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Surgical Site Infection Prevention: Time to Move Beyond the Surgical Care Improvement Program

Hawn, Mary T. MD, MPH*,†; Vick, Catherine C. MS*; Richman, Joshua MD, PhD*,†; Holman, William MD*,†; Deierhoi, Rhiannon J. MPH*; Graham, Laura A. MPH*; Henderson, William G. MPH, PhD; Itani, Kamal M.F. MD§

doi: 10.1097/SLA.0b013e31822c6929
Papers of the 131st ASA Annual Meeting

Objectives: The objective of this study was to evaluate whether the Surgical Care Improvement Project (SCIP) improved surgical site infection (SSI) rates using national data at the patient level for both SCIP adherence and SSI occurrence.

Background: The SCIP was established in 2006 with the goal of reducing surgical complications by 25% in 2010.

Methods: National Veterans' Affairs (VA) data from 2005 to 2009 on adherence to 5 SCIP SSI prevention measures were linked to Veterans' Affairs Surgical Quality Improvement Program SSI outcome data. Effect of SCIP adherence and year of surgery on SSI outcome were assessed with logistic regression using generalized estimating equations, adjusting for procedure type and variables known to predict SSI. Correlation between hospital SCIP adherence and SSI rate was assessed using linear regression.

Results: There were 60,853 surgeries at 112 VA hospitals analyzed. SCIP adherence ranged from 75% for normothermia to 99% for hair removal and all significantly improved over the study period (P < 0.001). Surgical site infection occurred after 6.2% of surgeries (1.6% for orthopedic surgeries to 11.3% for colorectal surgeries). None of the 5 SCIP measures were significantly associated with lower odds of SSI after adjusting for variables known to predict SSI and procedure type. Year was not associated with SSI (P = 0.71). Hospital SCIP performance was not correlated with hospital SSI rates (r = –0.06, P = 0.54).

Conclusions: Adherence to SCIP measures improved whereas risk-adjusted SSI rates remained stable. SCIP adherence was neither associated with a lower SSI rate at the patient level, nor associated with hospital SSI rates. Policies regarding continued SCIP measurement and reporting should be reassessed.

The association between Surgical Care Improvement Program (SCIP) infection prevention measure adherence and surgical site infection was assessed. Adherence was not associated with lower infection rates at the patient or hospital level. While compliance with SCIP measures improved over time, risk adjusted surgical infection rates remained stable.

*Center for Medical, Surgical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, Alabama

Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama

Colorado Health Outcomes Program, University of Colorado Denver, Aurora, CO

§VA Boston Health Care System, Boston University and Harvard Medical School.

Reprints: Mary T. Hawn, MD, MPH, FACS, Department of Surgery, Section of Gastrointestinal Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, KB 428, Birmingham, AL 35294-0016. E-mail:

Disclosure: The study was funded by VA Health Services Research and Development Grant# PPO 10–296. The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs of the United States Government.

© 2011 Lippincott Williams & Wilkins, Inc.