Perioperative Enterprise CommitteeSurgical Site Infection Report

October 15, 2009

ProcedureRate Q3

2009Rate Q3

2008% Change from 1 yr

CDC Benchmark

O/E Inf Rate*

Cardiac

Cardiac surgery (non-CABG) 0.6 1.2 -100% 1.71 0.4

Coronary bypass w/chest and donor incision 4.3 1.8 139% 4.88 0.8

Coronary bypass graft with chest incision 0 0.6 -100% 2.88 0

Cardiac surgery (pediatric, primary closure) 2.3 1.3 77% 1.71 1.34

Colorectal

Elective Colon 8.4 12.5 -32.8% 10.8 0.7

Elective Rectal 21.2 22.2 -4% 20 1.06

EGS Colon 15.6 21.5 -27.4 10.8 1.4

  EGS Rectal 0 0 0% 15 0

Craniotomy  2.7 7.5 -64% 4.68 0.6

ProcedureRate Q3

2009Rate Q3

2008% Change from 1 yr

CDC Benchmark

O/E Infection

Rate*

 Total Hip 4.9 3.4 44% 2.97 1.65

 Total Knee 0 1.0 -100% 1.82 0

Vascular AAA Repair 0 0 0% 5.2 0

  CEA 6.7 0 100% 0.42 16

  Peripheral Bypass 9.1 0 100% 6.7 7.3

OB/GYN Hyst - Vaginal 0 0 -100% 1.26 0

Hyst - Abdominal 4.9 2.4 104% 4.37 1.12

 C-sections 2.4 7.4 -67% 2.64 0.9

Pediatric VP shunts  4.7 6.7 -30% 5.16 0.9

Pod 1C-Section

Hysterectomy

Cesarean Section SSIs

2.4%

2.64%

Abdominal Hysterectomy SSIs

4.37%

4.5%

Vaginal Hysterectomy SSIs

1.3%

0%

Pod 3Colorectal Surgery

Elective Colon Surgery SSIs

10.86%

8.4%

20% 21.2%

Elective Rectal Surgery SSIs

Pod 4Ambulatory Services

Outbreak in Thyroidectomy Cases 5 cases from 2 surgeons within a 3 month

time frame No common pathogens IC Team needs to observe

Sterilization in the Dental Clinic Non-standard practices observed in the

Dental/Orthodontic clinics at VAV One person was the local expert Non-standard practices when this person was out

Standardized to off site sterilization Labeling instruments Be able to inspect and repair Standard treatment for all persons

Pod 6Orthopedic Surgery

Total Hip Arthroplasty SSIs

2.97%

4.9%

Hip Infection Details One infection occurring in July

1 infection deep ( 6+ hr surgery, EBL 1300-1500cc, with 5 units PRBCs/FFP intraop. Multiple procs– ORIF then THA.

ABX and timing appropriate Three infections for August

1 SIP 2 DIP

Total Knee Arthroplasty SSIs

1.82%

Pod 7EGS - Colorectal

EGS Colon Surgery SSIs

10.86%

15.6%

15%

0%

EGS Rectal Surgery SSIs

Pod 8Neurosurgery

Craniotomy SSI

4.68%

2.7%

Pod 9Vascular Surgery

Abdominal Aortic Aneurysm SSI

5.2%

0%

Carotid Endarterectomy SSI

0.42%

1/15=6.7%

Peripheral Vascular Bypass SSI

6.7%

25%

Pod 10Cardiac Surgery

Adult CABG (Procedures w/ Sternotomy + Donor Site) SSIs

4.88% 4.3%

Adult CABG (Sternotomy-Only Procedures) SSIs

2.88% 0%

Adult Cardiac (non-CABG) SSIs

1.71%

0%

State Mandatory Reporting Delayed due to H1N1 TDOH will publish hospital infection rates for the

public to view CLABSI rates for each ICU will be published by

unit per facility (excluding BICU and Trauma) Cardiac SSI rates will be published as an aggregate

for the state (Coronary bypass grafts) Will likely be a SIR for 2008 Tennessee regions may be separate

Vanderbilt Cardiac SIR (CBGB)

0

1

2

3

4

5

6

J F M A M J J A S O N D

CBGB SIR CDC Benchmark

VCH ORsPediatric Cardiac

Pediatric V Shunt

Pediatric Cardiac SSIs

1.71%

2.3%

Pediatric VP Shunt SSI

5.16% 2.3%