Surgical Site Infection Reporting Readiness: A Survey of Washington State Hospitals

Background: A 2008 General Accountability Office report lists 15 states mandating surgical site infection (SSI) reporting. Assessing hospital resources & readiness to comply is critical to success of these healthcare associated infection (HAI) programs. Little information on workload impact is available to guide hospital or state HAI programs. Washington, where SSI reporting is to begin in January 2010, started readiness surveys in 2009.

Objective:

Assess workload impact, support needed and level of readiness among Washington’s hospitals to report SSI through the National Healthcare Safety Network (NHSN).

Methods: Infection control programs at acute-care hospitals were asked to identify annual surgical volume for cardiac procedures with a sternal incision, hip or knee replacement, and hysterectomy (the procedures covered by state law to report). The on-line survey also asked questions about completing NHSN SSI training, which staff were involved in preparing to report, and whether NHSN variables could be acquired from electronic databases at that hospital.  We also surveyed other state HAI programs and their hospitals’ knowledge of time required to assemble data to upload to NHSN.

Results: 63% (59/93) of Washington hospitals responded.  Of the 59, 48 met criteria for mandatory SSI reporting. This is 69% (48/70) of all hospitals we anticipated would have to report.  Annual case volumes for specific SSI procedures are shown in the table. Few states knew workload impact for hospital reporting; time estimates from 3 hospitals in other states, 1 in Washington, and one state based on its 13 hospitals  (ranges shown in table).

81% (39/48) reported completing online NHSN training materials related to SSI reporting; 19% had not studied this material because of being too busy.  None reported lack of access blocking online training materials.

Most of the 48 indicated infection prevention staff would be involved in SSI reporting;  some indicated support from Information Technology (23%), OR/Surgery leadership (19%), ICD-9 specialists (11%), or others (15%, including senior leadership, RN staff, Infection Control support staff, or unspecified).

81% of hospitals eligible to report lacked automated SSI information exchange (NHSN numerator & denominator variables). Monthly SSI reporting workload per type of surgery ranges from 0.04 hours in low-volume highly-automated hospitals to 6.25 in high-volume moderately-automated hospitals & from 0.5-41.6 across unautomated hospitals.

Conclusions:

Less than 25% of hospitals had involved staff beyond infection prevention and control to prepare for SSI reporting.  Only 15% reported current automated database capability; without this, the workload of manual data review and entry for NHSN SSI surveillance can be formidable.  Support for automating NHSN data element capture & upload capacity (electronic data interchange)  is  essential  for efficient HAI reporting.