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Study identifies characteristics of hospitals with low rates of surgical site infections

December 09, 2008

New research published in the December issue of the Journal of the American College of Surgeons (JACS) suggests that surgical procedures that are shorter in duration and the use of fewer blood transfusions characterize hospitals that have a lower incidence of surgical site infections (SSI). Furthermore, the study concludes that strategies to reduce the length of operations and the number of blood transfusions should complement basic aseptic techniques in the operating room.

SSIs are a persistent problem that contribute to patient discomfort, longer hospital stays, and higher health care costs. Previously, evidence-based prevention measures implemented by the Surgical Infections Prevention Project (SIPP) resulted in a 27 percent reduction in the incidence of SSIs in 44 participating hospitals over the course of one year. This study, part of the first American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Best Practices Initiative, aimed to identify "best practices" that have not yet achieved the evidence requirement and therefore were not included in the SIPP.

Researchers compared 20 low SSI incidence and 13 high SSI incidence hospitals with regard to patient characteristics, operative variables, structural variables, and processes of care. Results of the analysis showed that hospitals with high SSI rates performed operations that took significantly longer on average compared with hospitals with low SSI rates (128 +/- 104.3 minutes versus 102.7 +/- 89.9 minutes, respectively; p<0.001). In addition, hospitals with low SSI rates were less likely to administer transfusions than hospitals with high SSI rates (5.1 percent versus 9.7 percent, respectively; p = 0.03).

"Most hospitals have been employing basic SSI prevention techniques for decades. In order to make a real impact on reducing the incidence of these infections, the standard procedures need to be complemented by strategies that reduce the length of operations and the frequency of blood transfusion," said lead study author Darrell A. Campbell Jr., MD, FACS, professor of surgery at the University of Michigan, Ann Arbor.

Data showed that hospitals that were substantially more involved with training young surgeons had operations with longer durations. In the article in the December issue of JACS, researchers called for further studies to explore the link between higher transfusion rates in higher SSI incidence hospitals and commented that the practice of reducing operating room traffic also deserves more research. Overall, results of the study showed that hospitals with low SSI incidence rates were smaller, more efficient in the delivery of care, and experienced little operative staff turnover.

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