The time to act is now
Even in today’s highly sterile operating room, up to ten percent of surgical procedures lead to surgical site infections (SSI) (1). The true rate of surgical site infections is likely to be underestimated (2).
Even though the causes of surgical site infections are widely known, these infections remain an unsolved problem in the medical world. Mistakes still commonly happen along the treatment pathway, including the preoperative preparation of the patient, the awareness and behavior of staff and the operating room (OR) environment. The good news: Studies have shown that a bundle of three to five measures can have a significant impact on reducing the risk of SSI in the OR (3, 4).
Would you like to find out whether anything is missing in your process to reach 100 percent guideline compliance? We have set up a test based on international guidelines and evidence (QuickScan) to help you check the current situation in your institution.
The B. Braun SSI pathway
Between November 2016 and April 2019, large organizations such as the World Health Organization (WHO), the US-American Centers for Disease Control and Prevention (CDC), the German Commission for Hospital Hygiene and Infection Prevention (KRINKO), and the British National Institute for Health and Care Excellence (NICE) established and published guidelines on the prevention of SSI. Due to the different methodology of the preparation and type of recommendations, a 1:1 comparison of the four guidelines is not fully possible for the time being. At B. Braun, we established recommendations together with experts and based them on the available evidence and best practices.
The B. Braun SSI Pathway describes 24 evidence-based measures to prevent surgical site infections, for surgeons, operating team and patients. The concise, short and practical pathway allows every hospital to tailor its own SSI bundle to suit its own needs. Following her own experience of SSI within the family, B. Braun expert Susanne Hellmich-Amendt concludes: “We have the evidence, we know what to do. Now let’s be the change.”
Points of view from clinical experts
Bundle strategies have been shown to significantly reduce SSI rates, states Prof Markus Golling. This requires a whole set of changes in order to improve a complex situation. (Interview held in August, 2020)
The problem with SSI and COVID-19 infections is that both may present with high temperatures. Prof Markus Golling offers an overview of how to filter out potential COVID-19 patients before surgery. (Interview held in August, 2020)
OR traffic might not top the list of well-known SSI issues, but people constantly walking in and out of the OR are in fact a major problem in clinical practice, warns Dr Madeleine Rupp. In addition, clinicians must always consider patient-associated factors. (Interview held in July, 2020)
If stakeholders like surgeons and hospital management are to successfully implement a big change like an SSI bundle strategy, everyone has to be on board, from the top down. It is the only way to improvement, according to Prof Eckhart Mayr. (Interview held in August, 2020)
The bundle strategy to prevent SSI does not only affect the change process, but also the key performance indicators. If you would like to find out how the economic goals are affected, our cost calculator will give you a first insight.
Surgical site infections cause enormous suffering for the affected patient, and in addition put a huge burden on health care budgets (5). Recent literature shows that patients with SSI have an increased length of stay of up to nine days on average, and cost approximately 4,720 Euros more per patient than patients without SSI (6).
The following link will direct you to our “SSI Calculator”. Based on either individual hospital data or data from the literature, the calculator will show:
- Current cost for SSI per year
- Potential future cost for SSI following a particular B. Braun SSI concept per year
- Potential monetary savings due to SSI avoided per year.
The calculations are based on the assumption that SSI patients have a prolonged length of stay that in turn increases cost per case, which may not be completely covered by reimbursement. The calculator assumes a certain cost per hospital bed day.
This calculator aims to give a first impression of possible monetary savings after process improvement. The actual financial impact will strongly depend on:
- Correctness of hospital input data
- Compliance and control of the new implemented process
- Individual circumstances in the country and hospital.
The statistics on surgical site infections are well known (if sometimes difficult to compare), as are the necessary measures to drive the infection rate down to the lowest possible percentage. B. Braun and our practical SSI bundle pathway is there to support you every step of the way. We all know that all it takes is a collective focus and a willingness to make a few small changes to everyday surgical practice.
„If you prevent just one infection, that is a success.“ (Quote Prof Eckart Mayr)
- Healthcare-associated infections: surgical site infections – ECDC - Annual Epidemiological Report for 2017 https://www.ecdc.europa.eu/en/publications-data/healthcare-associated-infections-surgical-site-infections-annual-1
- Curcio, D., Cane, A., Fernández, F., & Correa, J. (2019). Surgical site infection in elective clean and clean-contaminated surgeries in developing countries. Int J Infect Dis Mar; 80:34-45. doi: 10.1016/j.ijid.2018.12.013
- Tanner, J., Padley, W., Assadian, O., Leaper, D., Kiernan, M., & Edmiston, C. (2015). Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery, 158(1), 66–77. doi:10.1016/j.surg.2015.03.009
- Van der Slegt, J., van der Laan, L., Veen, E. J., Hendriks, Y., Romme, J., & Kluytmans, J. (2013). Implementation of a Bundle of Care to Reduce Surgical Site Infections in Patients Undergoing Vascular Surgery. PLoS ONE, 8(8), e71566. doi:10.1371/journal.pone.0071566
- Yamamoto, T., Morimoto, T., Kita, R., Masui, H., Kinoshita, H., Sakamoto, Y., … Hosotani, R. (2015). The preventive surgical site infection bundle in patients with colorectal perforation. BMC Surgery, 15(1). doi:10.1186/s12893-015-0115-0
- Nachtigall, I., & Bonsignore, M. (2018). Ökonomische Auswirkungen der Hygiene. Krankenhaushygiene Up2date, 13(04), 419–431. doi:10.1055/a-0749-6933
How to beat SSI Brochure
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