Surgical Site Infection Prevention
Surgical site infections (SSIs) are among the most common healthcare-associated infections and represent a significant quality and safety concern. SSIs increase morbidity, length of stay, costs, and mortality. CMS includes certain SSIs as hospital-acquired conditions, directly linking prevention to reimbursement. CPHQ candidates should understand SSI prevention strategies and measurement.
SSI Classification
Surgical site infections are classified by depth. Superficial incisional SSIs involve the skin and subcutaneous tissue. Deep incisional SSIs involve fascial and muscle layers. Organ/space SSIs affect the anatomical area manipulated during the procedure. The CDC's National Healthcare Safety Network (NHSN) provides standardized surveillance definitions that allow comparison across facilities.
Preoperative Prevention
Preoperative prevention strategies include appropriate hair removal (clipping rather than shaving), preoperative bathing with antiseptic agents, blood glucose control for diabetic patients, screening and decolonization for MRSA in high-risk procedures, and appropriate timing and selection of prophylactic antibiotics. Antibiotic prophylaxis should be administered within 60 minutes of surgical incision (120 minutes for vancomycin and fluoroquinolones).
Intraoperative Measures
Intraoperative SSI prevention includes maintaining normothermia, appropriate skin preparation with chlorhexidine-alcohol based agents, maintaining adequate oxygenation, minimizing operating room traffic, ensuring surgical instrument sterility, and adhering to sterile technique. The surgical team should follow standardized protocols that address each of these factors.
Postoperative Surveillance
SSI surveillance extends beyond the hospital stay. For most procedures, the surveillance period is 30 days; for procedures involving implants, surveillance extends to 90 days. Post-discharge surveillance methods include follow-up phone calls, clinic visit assessment, and review of readmission data. Accurate surveillance requires consistent application of NHSN definitions.
Quality Measurement and Reporting
SSI rates are calculated as standardized infection ratios (SIRs) comparing observed infections to expected infections based on national data. CMS requires reporting of SSIs for specific procedures through the NHSN. Results are publicly reported on Hospital Compare and affect payment through the Hospital-Acquired Condition Reduction Program and the Hospital Value-Based Purchasing Program.