Infection Control - Surgical Infection Term Paper

70% 36-38 0-0-5 Overall Rate

SIP 2a Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases

Population

Numerator

SIP 2b Data Prophylactic

Jul-04

Antibiotic selection for Aug-04 surgical patients

CABG Sep-04-100% 10-10 0-0-33 SIP 2b Subtotal

SIP 2c Prophylactic

Jul-04

Antibiotic selection for Aug-04

Cardiac Surgery

Sep-04 0-1 0-0-42 SIP 2c Subtotal

SIP 2d Prophylactic

Jul-04

Antibiotic selection for Aug-04 hip arthroplasty

Sep-04-100% 8-8 0-0-35 SIP 2d Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases SIP 2e

Population

Numerator

Data Data Prophylactic

Jul-04

Antibiotic selection for Aug-04 surgical patients

Knee arthroplasty

SIP 2e Subtotals

SIP 2f Prophylactic

Jul-04

Antibiotic selection for Aug-04 surgical patients

Colon Surgery

SIP 2f Subtotals

SIP 2h Prophylactic

Jul-04

Antibiotic selection for Aug-04 surgical patients

Vascular surgery

SIP 2h Subtotals

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases Population Numerator Data SIP 3a Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time

Overall Rate

SIP 3a Subtotal

SIP 3b Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time

CABG Sep-04-70% 7-10 0-0-33 SIP 3b Subtotal

SIP 3c Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time

Cardiac Surgery

SIP 3c Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases

Population

Numerator

SIP 3d Data Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time

Hip arthroplasty

SIP 3d Subtotal

SIP 3e Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time knee arthroplasty

SIP 3e Subtotal

SIP 3f Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time

Colon surgery

SIP 3f Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases

Population

Numerator

Data Data SIP 3g Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time hysterectomy

SIP 3g Subtotal

SIP 3h Prophylactic

Jul-04 antibiotics d/c'd within 24 hours after Aug-04 surgery end time

Vascular surgery

SIP 3h Subtotal

Date Period Quarter 4-2004

SIP-1a Prophylactic

Oct-04

Antibiotic received within Nov-04 one hour prior to surgical incision-

Dec-04 overall rate

SIP 1a Subtotal

SIP 1b Oct-04 0-0 0-0-37 Prophylactic antibiotic Nov-04-50% 5-10 0-0-36 received within one hour prior to Dec-04 surgical incision-

CABG SIP-1b Subtotal

SIP-1c Oct-04-100% 1-1 0-0-36 Prophylactic Antibiotic received within Nov-04 one hour prior to surgical incision-

Dec-04 cardiac surgery

SIP -1c Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases

Population

Numerator

Data Data Prophylactic

Oct-04 antibiotic received within Nov-04 one hour prior to Dec-04-50% 2-4 0-0-31 surgical incision- hip arthroplasty

SIP 1d Subtotal

SIP 1e Prophylactic

Oct-04 antibiotic received within Nov-04 one hour prior to surgical incision

Dec-04

Knee arthroplasty

SIP 1e Subtotal

SIP 1f Prophylactic

Oct-04 antibiotic received within Nov-04 one hour prior to surgical incision

Dec-04

Colon Surgery

SIP 1f Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases SIP 1-g

Population

Numerator

Prophylactic

Data antibiotic Oct-04-83.30% 5-6 0-0-31 received within one hour Nov-04-56% 5-9 0-0-37 prior to surgical incision-

Dec-04 hysterectomy

SIP 1g Subtotal

SIP 1h Oct-04-100% 1-1 0-0-36 Prophylactic antibiotic Nov-04 0% 0-1 0-0-46 received within one hour Dec-04 0% 0-2 0-0-36 prior to surgical incision-

Vascular surgery

SIP 1h Subtotal

SIP 2a Oct-04-93% 27-29 0-0-8 Prophylactic

Antibiotic selection

Nov-04 for surgical patients Dec-04-100.00% 23-23 0-0-12 Overall Rate

SIP 2a Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases

Population

Numerator

SIP 2b Data Prophylactic

Oct-04

Antibiotic selection for Nov-04 surgical patients

CABG Dec-04-100% 5-5 0-0-30 SIP 2b Subtotal

SIP 2c Prophylactic

Oct-04

Antibiotic selection for Nov-04

Cardiac Surgery

Dec-04 0-0 0-0-0-36 SIP 2c Subtotal

SIP 2d Prophylactic

Oct-04

Antibiotic selection for Nov-04 hip arthroplasty

Dec-04-100% 4-4 0-0-31 SIP 2d Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases SIP 2e

Population

Numerator

Data Data Prophylactic

Oct-04

Antibiotic selection for Nov-04 surgical patients

Knee arthroplasty

Dec-04

SIP 2e Subtotals

SIP 2f Prophylactic

Oct-04

Antibiotic selection for Nov-04 surgical patients

Colon Surgery

Dec-04

SIP 2f Subtotals

SIP 2h Prophylactic

Oct-04

Antibiotic selection for Nov-04 surgical patients

Vascular surgery

Dec-04

SIP 2h Subtotals

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases Population Numerator Data SIP 3a Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time

Overall Rate

Dec-04

SIP 3a Subtotal

SIP 3b Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time

CABG Dec-04-80% 4-5 0-0-30 SIP 3b Subtotal

SIP 3c Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time

Cardiac Surgery

Dec-04

SIP 3c Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases

Population

Numerator

SIP 3d Data Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time

Hip arthroplasty

Dec-04

SIP 3d Subtotal

SIP 3e Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time knee arthroplasty

Dec-04

SIP 3e Subtotal

SIP 3f Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time

Colon surgery

Dec-04

SIP 3f Subtotal

Measure Title

Data Period

Rate/Value

Numerator

Denominator

Missing

Excluded

Cat-E) Invalid Cases

Population

Numerator

Data Data SIP 3g Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time hysterectomy

Dec-04

SIP 3g Subtotal

SIP 3h Prophylactic

Oct-04 antibiotics d/c'd within 24 hours after Nov-04 surgery end time

Vascular surgery

Dec-04

SIP 3h Subtotal

Core Measures Gold Star Report - 2004 O4

3Q 2004

4Q 2004

Change from Provena St. Joseph Hospital - Elgin, IL previous quarter

SP1a Prophylactic Antibiotic received with one hour prior to surgical incision

Overall rate) 45.20% 40.80%

SP1b Prophylactic Antibiotic received with one hour prior to surgical incision

CABG 68.40% 48.70%

SP1c Prophylactic Antibiotic received with one hour prior to surgical incision

Cardiac Surgery 0% 50%

SP1d Prophylactic Antibiotic received with one hour prior to surgical incision

Hip Arthroplasty 40% 21.10%

SP1e Prophylactic Antibiotic received with one hour prior to surgical incision

Knee Arthroplasty 28.30% 28.90%

SP1f Prophylactic Antibiotic received with one hour prior to surgical incision

Colon Surgery 71.40% 61.50%

SP1g Prophylactic Antibiotic received with one hour prior to surgical incision

Hysterectomy 41.70% 60%

SP1h Prophylactic Antibiotic received with one hour prior to surgical incision

Vascular Surgery 33.30% 33.30%

SP2a Prophylactic antibiotic selection for surgical patients (Overall)

SP2b Prophylactic antibiotic selection for surgical patients (CABG)

SP2c Prophylactic antibiotic selection for surgical patients Cardiac Surgery

SP2d Prophylactic antibiotic selection for surgical patients (Hip Arthroplasty)

SP2e Prophylactic antibiotic selection for surgical patients (Knee Arthro)

SP2f Prophylactic antibiotic selection for surgical patients (Colon)

SP2g Prophylactic antibiotic selection for surgical patients (Hysterectomy)

SP2h Prophylactic antibiotic selection for surgical patients (Vascular)

SP3a Prophylactic antibiotic discontinued within 24 hours after surgery end

Overall 64.40% 56.50%

SP3b Prophylactic antibiotic discontinued within 24 hours after surgery end

CABG 81.10% 86.70%

SP3c Prophylactic antibiotic discontinued within 24 hours after surgery end

Cardiac 100% 60%

SP3d Prophylactic antibiotic discontinued within 24 hours after surgery end

Hip arthroplasty 60% 56.20%

SP3e Prophylactic antibiotic discontinued within 24 hours after surgery end

Knee arthroplasty 79% 69.60%

SP3f Prophylactic antibiotic discontinued within 24 hours after surgery end

Colon Surgery 0% 0%

SP3g Prophylactic antibiotic discontinued within 24 hours after surgery end

Hysterectomy 78.30% 70%

SP3h Prophylactic antibiotic discontinued within 24 hours after surgery end

Vascular Surgery 33.30% 66.70%

Discussion

The general inclusion data for this information was obtained via evidence of a selected ICD-9 procedure code during the hospital admission. General exclusion criteria included patients who were on antibiotics at the time of admission, except for those patients undergoing colon surgery who were on oral antibiotics. Also excluded were patients who were being treated for an infection prior to the first surgical procedure of interest, patients who had antibiotic start dates missing. The numerator data includes all patients who receive antibiotics within one hour before surgical incision (within two hours if vancomycin is required for prophylaxis). The denominator consisted of patients meeting the general inclusion criteria and measure specific exclusions (patients undergoing colon surgery who were given prophylactic oral antibiotics only, and those on whom it was unable to be determined if an antibiotic was started within one hour of the surgery start time due to missing time values.

Arguments for change

Studies clearly indicate that antimicrobial prophylaxis is the most effective when provided prior to the initial incision. Risk of infection is actually felt to increase when prophylaxis is given either too early (meaning more than 2 hours prior to initial incision) or too late (after initial incision) (Classen, Evans, et.al. 1992). The most optimal time for administration would appear to be in the 30 to 60 minutes prior to the initial incision. A brief course of antimicrobial prophylaxis…