This paper examines surgical site infections (SSIs) as a critical quality-control challenge for healthcare managers. It reviews the incidence and causal factors of SSIs, including patient health status, surgical technique, and antibiotic prophylaxis, and outlines the three infection types: superficial, deep incisional, and organ/space. The paper then analyzes the financial consequences of SSIs—extended hospital stays, malpractice liability, and insurance costs—before addressing an above-average facility SSI rate. A multi-part action plan is proposed, emphasizing organizational culture, staff training, appropriate antibiotic use, and evidence-based best practices to sustainably reduce SSI rates.
Surgical site infections are a significant issue for healthcare managers, especially with respect to their quality control systems. There are several reasons why reducing SSIs is a critical issue in healthcare management, including malpractice costs and patient health. For every stakeholder, reducing SSIs benefits the organization, making it one of the easier issues for which to gain consensus on a plan of action. Yet SSIs still occur, and it is important to understand how they occur and what steps can be taken to reduce their incidence.
Anderson (2009) notes that despite 150 years of continuous improvement efforts to reduce the incidence of surgical site infections (SSIs), they still occur in 2–5% of patients undergoing surgery in the United States — a total of 300,000 to 500,000 incidents per year. The single most common pathogen resulting in SSI is Staphylococcus aureus (staph infection). The ongoing high rate of SSIs contributes to adverse health outcomes for patients, including death, and adds costs for the hospital and patient alike. SSIs almost always extend the patient's hospital stay, adding to costs (Anderson, 2009), and there is also a risk of legal action arising from complications like SSIs.
Barie and Eachempati (2005) outline some of the causal factors for SSIs. They note that factors in the development of SSIs include "the patient's health status, preparation of the patient before surgery and the use of appropriate antibiotic prophylaxis." The implication of these findings is that most SSIs are preventable, given sufficient understanding of the risk factors and the execution of best practices. Thus, SSIs are as much a quality control issue as they are a medical issue for healthcare institutions.
There are three types of surgical site infections, according to Lauwers and de Smet (1998): superficial, deep incisional, and organ/space. It is mainly during the surgical intervention, the authors note, that microbial contamination occurs. Sometimes the infection involves the patient's own commensal flora (Lauwers & de Smet, 1998), meaning there is occasionally little the hospital can do to prevent such an infection. However, it has also been shown that the skill of the surgeon, along with the type and duration of the surgery, are contributing factors that affect the rate at which SSIs occur. Again, this points to an institution being able to reduce its SSI rate through targeted training.
The financial impact of SSIs stems from several different factors. The first is that SSIs typically result in the patient spending more time in the hospital, and sometimes the infection is a complication that results in the patient's death. Both outcomes can negatively affect the hospital. For example, the greater the cost of treating an SSI, the less the hospital can expect to recover. Additionally, extended hospitalization time may be refused by the patient's insurance company if it is determined that the SSI was the fault of the hospital. There are therefore direct costs associated not only with the treatment of the SSI itself but also with the added hospitalization required to manage it.
The other key cost is associated with the hospital's malpractice insurance. If a patient dies or suffers another adverse outcome as the result of a preventable SSI, the hospital may face legal action. These costs, especially where punitive damages are relevant, can range well into the millions and may not be fully covered by the hospital's malpractice insurance. It is therefore in the hospital's best financial interest to work continuously to reduce the rate of SSIs.
"Facility rate benchmarked against national averages"
"Culture, training, antibiotics, and best practices"
Surgical site infections are costly for hospitals, both in terms of patient outcomes and in terms of the bottom line. While not all SSIs are preventable, most are. This means that the hospital often bears the cost of such errors, especially when the patient lacks the financial means to do so. It is imperative, therefore, that hospitals take steps to address the problem of SSIs in both the short term and the long term. In the short term, the use of antimicrobials is essential, as is adherence to basic best practices regarding hygiene in the surgical suite. The institution should also take a long-run perspective, however, and avoid using antimicrobials excessively, because antimicrobial resistance is one of the major reasons why SSI rates remain persistently high despite a century and a half of continuous improvement efforts.
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