Enabling a Standardized Assessment of SSI post-discharge

Author(s):
Corrine McIsaac

Background:

Surgical site infections (SSIs) are the most common of hospital acquired infections, occurring in 2-5% of patients undergoing inpatient surgery. SSIs are expensive for the healthcare system, and cause significant morbidity and mortality among surgical patients.  At present, most SSI surveillance is completed in the acute-care setting, and hospital infection control programs do not always include a standardized methodology for post-discharge surveillance (PDS).  However, approximately 60% of SSIs occur following discharge and therefore, the true rate of SSI is likely underreported. Moreover, the lack of standardization for post-discharge data collection has resulted in a limited understanding of SSIs in the post-acute and home care areas.

Hypothesis:

Evaluate the feasibility of a web-based surgical site infection (SSI) tool(how2trak) that used the 1999 United States Centers for Disease Control and Prevention guidelines for the detection of SSIs (Mangram, et al., 1999).

Methods:

Feasibility was evaluated by measuring concordance, a measure of inter-rater reliability, within paired nurse assessors and nurse assessor feedback regarding the usefulness of the tool.Patient referral and recruitment, nurse pair assessments using the how2trak SSI tool, and follow-up visits with the patients occurred from March 2015 through July 2016 at 3 Calea Home Care Clinics in Toronto. Discussion groups were carried out in 2 sessions via teleconference on September 6 and 7, 2016.

Results:

Overall positive concordance between nurse assessors was demonstrated; in many instances, concordance rates were reported above eighty percent. Discussion groups reported that: (1) that the how2trak tool was user friendly; (2) that it proved to be a productive data collection tool in the clinical setting; and (3) that it made tracking patient outcomes far more efficient than the traditional paper-based tool. Using the CDC guidelines for the identification of an SSI, the prevalence of SSIs post-discharge in the Calea Clinic was found to be 34.6 %.

Conclusions:

Overall, this study demonstrated that the how2trak tool is a feasible data collection tool for nurses in the Calea Clinics. Therefore, the how2trak tool provides a feasible option for standardizing data collection and analysis for the assessment of SSIs post-discharge across clinic settings.