1. CSTS – SSI reporting for CABG Armstrong Institute for Patient Safety and Quality Presented by: Kathleen Speck, MPH Lisa Maragakis, MD, MPH

2. SSI Reporting for CABG Objectives 1.To review the types of SSIs involved in CABG 2.To review the criteria for determination of SSI 3.To discuss the reporting of SSIs to CSTS Armstrong Institute for Patient Safety and Quality 2

3. NHSN Definition SSI 3 types of SSIs 1.Superficial 2.Deep Incisional 3.Organ/Space Armstrong Institute for Patient Safety and Quality 3

4. NHSN Definition Operative Procedure NHSN operative procedure –Takes place during a single trip to the OR –The surgeon makes at least one incision through the skin –The incision is closed before the patient leaves the OR Armstrong Institute for Patient Safety and Quality 4

5. SSI Definitions Superficial: 3 criteria 1.Occurs within 30 days of operative procedure 2.Involves only skin and subcutaneous tissue of the incision 3.(On next slide) Armstrong Institute for Patient Safety and Quality 5

6. SSI-Definitions (cont) Superficial: 3 criteria 3.Patient has at least one of the following: a)Purulent drainage from the superficial incision b)Organisms are isolated from fluid or tissue from that site c)At least one of the following signs or symptoms of infection a)Pain or tenderness b)Localized swelling c)Redness d)Heat e)Superficial incision is opened by surgeon and is culture positive or not-cultured f)Diagnosis of superficial infection is made by surgeon or attending Armstrong Institute for Patient Safety and Quality 6

7. SSI Definitions Superficial: 2 types 1.Superficial Incisional Primary (SIP) a)Primary incision from operation with more than 1 incision (in this case, chest incision for CABG) 2.Superficial Incisional Secondary (SIS) a)Secondary incision from operation with more than one incision (in this case, donor site [leg] incision for CABG) Armstrong Institute for Patient Safety and Quality 7

8. SSI Definitions non-reportable superficial events Stitch abscesses Cellulitis Armstrong Institute for Patient Safety and Quality 8

9. SSI Definitions Deep Incisional: 3 criteria 1.Infection occurs within 30 days of operative procedure (if no implant is left in place) or 1 year (if implant is in place and infection appears to be related to operative procedure AND 2.Infection involves deep soft tissues (e.g., fascial and muscle layers) AND Armstrong Institute for Patient Safety and Quality 9

10. SSI Definitions Deep Incisional: 4 criteria (Cont.) 3.Patient has at least one of the following: a)Purulent drainage from the deep incision but not from the organ space component of the surgical site b)Deep incision spontaneously dehisces or is opened by the surgeon and is culture positive or not cultured and the patient has: i.Fever (>38 ⁰C) ii.Localized pain or tenderness Armstrong Institute for Patient Safety and Quality 10

11. SSI Definitions Deep Incisional: 4 criteria (cont.) d)An abscess or other evidence of deep infection found i.On direct examination ii.During recuperation iii.By histopathologic or radiologic examination e)Diagnosis of a deep incisional SSI by surgeon or attending Armstrong Institute for Patient Safety and Quality 11

12. SSI Definitions Deep incisional: 2 types 1.Deep Incisional Primary (DIP) a)Primary incision from operation with more than 1 incision (in this case, chest incision for CABG) 2.Deep Incisional Secondary (DIS) a)Secondary incision from operation with more than one incision (in this case, donor site [leg] incision for CABG) Armstrong Institute for Patient Safety and Quality 12

13. SSI Definitions Organ/Space: 3 criteria 1.Infection occurs within 30 days of operative procedure (if no implant is left in place) or 1 year (if implant is in place and infection appears to be related to operative procedure AND 2.Infection involves any part of the body, excluding the skin incision, fascia or muscle layers, that is opened or manipulated during the operative procedure AND Armstrong Institute for Patient Safety and Quality 13

14. SSI Definitions Organ/Space: 3 criteria (cont.) 3.Patient has at least one of the following a)Purulent drainage from a drain that is placed through a stab wound into the organ/space b)Organisms are isolated from an aseptically obtained culture of the fluid of tissue in the organ/space c)An abscess or other evidence of infection involving the organ space is found by direct examination, during reoperation, or by histopathologic or radiologic examination d)Diagnosis of an organ/space SSI by surgeon or attending Armstrong Institute for Patient Safety and Quality 14

15. SSI Reporting for CSTS SSIs will be reported by the following Armstrong Institute for Patient Safety and Quality 15 NumeratorsDenominator 1 # of patients with Superficial Incisional Primary (SIP) infections # of patients >age 18 having CABG 2 # of patients with Superficial Incisional Secondary (SIS) infections 3 # of patients with Deep Incisional Primary (DIP) infections 4 # of patient with Deep Incisional Secondary (DIS) infections 5# of patients with Organ/Space infections