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On January 1, 2007 NYS hospitals began mandatory reporting of select hospital acquired infections (HAIs) via the National Healthcare Safety Network (NHSN).The NHSN requires post-discharge surveillance (PDS) to capture surgical site infections (SSI) but does not recommend a specific method.
Objective: Evaluate PDS methods used by hospitals to identify SSI.
Methods: Using a standardized questionnaire, a telephone interview was conducted with infection preventionists (IPs) to assess PDS methods used to identify colon and coronary artery bypass (CABG) SSIs. 2007 NHSN data was used to assess the proportion and severity of SSIs identified by PDS.
Results: 93% (166/176) of hospitals performing colon and/or CABG surgery were interviewed. Systematic PDS was conducted in 55% (91/166) of hospitals performing colon and 55 %( 21/38) performing CABG procedures. In 2007, 89% (1287/1444) of SSIs were reported as identified on initial admission or readmission to the same hospital. 13% of colon and 6% of CABG chest site SSI were reported to have been identified post-discharge. The PDS cases reported the extent of colon SSIs as superficial incision (SIP)-10 %( 105/1082), deep incision (DIP)-1.5% (16/1082), and organ space (OS)-1.6% (17/1082) and for CABG chest site, SIP-3 %( 12/362), DIP-1.7 %(5/362) and OS-0.6 (2/362). 72% of IPs had been notified by other facilities of an SSI associated with their facility on at least 1 occasion.
Conclusions: Systematic PDS is performed by only half of NYS hospitals reporting to NHSN. The majority of SSIs are identified during the initial admission or readmission to the same hospital. Without a universally acceptable and applicable PDS methodology this labor intensive process has a low yield of identifying significant SSIs. Until a more systematic and less labor intensive method of PDS can be implemented in all hospitals, these SSIs will be excluded from NYS publically reported hospital surgical procedure rates.