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Chasing Zero: The Drive to Eliminate Surgical Site Infections

Thompson, Kristine M. MD*; Oldenburg, W. Andrew MD; Deschamps, Claude MD; Rupp, William C. MD§; Smith, C. Daniel MD

doi: 10.1097/SLA.0b013e31822cc0ad
Papers of the 131st ASA Annual Meeting

Objectives: It is estimated that healthcare associated infections (HAI) account for 1.7 million infections and 99,000 associated deaths each year, with annual direct medical costs of up to $45 billion. Surgical Site Infections (SSI) account for 17% of HAIs, an estimated annual cost of $3.5 to 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, along with additional interventions based on literature showing relationships with SSI reduction and best practices. Rapid deployment of multiple interventions (SSI Bundle) was undertaken. Tactics included standardized order sets, a centralized preoperative evaluation (POE) clinic, high compliance with intraoperative interventions, and widespread monthly reporting of compliance and results. Data from 2008 to 2010 were collected and analyzed.

Results: Between May 1, 2008 and June 30, 2010, all patients with Class I and Class II wounds were tracked for SSIs. Baseline data (May–June 2008) was obtained showing a Class I surgical site infection rate of 1.78%, Class II of 2.82% (total surgical volume: 4160 cases). As of the second quarter 2010, those rates have dropped to 0.51% and 1.44%, respectively (P < 0.001 and P = 0.013; total surgical cases: 2826). This represents a 57% decrease in the SSI rate with an estimated institution specific cost savings of nearly $1 million during the study period.

Conclusion: Committed leadership, aggressive assurance of high compliance with multiple known interventions (SSI Bundle), 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.

We present a case study of prospective implementation of established interventions (SSI Bundle) to decrease surgical site infections with a retrospective analysis of data focusing on the process for developing and diffusing strategies to decrease surgical site infections. Over an 18-month period, using an SSI Bundle, SSIs were reduced 57% (P < 0.001).

*Department of Emergency Medicine

Department of Surgery, Mayo Clinic in Florida, Jacksonville, FL

Department of Surgery, Mayo Clinic in Rochester, Rochester, MN

§Department of Medicine, Division of Oncology, Mayo Clinic in Florida, Jacksonville, FL.

Reprints: C. Daniel Smith, MD, Department of Surgery, Mayo Clinic Florida, 4200 San Pablo Road, Jacksonville, FL 32224. E-mail:

Presented at the 131st Annual Meeting of the American Surgical Association, Boca Raton, FL.

Disclosure: The authors declare that they have nothing to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.