Implementation of Targeted Infection Surveillance in an Outpatient Surgery Center

ISSUE: In the past our surgery center (SC) performed <200 cases monthly, performed surgical site infection surveillance (SSIS) by sending letters to surgeons, and reported overall SSI rates quarterly. In late 2002, the volume increased to 400–500 cases per month. Infection Control and Epidemiology (IC) and the SC administrative team collaborated to design a new SSIS system in an area where infection rates are expected to be very low. PROJECT: We implemented a targeted SSIS system; we target high-volume, riskier procedures, based on review of the medical literature and historical SSIS results. Initially IC staff developed an Excel spreadsheet and a report template to track and display the data. Surveillance is performed monthly. IC staff print a list from the surgery database of patients who had procedures at the SC, sorted by surgical service. Clinical and microbiology data on the targeted cases are reviewed via our online medical information system. The NNIS SSI definition is used to determine any SSIs. The IC specialist sends a monthly summary to the SC team. This part of the surveillance takes about 8 hours per month. Semi-annually the IC specialist and the SC team meet formally to discuss the results and develop recommendations. RESULTS: During 2003, we followed nine types of surgeries. Our overall SSI rate was 0.75% (monthly range 0%–1.6%). Although procedure-specific rates varied from 0% to 20%, low numbers of procedures in several categories limit interpretation of this data. Of six SSIs detected, only one was cultured. LESSONS LEARNED: Our targeted SSIS system is time-effective and takes advantage of computer technology. Procedure-specific rates enable us to focus IC efforts and to detect potential problems. We are able to identify SSIs that are not cultured. Dividends include increased communication between IC and SC staff. We expect the significance of internal benchmarking to increase in the future as we have more data.