improving post-discharge surveillance of surgical site infection following caesarean
TRANSCRIPT
POST-DISCHARGE SURVEILLANCE OF
SURGICAL SITE INFECTION FOLLOWING
CESAREAN SECTION
BREAKOUT G: I SPY SOMETHING THAT’S… INFECTED!
I have no conflict of interest/disclosure
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
DISCLOSURE
• Previous hospital surveillance of CS SSI accounts for:
▫ Cases identified through targeted chart review 30 days post-delivery
Only looks at patients delivering by C/S on MONDAYS
▫ Cases identified during weekly rounds (Wednesday) by Infection Control
▫ Patients with positive wound culture done in-hospital
• During 2013-2014, BCWH’s reported rate of SSI post C/S ranged from 0.0% – 1.1%
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
BCWH’S PAST SSI SURVEILLANCE SYSTEM
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2013 2014
# SSI 1 0 0 0 0 2 0 1 1 1 1 2
C-section procedures 167 179 168 215 202 174 193 168 189 184 149 187
Rate per 100 C-section 0.6% 0.0% 0.0% 0.0% 0.0% 1.1% 0.0% 0.6% 0.5% 0.5% 0.7% 1.1%
0.0%
2.0%
4.0%
6.0%
C-section SSI Incidence Rate at BCWH
• Unable to follow-up all patients during their hospitalization (only
‘Monday’ cases)
• Unable to identify SSI’s that occur post-discharge (unless patients are
readmitted to this hospital)
• Does not include any SSI’s that are dealt with in the community
E.g., women with CS complications that present to care providers, a clinic or
another hospital are not captured by the current system
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
LIMITATIONS OF THE PAST SYSTEM
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
LIMITATIONS OF THE PAST SYSTEM
• PHSA Infection Prevention and Control (IPAC) team conducted a chart
review 30 days post-delivery in 2012
▫ SSI rate identified: 6.5%
• Pilot post-discharge surveillance project conducted in Feb-Jul 2014
• CS SSI rate: 6%
• Previous surveillance of post-CS SSI and reported rate (0.0% – 1.1%)
underestimates the true rate of SSI
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SSI POST C/S WITH POST-DISCHARGE SURVEILLANCE
• Norway - Prospective cohort 12 months, 2000 deliveries
• SSI rate 1.8% at initial hospital discharge
• SSI rate 8.9% follow-up for 30d Opoein, et al. Act Obstet Gynecol Scand 2007
• Scotland - Prospective surveillance study
• >12,000 acute short stay procedures
• Cesarean section
• SSI 2.6% no PDS vs 6.3% with PDS
• Without follow-up, 60% wound infections undetected – preventable morbidity and
health care costs Reilly et al, Infect Control Hosp Epidemiol 2006
• Alberta - 1250 elective c/s cases
• SSI rate 9.9%
• 23% of cases received prophylactic antibiotics***
• High SSI rate for low risk procedure Griffiths et al, JOGC 2005 April 27(4)
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SURVEILLANCE PROCEDURES
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SURVEILLANCE PROCEDURES
1770
1348 (76%)
1221 (69%)
127 (7%)
422 (24%)
0
200
400
600
800
1000
1200
1400
1600
1800
Total number of C/S patientsdischarged (04/18/16 -
01/22/17)
Total number of C/S patientsapproached
Total number of C/S patientsconsented to be contacted
Total number of C/S patientsdeclined to be contacted
Total number of C/S patientsnot approached
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SURVEILLANCE PROCEDURES
926
703 (76%)
366 (52%)
0
100
200
300
400
500
600
700
800
900
1000
Total number of surveys distributed (up to12/31/16)
Total numbers of surveys received Number of patients reporting a problem with theirC/S SSI site
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SURVEILLANCE PROCEDURES
1383
1002 (72%)
0
200
400
600
800
1000
1200
1400
Total number of providers faxed (up to 12/31/16) Total number of faxes received from providers
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SURVEILLANCE PROCEDURES
1053
83 (7.9%)
0
200
400
600
800
1000
1200
Total number of patients completed (up to 01/30/17) Total number of SSIs
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SURVEILLANCE PROCEDURES
83
60 (72%)
23 (28%)
0
10
20
30
40
50
60
70
80
90
Total number of SSIs Number of SSIs confirmed by provider Number of SSIs reported by patients but not yetconfirmed by provider
• Started April 2016 - NP Melissa Glen
• Self-referral Monday to Friday 8-4
• Initial diagnosis and management
• ~ 100 pts seen
• True SSI <10
• No acute systemic infections
• Feedback very positive – reassurance!!!
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
SSI CLINIC AT BCWH
• CS SSI rate confirmed by provider of 5.7% CS SSI rate
indicates clear need for enhanced surveillance post
hospital-discharge
• Surveillance by online survey yields a high response
rate (91% agreed to email contact, 76% online survey
response rate)
• Faxing providers also yields a high response rate of 72%
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
LESSONS LEARNED
• The initiative’s main challenge is ensuring that all
women who have undergone CS are approached to request email addresses for follow-up.
• We are working on both increasing the number of women being approached prior to hospital discharge, and following-up with providers of women who were not approached.
• In process of including patient feedback and input as to how this surveillance is perceived and how to improve.
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
CURRENT LIMITATIONS
Julie van Schalkwyk
Emma Branch
Kathryn Dewar
POST-DISCHARGE SURVEILLANCE OF SSI FOLLOWING CS
CONTACT INFORMATION