“We’re thrilled to see such a positive outcome in an area where it has traditionally been very tough to move the needle," said study leader Elizabeth Wick, MD, an assistant professor of surgery at the Johns Hopkins University School of Medicine. “Until now, there’s been little evidence on how to effectively address SSIs among this group of patients," Wick explained, adding that the nature of colorectal procedures—cutting in the bacteria-rich environment of the bowel—lends itself to a high risk of infection.
The Johns Hopkins study reflects increasing pressure on hospitals to reduce preventable harm, Wick notes. The U.S. Centers for Medicare and Medicaid Services already is using SSI rates as a quality indicator and, in some instances, the agency is refusing to reimburse hospitals for the costs associated with treating these infections. But despite heightened attention and required reporting on process measures, SSI rates remain high, even among hospitals with near-perfect compliance with national guidelines, Wick said.
Using a pilot study protocol for high risk patients set by the American College of Surgeons National Surgical Quality Improvement Program, Wick and her colleagues collected baseline SSI rates after colorectal surgeries at The Johns Hopkins Hospital for one year leading up to and following the Hopkins safety team’s checklist and “speak up" interventions.
In the first year of the study, beginning in July 2009, 76 of 278 patients at JHH or 27.3 percent, developed an SSI after colorectal surgery. The rate dropped to 18.2 percent in the subsequent year after interventions were in place, with 59 of 324 patients contracting an SSI. Procedures for which data was collected include colectomies and proctectomies, removal of part of or the entire colon and rectum, respectively.
