| Sumario: | Background: This study compared post-total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgical site infection (SSI) rates calculated using two surveillance methodologies to assess their reliability as quality indicators in a community hospital. SSI rates from the National Surgical Quality Improvement Program (NSQIP) were compared with those from an independent Infection Prevention and Control (IPAC) SSI surveillance program based on National Healthcare Safety Network (NHSN) guidance. Methods: The study period ranged from April 1, 2021, to March 31, 2023. The IPAC program actively reviewed all THA and TKA cases for 90 days post-operatively, while NSQIP followed a subset of patients for 30 days. Both methodologies applied the same NHSN case definitions to identify complex SSI cases, and SSI rates were calculated. All identified cases were reviewed and shared with stakeholders. The IPAC program audited compliance with SSI preventive measures beginning in April 2022. Results: In the first fiscal year, IPAC surveillance identified six complex SSI cases (THA: 3; TKA: 3), with SSI rates of 0.71 for THA and 0.54 for TKA. NSQIP identified one case (THA: 1; TKA: 0), with SSI rates of 0.87 for THA and 0 for TKA. In the second fiscal year, IPAC identified six additional complex SSI cases (THA: 3; TKA: 3), with SSI rates of 0.58 for THA and 0.36 for TKA, while NSQIP identified no cases. Using IPAC surveillance, SSI rates decreased by 18% for THA and 33% for TKA over the study period. Of the 12 SSI cases identified by IPAC, five (41.2%) were detected beyond 30 days post-operatively and would not have been captured by NSQIP. Improvements in preventive practices were observed, including normothermia compliance increasing from <20% to 80% and appropriate hair removal education improving from 60% to 93%. Conclusion: The IPAC SSI surveillance program provided a more accurate and sensitive indicator for detecting changes in SSI rates.
|
|---|