exploratory study, with data collection by means of two-phases: characterization of the healthcare structure and of the HAI surveillance system. Results: The governmental teams for prevention and control of HAI in each State ranged from one to six members, having at least one nurse. All States implemented their own surveillance system. The information systems were classified into chain (n=2), circle (n=4) or wheel (n=1). Conclusion: Were identified differences in the structure and information flow from governmental surveillance systems, possibly limiting a nationwide standardization. The present study points to the need for establishing minimum requirements in public policies, in order to guide the development of HAI surveillance systems.


Apples to Apples: A Model for Standardizing Surveillance Throughout a Healthcare System After Implementation of an Electronic Surveillance System

2012 ◽  
Vol 40 (5) ◽  
pp. e171-e172
Author(s):  
Katie Wickman ◽  
Linda Stein ◽  
Sinead Forkan-Kelly ◽  
Jean Watson ◽  
Karen Martin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Surveillance System ◽  
Electronic Surveillance

scholarly journals Healthcare resources attributable to methicillin-resistant Staphylococcus aureus orthopedic surgical site infections

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Haruhisa Fukuda ◽  
Daisuke Sato ◽  
Tetsuya Iwamoto ◽  
Koji Yamada ◽  
Kazuhiko Matsushita
Keyword(s):  
Staphylococcus Aureus ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Healthcare Resource Utilization ◽  
Prevention Measures ◽  
Healthcare Resources ◽  
Methicillin Resistant ◽  
Japanese Residents ◽  
Almost All

Abstract The number of orthopedic surgeries is increasing as populations steadily age, but surgical site infection (SSI) rates remain relatively consistent. This study aimed to quantify the healthcare resources attributable to methicillin-resistant Staphylococcus aureus (MRSA) SSIs in orthopedic surgical patients. The analysis was conducted using a national claims database comprising data from almost all Japanese residents. We examined patients who underwent any of the following surgeries between April 2012 and March 2018: amputation (AMP), spinal fusion (FUSN), open reduction of fracture (FX), hip prosthesis (HPRO), knee prosthesis (KPRO), and laminectomy (LAM). Propensity score matching was performed to identify non-SSI control patients, and generalized estimating equations were used to estimate the differences in outcomes between the case and control groups. The numbers of MRSA SSI cases (infection rates) ranged from 64 (0.03%) to 1,152 (2.33%). MRSA SSI-attributable increases in healthcare expenditure ranged from $11,630 ($21,151 vs. $9,521) for LAM to $35,693 ($50,122 vs. $14,429) for FX, and increases in hospital stay ranged from 40.6 days (59.2 vs. 18.6) for LAM to 89.5 days (122.0 vs. 32.5) for FX. In conclusion, MRSA SSIs contribute to substantial increases in healthcare resource utilization, emphasizing the need to implement effective infection prevention measures for orthopedic surgeries.

scholarly journals METHOD OF IMAGE PROCESSING IN THE PROBLEM OF DETECTING MOVING OBJECTS IN OPTICAL-ELECTRONIC SURVEILLANCE SYSTEMS OF THERMAL IMAGING TYPE

Doklady BGUIR ◽  
2020 ◽  
Vol 18 (2) ◽  
pp. 96-104
Author(s):  
E. I. Mikhnionok
Keyword(s):  
Image Processing ◽  
False Alarm ◽  
Background Subtraction ◽  
Thermal Imaging ◽  
Surveillance System ◽  
Moving Objects ◽  
Field Of View ◽  
Surveillance Systems ◽  
Electronic Surveillance ◽  
Noise Component

The article considers the method of image processing proposed by the author in relation to the problem of automatic detection of moving objects in optoelectronic thermal imaging systems. Moving objects on the observed scene are subject to investigation, so it is advisable to use algorithms based on background subtraction methods to solve the detection problem. However, the observed objects may include objects of interest (a person, a vehicle), as well as other objects and background elements that increase the noise component of the observed situation. Also, the increase in the noise component is greatly influenced by false segmentation in the foreground of the areas of processed images when transferring the field of view of the sensor of the optical-electronic surveillance system. The purpose of this article is to prove the reduction of the probability of false alarm of an automatic detector due to the author's proposed approaches to image processing. The research uses the mathematical apparatus of probability theory and simulation with subsequent statistical processing of data. The article shows that the probability of a false alarm of an automatic detector based on the background subtraction method increases significantly after the transfer of the field of view of the sensor of the optical-electronic surveillance system and decreases after the movement stops as the areas of the processed image that are falsely highlighted in the foreground are automatically segmented. The simulation showed that the approaches proposed by the author can increase the peak signal-to-noise ratio of processed images and reduce the probability of a false alarm of the automatic detector of objects of interest. The results obtained show the feasibility of adapting detection algorithms based on background subtraction methods to work in scanning optoelectronic surveillance systems.

scholarly journals POST CAESAREAN SECTION WOUND INFECTION: MICROBIOLOGICAL PATTERN AND SUSCEPTIBILITY IN A TERTIARY CARE HOSPITAL, JHALAWAR

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Dr.Shilpi Hora ◽  
Dr. Manish Pokra ◽  
Dr.Pawan Sharma ◽  
Dr.Tarun Vijaywargiya Vijaywargiya ◽  
Dr.Anshul Jhanwar
Keyword(s):  
Nosocomial Infection ◽  
Surveillance System ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Surgical Patients ◽  
Care Hospital ◽  
The Third ◽  
Infection Surveillance ◽  
Surgical Operations

Surgical site infection (SSI) is the third most common nosocomial infection. According to CDC’s National Nosocomial Infection Surveillance system 38% of all nosocomial infections in surgical patients are surgical site infections (SSI).1 They have been responsible for the increasing cost, morbidity and mortality related to surgical operations .Even in hospitals, with modern facilities and following standard protocols of pre operative preparation and antibiotic prophylaxis, SSI continues to be a major problem

scholarly journals 1248. 30-Day Colon Surgical Site Infections: Using NSQIP to Cross Check NHSN

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S449-S449
Author(s):  
Stephanie L Strollo ◽  
Anupama Neelakanta ◽  
Caroline Reinke ◽  
Michael Barringer ◽  
Catherine Passaretti
Keyword(s):  
Human Error ◽  
Positive Culture ◽  
Surgical Site Infections ◽  
Colon Surgery ◽  
Case Finding ◽  
Electronic Surveillance ◽  
Healthcare Associated Infection ◽  
Post Discharge ◽  
Improvement Project ◽  
Physician Review

Abstract Background While infection prevention (IP) programs utilize National Health Safety Network (NHSN) definitions, surgical site infection (SSI) case-finding methods may vary between facilities based on resources and availability/type of healthcare-associated infection (HAI) electronic surveillance tracking software. Furthermore, surgeons may receive SSI data from other databases such as National Surgery Quality Improvement Project (NSQIP) which has slightly different definitions and case finding methodologies. Our goal was to compare colon SSIs across our health system found by IP using NHSN definitions to those obtained utilizing NSQIP case finding methodology and definitions. Methods Between January 2018 and September 2018 across 8 acute care facilities ranging in size from 100 to 898 beds, HAI electronic surveillance tracking triggered IP and infectious diseases (ID) trained physician review for NHSN SSI criteria if a patient was either readmitted or had a positive culture within 30 days of colon surgery. SSI results were compared with NSQIP SSI data which reviews all charts and conducts post-discharge surveillance during active surveillance periods. All discrepant cases were reviewed by an infection preventionist, an ID physician and surgery physician champion. Cases were classified as discrepant due to different case inclusion criteria, different case finding or clinical misclassification. Results 69 cases were reviewed. Both databases called 11 cases (16%) an SSI initially. NSQIP identified 35 cases that were not detected by IP surveillance. Of the 35 NSQIP detected SSI, 17 (49%) were felt to meet NHSN SSI criteria after review (7 organ space, 10 superficial). Majority (76%) were discordant due to case finding issues (diagnosed as outpatient, same hospital course with no cultures to flag for review). Two infections were missed because of human error. Once the SSIs were entered into NHSN, only one facility had an increase in the SIR which impacted interpretation of SSI performance (from 0.949 up to 1.423). NHSN identified 23 cases that were not identified in the NSQIP database. There were 8 organ space infections and 8 superficial site infections. Conclusion Without 100% surveillance, SSIs may be missed. Not all missed infections were superficial. Opportunities were found for both NHSN and NSQIP. Disclosures All authors: No reported disclosures.

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