Chasing Zero; The Drive To Eliminate Surgical Site Infections
C. Daniel Smith, MD*, Kristine M. Thompson, MD*, Claude Deschamps, MD, William C. Rupp, MD*
Mayo Clinic in Florida, Jacksonville, FL
OBJECTIVES:Healthcare associated infections (HAIs) account for 1.7 million infections and 99,000 associated deaths annually, with direct medical costs of up to $45 billion. Surgical Site Infections (SSIs) account for 22% of HAIs, an estimated annual cost of $3.5-10 billion for our country alone. This project was designed to pursue elimination of SSIs and document results.
METHODS: Starting in 2009 a program to eliminate SSIs was undertaken at a nationally recognized academic health center. Interventions already outlined by CMS and IHI were utilized, focusing initial actions at consistent delivery of Surgical Care Improvement Project (SCIP) interventions. Tactics included standardized order sets, a centralized Pre-Operative Evaluation (POE) clinic, high compliance with intraoperative interventions, and widespread monthly reporting of compliance and results. Data from 2008-2010 were collected and analyzed.
RESULTS: See figures below. This represents an 84% decrease in the number of SSIs with an estimated institution specific cost savings of $1.6-4.6 million. If similar success were generalized, this could represent a U.S. cost savings of $1.8-7.1 billion.
CONCLUSION: Committed leadership, aggressive assurance of high compliance with known interventions, transparency to achieve high levels of staff engagement, and centralization of critical surgical activities result in significant declines in SSIs with resulting substantial cost savings.
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