Surgical site infection: Incidence and impact on hospital utilization and treatment costs

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American journal of infection control (Impact Factor: 2.21). 05/2009; 37(5):387-97. DOI: 10.1016/j.ajic.2008.12.010
Source: PubMed


Surgical site infections (SSIs) are serious operative complications that occur in approximately 2% of surgical procedures and account for some 20% of health care-associated infections.
SSI was identified based on the presence of ICD-9-CM diagnosis code 998.59 in hospital discharge records for 7 categories of surgical procedures: neurological; cardiovascular; colorectal; skin, subcutaneous tissue, and breast; gastrointestinal; orthopedic; and obstetric and gynecologic. Source of data was the 2005 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS). Primary study outcomes were rate of SSI by surgical category and impact of SSI on length of stay and cost. Results were projected to the national level.
Among 723,490 surgical hospitalizations in the sample, 6891 cases of SSI were identified (1%). On average, SSI extended length of stay by 9.7 days while increasing cost by $20,842 per admission. From the national perspective, these cases of SSI were associated with an additional 406,730 hospital-days and hospital costs exceeding $900 million. An additional 91,613 readmissions for treatment of SSI accounted for a further 521,933 days of care at a cost of nearly $700 million.
SSI is associated with a significant economic burden in terms of extended length of stay and increased costs of treatment. Our analysis documented nearly 1 million additional inpatient-days and $1.6 billion in excess costs.

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    • "Surgical site infection (SSI) is the third most commonly reported health care associated infection in France [1]. The occurrence of SSI increases hospitalization costs and length of stay, and impairs patients' quality of life [2] [3] [4]. Hence, reducing the rate of SSIs is an important medico-economic issue. "
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    ABSTRACT: Object: Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. Methods: This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). Results: One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. Conclusion: Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method.
    Orthopaedics & Traumatology Surgery & Research 11/2015; 101(7). DOI:10.1016/j.otsr.2015.08.001 · 1.26 Impact Factor
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    • "It was observed that operating table, floor and OR light were heavily contaminated with S. aureus. This finding is in line with similar studies in India (De Lissovoy et al., 2009). However, this was contradicted with a study conducted in Pakistan (Saadoun et al., 2008), which reported Bacillus spp. "
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    ABSTRACT: Microbial contamination of the operating theatre (OT) is a major cause of nosocomial infection (NI). The study assessed the level of microbial contamination and determines the antimicrobial resistance of the bacterial isolates. Settle plate's method was used for air sample collection while swab method was used to collect samples from surfaces and other articles in the major OT. Collected samples were transported and microbiologically processed using standard procedures. One hundred and twenty air, 36 article and 12 surface samples were taken for microbiological evaluation. The highest level of microbial contamination was detected in the OT air before proper cleaning-fumigation as compared to after the intervention. Moreover, microbial growth was found on surfaces and semi-critical articles. On the other hand, articles which were sterilized by autoclave showed no microbial growth. The five types of bacteria isolated were coagulase negative Staphyllococci (68; 53.4%), Staphyllococcus aureus (42; 33.1%), Pseudomonas aeruginosa (13; 10.2%), E. coli (2; 1.6%), and Bacillus spp. (2; 1.6%). Methicillin resistance S. aureus (MRSA) account for 7.7% of the S. aureus isolates. The highest resistance was found against penicillin G and ampicillin with a resistance rate of 52.7 and 44.5%, respectively. Multidrug resistance was observed among 23 (36.5%) of the bacterial isolates. In general, the results indicate proper cleaning-fumigation of OT significantly reduced the microbial contamination, and bacterial strains such as coagulase negative Staphylococci, and S. aureus have a greater propensity to cause contamination in OT. In conclusion, there was high level of microbial contamination in the OT, particularly in air and semi-critical articles. However, it has been dramatically reduced through proper cleaning-fumigation of the OT. Therefore, regular microbiological surveillance of the OT is mandatory in reducing microbial contamination. Furthermore, efforts should be made to ensure strict infection control practices in the OT.
    African journal of microbiology research 04/2015; 9(9):639-642. DOI:10.5897/AJMR2014.7276 · 0.54 Impact Factor
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    • "SSI remains one of the critically serious problems in post-operative complications, constituting approximately 20% of all of health care-associated infections (2). "
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    ABSTRACT: In low income countries, surgical site infections (SSIs) are costly and impose a heavy and potentially preventable burden on both patients and healthcare providers. This study aimed to determine the occurrence of SSI, pathogens associated with SSI, the antibiogram of the causative pathogens and specific risk factors associated with SSI at the hospital. Two hundred and sixty-eight respondents admitted for general surgical procedures (other than neurological and cardiothoracic surgeries) at the Aga Khan University Hospital were eligible to take part in the study. Post-surgery patients were observed for symptoms of infection. Follow ups were done through the consulting clinics, breast clinic and casualty dressing clinic by a team of surgeons. In cases of infection, pus swabs were collected for culture. SSI incidence rate was 7.0%, pathogens isolated from SSI included gram negative enteric bacilli and S. aureus which was the most prevalent bacterial isolate. Only one isolate of MRSA was found and all staphylococci were susceptible to Vancomycin. Preoperative stay ≥ 2 days and wound class were the risk factors associated with SSI. The SSI incidence rates (7.0%) observed in this study were relatively lower than the ones documented in other studies in Kenya. S. aureus is the most prevalent pathogen associated with SSI. Similar to findings from other studies done in the region; prolonged hospital stay and dirty wounds were the risks associated with postsurgical sepsis at the hospital.
    Ethiopian journal of health sciences 07/2013; 23(2):141-9.
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