Surgeon/ Operating Room (OR) Staff Questionnaires to Improve Surgical Site Infection (SSI) Rates: A Cohort Study

Background: Many interventions have been employed to reduce SSI. Interventions that can rapidly identify/mitigate risks factors in specific institutions are needed. 

Objective:  Assess the impact of post infection surgeon and OR staff questionnaires on SSI rates.

Methods: Baylor Regional Medical Center at Grapevine (BRMCG) is a not-for-profit 233-bed hospital serving residents in more than 20 cities throughout Dallas/Fort Worth. A retrospective cohort study compared historical SSI rates (May2007- 0ct2008) to rates obtained after initiating a post infection intervention strategy that included standardized surgeon/OR questionnaires/team meetings (Nov2008 –Apr2010). SSIs were determined by post discharge mailings (70-80% return both intervals) and readmission data. The surgeon questionnaire included pre-hospital risk factors, operative risk factors, postoperative hospital care and post discharge course.  OR staff that assisted with the procedure also completed a questionnaire. Surgeon, infection control and OR staff met as a team to discuss issues identified in questionnaires.

Results: The surgical site infection rate decreased from 2.8% to 1.2% in the targeted surgical procedures.  The odds ratio for SSI was 0.418 (95% confidence interval 0.224-0.779).  

Procedure	SSI rate Prior(May07-Oct08)	SSI rate Post(Nov08-Apr10)	Odds Ratio (95% CI)
	# SSI/#procedures	#SSI/#procedures
CABG	8/180 = 4.4	2/167 = 1.2
T Hip	3/98 = 3.0	1/99 = 1.0
T Knee	4/198 = 2.0	0/120 = 0.0
Abd Hyst	11/504 = 2.2	2/370 = 0.5
Vag hyst	2/88 = 2.3	3/186 = 1.6
Colon	8/217 = 3.7	6/234 = 2.6
Total	36/1285=2.8	14/1176=1.2	0.418 (0.224-0.779)

Surgeon questionnaires identified smoking, poor glucose control, high BMI, dialysis status, inconsistent preoperative cleansing, multiple admits, transfusion, poor home support and wound care/ hygiene in long term care facilities as areas of concern. Action included standardizing the pre- hospital evaluation/ education process, weight based antibiotic dose, and nursing/ case management feedback for discharge issues.  Questionnaires from operative personnel identified delays or late in day start times, excess traffic, availability of implants, flash sterilization. Action included traffic restriction, preparation for implant case, mandated early start time for spine cases/ enforcement of start times by scheduling restriction.

Conclusions: Targeted post infection questionnaires encouraged feedback from surgeons and OR staff to identify action items. The odds ratio for targeted surgeries in the post intervention interval versus pre-intervention time frame was 0.418 (95 percent confidence interval 0.224; 0.779). Engaged stakeholders are necessary to generalize these results.  A randomized controlled study may be warranted to confirm these results.