Table 11 'Hospital Acquired Infection Registration - Post-Operative Wound Infections'

PSI 10: Hospital Acquired-Infection Registration – Post Operative Wound Infections
Origin: PSI by SimPatIE
Dimension Description
Description of Specific
Aspects of Patient Safety
Hospital acquired infections are a major problem, leading to prolonged
hospital stay increased morbidity and mortality for patients and to
increased costs for the health care system. Among 1510 patients the
overall prevalence of hospital-acquired infections (HAI) was found to
be 10%. The distribution of the most frequent HAIs was urinary tract
infection (34%), postoperative wound infection (19%), pneumonia
(12%) and septicaemia (9%), respectively. A total of 456 patients
(30%) received antibiotics on the prevalence day. The antibiotics were
given as prophylaxis to 64 (14%) of these patients (35)
Consequently, Hospital Acquired-Infection Registration (HAIR) is a
suitable patient safety measure.
Aim of the PSI The PSI aims at surveillance of post operative wound infections.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Source(s) This method was developed by A. Leth and J.K. Moller in the
Department of Clinical Microbiology, Aarhus University Hospital, DK
(35;36).
Extent of Clinically
Testing
Registration of HAI was compared with conventional manual
registration (the gold standard i.e. reference method) by chart reviews
of nosocomial infections in patients from surgical and medical
departments. By combining selected infection parameters from various
electronic hospital registries, the computer detected postoperative
wound infections with a sensitivity of 94% and a specificity of ) 91%
(35;36).
Evidence of Clinically use
of Standards
No evidence of clinically use of standards was found.
PSI category Theme Related PSI: “Infection Control”.
Data definitions Cases of post operative wound infection
Numerator Description Discharges with code for postoperative wound infections (ICD-10).
Patients admitted less than two days, except for readmission are
excluded.
Denominator Description All elective surgical discharges age 18 and older defined by specific
DRGs and an ICD-10 code for an operating room procedure.
Patients admitted less than two days, except for readmission are
excluded.
Data Source HAIR is based on selected laboratory and administrative data,
including individual use of antimicrobial agents.
SImPatIE WP4 – Catalogue of Patients Safety Indicators
31
Identifying the
institutional context
This PSI is relevant to quality improvement, accreditation and cost
containment, as prolonged hospital stays due to infections have
considerable economic impact.
Care Setting The PSI applies for high quality surgical site preparation, careful and
sterile surgical techniques and high quality post-op care.
Professionals Responsible
for Health Care
Surgeons and nurses.
Lowest Level of Health
Care Delivery Addressed
Individual clinical units or departments.
Allowance for Patient
Factors
No risk adjustment described.
Stratification by
Vulnerable Populations
No stratification
Standard of Comparison No time comparison specified.
Scoring Type of surgical procedure must be registered, and one or more of the
following criteria:
− culture positive swab from wound/drainage
− discharge code for postoperative wound infection (ICD-10)
− relevant antibiotic treatment prescribed after surgery and not for
other infections.