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Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation

Published online by Cambridge University Press:  31 July 2017

Michael S. Calderwood*
Affiliation:
Section of Infectious Disease and International Health, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
Susan S. Huang
Affiliation:
Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, California
Vicki Keller
Affiliation:
Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
Christina B. Bruce
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
N. Neely Kazerouni
Affiliation:
Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
Lynn Janssen
Affiliation:
Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
*
Address correspondence to Michael S. Calderwood, MD, MPH, Dartmouth-Hitchcock Medical Center, Section of Infectious Disease and International Health, One Medical Center Drive, Suite 5C, Lebanon, NH 03756 (Michael.S.Calderwood@Hitchcock.org).

Abstract

OBJECTIVE

To assess hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation

METHODS

Infection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency).

RESULTS

Upon validation review, CDPH IPs identified 239 SSIs following colon surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For colon surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone colon surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing colon surgery and 35% of validation hospitals performing abdominal hysterectomy.

CONCLUSIONS

Claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.

Infect Control Hosp Epidemiol 2017;38:1091–1097

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Variable Case Detection and Many Unreported Cases of Surgical-Site Infection Following Colon Surgery and Abdominal Hysterectomy in a Statewide Validation
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