Surgical site infections are the second most common type of healthcare associated infection (HAI) in U.S. hospitals (290,000 per year) and account for the greatest additional healthcare cost, between $3.5 and 10 billion per year. As of June 1, 2011, California hospitals are required to report deep incisional and organ/space SSIs and all surgeries in 29 surgical procedure categories via the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). Nine of these surgery types are included in the Interactive HAI Map along with other HAIs. This SSI report is the first based on a full year of data submitted via NHSN. It covers surgical procedures performed during 2012 and any subsequent infections reported to CDPH by May 3, 2013.
CDPH is mandated to report SSI data using risk adjustments according to NHSN protocols. NHSN developed a category-specific Standardized Infection Ratio (SIR) for SSI in each surgical procedure category. The SIR is a comparison of the observed number of infections to the predicted number based on the national average. For 24 of the 29 reported surgical procedure categories, the SIR is risk adjusted by using information reported by hospitals on each surgery performed, including information on patient health.
Risk adjusted SIRs allow comparison among hospitals for a surgical procedure category. However, it is important to keep in mind that the NHSN risk adjustment method may not take into account all of the differences in risk of infection for patients in those hospitals. Furthermore, many of these differences are not large and may change from year to year.
To view the Key Findings and Public Health Actions for this report, see Key Findings
What’s in Key Findings? This is a summary of the key findings, including introduction, important results and suggested public health actions, based on the data and results displayed in the 34 tables.
Tables 1 to 12 (6MB) for abdominal aortic aneurysm repair, appendix surgery, bile duct, liver or pancreatic surgery, cardiac surgery, coronary artery bypass graft with both chest and donor site incisions, coronary artery bypass graft with chest incision only, gallbladder surgery, colon surgery, Cesarean section, spinal fusion, open reduction of fracture and gastric surgery.
Tables 13 to 24 (4MB) for hip prosthesis, abdominal hysterectomy, knee prosthesis, kidney transplant, laminectomy, liver transplant, rectal surgery, refusion of spine, small bowel surgery, thoracic surgery, vaginal hysterectomy, and abdominal surgery.
What’s in Tables 1 to 24? These tables display each hospital that submitted data on the procedure category with the numbers of procedures and infections, the risk adjusted SIR, and its 95 percent confidence interval with a comparison based on the confidence interval indicating an infection count that was lower, no different or higher than predicted.
What’s in Tables 25 to 29? The information displayed is limited to the reported procedure and infection counts as there is no risk adjustment for comparisons.
What’s in Tables 30 to 34? NHSN does not currently provide an appropriately risk adjusted SIR for LTACs and rehabilitation hospitals, which perform few surgeries. Their data are listed in Tables 30 to 32. Table 33 lists hospitals with no surgeries, 34 lists hospitals with fewer than 20 reported surgeries.
What’s in Technical Notes? Information on the data sources, definitions, quality assurance and control, data presentation and statistical analysis and descriptions of the laws requiring reporting, the variables that go into risk adjusting and the limitations of these processes are described here.
For more information on SSI prevention, see SSI Information