Hospitals Cut Colorectal Surgical-Site Infections by a Third

November 28, 2012

Seven academic medical centers reduced their rate of colorectal surgical site infections (SSIs) by 32% with interventions that included hand sanitizer, new sets of instruments for closure, and postoperative telephone calls to patients about wound care, leaders of the quality improvement campaign announced at a press conference today.

The hospitals scored an even bigger success by lowering the rate for a type of colorectal SSI called superficial incisional by 45%. In all, they avoided an estimated 135 colorectal SSIs, thereby saving more than $3.7 million. They also lowered the average length of stay for patients with these infections from 15 days to 13 days.

"These improvements represent victories for patients, caregivers, and healthcare as a whole," said Mark Chassin, MD, MPH, president of the Joint Commission, which organized the 30-month project through its Center for Transforming Health Care in collaboration with the American College of Surgeons. The hospitals that voluntarily participated are:

  • Cedars-Sinai Health System, Los Angeles, California;

  • Cleveland Clinic, Cleveland, Ohio;

  • Mayo Clinic–Rochester Methodist Hospital, Rochester, Minnesota;

  • North Shore–Long Island Jewish Health System, Great Neck, New York;

  • Northwestern Memorial Hospital, Chicago, Illinois;

  • OSF Saint Francis Medical Center, Peoria, Illinois; and

  • Stanford Hospital & Clinics, Palo Alto, California.

Is the Patient Warm Enough?

Dr. Chassin said the researchers targeted colorectal SSIs because colorectal surgeries are very common, are performed in hospitals large and small, and are subject to significant infection risks. Plus, colorectal SSI rates vary widely from hospital to hospital, said Dr. Chassin, demonstrating ample room for improvement. Although the national rate is between 15% and 20%, it can approach 60% at some institutions, noted Shirin Towfigh, MD, director of the Medical Student Education Program in the surgery department at Cedars-Sinai Medical Center.

The 7 hospitals in the Joint Commission project lowered their colorectal SSI rate from 15.8% to 10.7%. To do that, said Dr. Chassin, they first identified the leading causes of the infections, which differed from hospital to hospital. The anti-infection tactics they developed covered all phases of care: preadmission, preoperative, intraoperative, postoperative, and postdischarge. They include:

  • attaching hand sanitizer containers to bed posts to make them readily available to clinicians,

  • screening patients for infections during preadmission testing,

  • establishing weight-based protocols for antibiotic dosing,

  • automatically redosing antibiotics if a surgery goes beyond 3 to 4 hours,

  • standardizing procedures to keep the patient sufficiently warm and initiating these procedures before the operation,

  • giving surgeons and nurses a new set of instruments as well as new gowns and gloves before closure,

  • consulting a wound ostomy nurse for complicated wound management, and

  • calling patients within a week after discharge to review wound-care management.

Dr. Chassin said the Joint Commission's Center for Transforming Health Care will proceed to share the lessons of the project with hospitals nationwide. He cautioned, however, that there is no "one-size-fits-all" solution, because every hospital's infection problem is different. Instead, solutions must be tailor-made.

"The only way you can do that is to measure the causes," he said.

More information about the campaign against colorectal SSIs is available on the Web site of the Center for Transforming Health Care.