Transcript Slide 1

CSTS – SSI reporting for CABG
Armstrong Institute for Patient Safety and Quality
Presented by:
Kathleen Speck, MPH
Lisa Maragakis, MD, MPH
SSI Reporting for CABG
Objectives
1. To review the types of SSIs involved in
CABG
2. To review the criteria for determination
of SSI
3. To discuss the reporting of SSIs to
CSTS
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NHSN Definition
SSI
• 3 types of SSIs
1. Superficial
2. Deep Incisional
3. Organ/Space
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NHSN Definition
Operative Procedure
• NHSN operative procedure
– Takes place during a single trip to the OR
– The surgeon makes at least one incision
through the skin
– The incision is closed before the patient
leaves the OR
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SSI Definitions
Superficial: 3 criteria
1. Occurs within 30 days of operative
procedure
2. Involves only skin and subcutaneous tissue
of the incision
3. (On next slide)
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SSI-Definitions (cont)
Superficial: 3 criteria
3. Patient has at least one of the following:
a) Purulent drainage from the superficial incision
b) Organisms are isolated from fluid or tissue from that site
c) At least one of the following signs or symptoms of
infection
a)
b)
c)
d)
e)
f)
Pain or tenderness
Localized swelling
Redness
Heat
Superficial incision is opened by surgeon and is culture
positive or not-cultured
Diagnosis of superficial infection is made by surgeon or
attending
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SSI Definitions
Superficial: 2 types
1. Superficial Incisional Primary (SIP)
a) Primary incision from operation with more
than 1 incision (in this case, chest incision
for CABG)
2. Superficial Incisional Secondary (SIS)
a) Secondary incision from operation with
more than one incision (in this case,
donor site [leg] incision for CABG)
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SSI Definitions
non-reportable superficial events
• Stitch abscesses
• Cellulitis
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SSI Definitions
Deep Incisional: 3 criteria
1. Infection occurs within 30 days of
operative procedure (if no implant is
left in place) or 1 year (if implant is in
place and infection appears to be
related to operative procedure AND
2. Infection involves deep soft tissues
(e.g., fascial and muscle layers) AND
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SSI Definitions
Deep Incisional: 4 criteria (Cont.)
3. Patient has at least one of the following:
a) Purulent drainage from the deep incision but not
from the organ space component of the surgical
site
b) Deep incision spontaneously dehisces or is
opened by the surgeon and is culture positive or
not cultured and the patient has:
i.
ii.
Fever (>38⁰C)
Localized pain or tenderness
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SSI Definitions
Deep Incisional: 4 criteria (cont.)
d) An abscess or other evidence of deep
infection found
i. On direct examination
ii. During recuperation
iii. By histopathologic or radiologic
examination
e) Diagnosis of a deep incisional SSI by
surgeon or attending
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SSI Definitions
Deep incisional: 2 types
1. Deep Incisional Primary (DIP)
a) Primary incision from operation with more
than 1 incision (in this case, chest incision
for CABG)
2. Deep Incisional Secondary (DIS)
a) Secondary incision from operation with
more than one incision (in this case,
donor site [leg] incision for CABG)
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SSI Definitions
Organ/Space: 3 criteria
1. Infection occurs within 30 days of operative
procedure (if no implant is left in place) or 1
year (if implant is in place and infection
appears to be related to operative procedure
AND
2. Infection involves any part of the body,
excluding the skin incision, fascia or muscle
layers, that is opened or manipulated during
the operative procedure AND
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SSI Definitions
Organ/Space: 3 criteria (cont.)
3. Patient has at least one of the following
a) Purulent drainage from a drain that is placed through
a stab wound into the organ/space
b) Organisms are isolated from an aseptically obtained
culture of the fluid of tissue in the organ/space
c) An abscess or other evidence of infection involving
the organ space is found by direct examination,
during reoperation, or by histopathologic or radiologic
examination
d) Diagnosis of an organ/space SSI by surgeon or
attending
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SSI Reporting for CSTS
• SSIs will be reported by the following
Numerators
Denominator
1
# of patients with Superficial Incisional Primary
(SIP) infections
2
# of patients with Superficial Incisional
Secondary (SIS) infections
3
# of patients with Deep Incisional Primary (DIP) # of patients >age 18
having CABG
infections
4
# of patient with Deep Incisional Secondary
(DIS) infections
5
# of patients with Organ/Space infections
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