Purpose:

This project was conducted to determine how well the risk factors described in the Surgical Site Infection (SSI) Bundle proposed by the "100K Lives Campaign" predicted infections in our patients undergoing hip, knee, or spinal fusion surgery.

Significance:

SSI is the most common nosocomial infection in surgery patients. Patients who develop SSI have increased health costs and are at greater risk for readmission or death.

Design/Background/Rationale:

Retrospective case control, quality improvement project to examine the risk factors contributing to SSI in our population.

Methods/Description:

All adults who developed SSI following knee/hip replacement or spinal fusion surgery between January 2002 and June 2004 (n = 88) comprised the infected group. Noninfected controls were matched 2:1 on gender, type of surgery, and age (n = 176). Univariate analyses were conducted to determine whether predictors were different by infection status. Significant individual predictors were entered into a logistic regression equation to determine their combined and relative contribution in SSI development.

Findings/Outcomes:

The significant individual risk factors for developing surgical site infections in this project were NNIS risk index, ASA score, and duration of surgery, controlling for all variables in the equation. Other elements of the IHI bundle, including hair removal technique, skin preparation, timing of antibiotic prophylaxis, wound class, and use of hardware, were not predictive of infection status.

Conclusions:

NNIS and ASA scores predicted infection. Identifying patients at risk for infection prior to surgery and providing additional management may help reduce infection rates.