By Terri Mahoney, CASC

Every month, your ASC likely receives its post-operative patient infection surveys back. Do you hold your breath as you scan the surveys to see if any patients have the dreaded “X” by their name indicating a surgical site infection (SSI)? If so, you’re not alone.

With the reported post-surgical infection rate in the ambulatory surgery space at less than 1%, it is unlikely that you will see that “X” very often. However, less than 1% still means there’s a chance. And if your ASC is in operation long enough, it’s likely that you will encounter at least one SSI. When that day comes, you must be ready with a plan on what to do next.

What to Look For

An SSI is an infection that occurs after surgery, that is at or near the surgical incision, within 30 days of the procedure or within 90 days if prosthetic material is implanted at surgery. Although many facilities survey their physicians for this information, some facilities will survey patients directly during a post-operative call or send a questionnaire to the patient in the mail or via email.

Another way you may learn that one of your ASC’s patients experienced an SSI is from an area hospital. That’s why it’s important to have a good relationship with the infection preventionist at your area hospital/s. If you have reached out to this person in the past, they are more likely to contact you and let you know if one of your patients presented at their facility with an SSI that required treatment.

When to Be Concerned

While all SSIs deserve your attention, some are more significant than others and will likely require increased scrutiny. These include the following:

• a deep incisional SSI;
• SSI that involves an organ;
• spike in the number cases above your typical number of cases;
• SSI with the same organism; and
• period of increased incidence of infection.

Preparation

Be prepared for the day when you must be able to obtain all information concerning a patient and their surgical procedures. You can do so by ensuring your documents are always accessible and maintained in an orderly fashion.

The documents and information you will need to be able to access in the event of an SSI are as follows:

• staff involved in the procedure;
• length of procedure;
• physical locations the patient accessed (eg, pre-operative and post-operative bays, operating room);
• wound classification;
• sterilization records, including any immediate-use sterilization;
• nurses’ notes;
• documented skin condition prior to surgery;
• general hygiene of the patient;
• patient risk factors (eg, smoker, obesity, elderly, diabetes); and
• any unusual incidents during the surgery.

Data Collection

The previously mentioned information should be easy to gather from your facility documents. However, you will also need the help of the performing physician and their office for some additional information to help you “paint the complete surgical picture.” They will need to supply you with information on how and when the infection was discovered. Was the wound cultured? If so, what pathogen was identified? How signification was the infection? How was it treated and was it resolved?

What do you do with all of this data? Compile it in some format that works for you. There are lots of samples available of how to organize such data or you can take your own approach. It should be easy to read and to compare data from one situation to another. Note: I find a spreadsheet with the relevant information helpful to log any SSIs reported.

Advice

When you bring a new physician into your facility, let them know the expectations if they discover an SSI in one of your patients. You want to know as soon as possible. They do not need to wait for a survey. The sooner you know of an issue, the sooner you can make any necessary changes to avoid a repeat situation. I would much rather be told about an SSI from the surgeon than receive a phone call from the patient or an area hospital.

Let’s be honest: Even after all of your investigation, you may never know the source of the infection. However, you must do your due diligence so that you can determine whether you need to take any action.

Terri Mahoney, CASC, is administrator of Bluffton Okatie Surgery Center in Okatie, South Carolina. Write her at tmahoney@uspi.com.