It’s “all-or-none” when it comes to post-op infection prevention measures

By: June 30th, 2010 Email This Post Print This Post

For the last four years participating hospital have used six post-operative infection prevention measures from the Surgical Care Improvement Project (SCIP), including public reporting on compliance with those measures.

But a study published in the June 23/30 issue of the Journal of the American Medical Association (JAMA), concludes that adherence to individual measures are “not associated with a significantly lower probability of infection.”

Instead the authors determined that adherence to a “global all-or-none” approach lead to a much lower probability of post-operative infections. Adherence to this method resulted in a decreased likelihood of developing a postoperative infection from 14.2 to 6.8 postoperative infections per 1,000 discharges.

The SCIP measures are:

  • Patients who received prophylactic antibiotics within one hour prior to surgical incision (two hours if receiving vancomycin)
  • Patients who received prophylactic antibiotics recommended for their specific surgical procedure
  • Patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time (48 hours for coronary artery bypass graft surgery or other cardiac surgery)
  • Cardiac surgery patients with controlled 6 AM postoperative blood glucose level (≤200 mg/dL [≤11.1 mmol/L])
  • Surgery patients with appropriate surgical site hair removal with clippers or depilatory or those not requiring surgical site hair removal
  • Colorectal surgery patients with immediate postoperative normothermia (first recorded temperature was ≥96.8°F within first 15 minutes after leaving the operating room)

“Based on our findings, the individual item performance rates reported publicly do not fulfill their stated purpose of pointing consumers toward high-quality hospitals,” the authors wrote. “However, when taken in aggregate, improved performance on our global all-or-none composite measure is associated with improved outcomes at the discharge level. Therefore, while the individual items may not imply quality differences, the overall ability to demonstrate adherence to multiple SCIP processes of care may. Improved methods for identification of quality of care are necessary to be able to define improvements in patient outcomes, and to justify the massive investment of time and money in tracking these processes of care.”


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