Surgical Infection-Prevention Program Has Mixed Results

Composite adherence scores may predict post-op infection risk; scores on individual items don't
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, June 22 (HealthDay News) -- Adherence to Surgical Care Improvement Project (SCIP) infection-prevention measures is associated with a decreased risk of postoperative infections only when the measures are analyzed as a composite score instead of individually, according to research published in the June 23/30 issue of the Journal of the American Medical Association.

Jonah J. Stulberg, M.D., of Case Western Reserve University in Cleveland, and colleagues conducted a retrospective cohort study to evaluate the association between compliance with infection-prevention SCIP measures and postoperative infection rates in 405,720 patients in 398 hospitals. SCIP aims to reduce surgical infection rates through measurement and reporting of specific infection-prevention measures, divided into two groups: a core group of the original three infection-prevention measures (S-INF-Core), as well as a global group comprising all six infection-prevention measures (S-INF). An all-or-nothing composite score for both S-INF-Core and S-INF was determined for each patient.

There were 3,996 postoperative infections. The researchers found that, when the SCIP had been adhered to, as evidenced by the all-or-nothing composite S-INF score, there was a significant association with a decreased rate of postoperative infections (adjusted odds ratio, 0.85). Adherence to SCIP as measured by the all-or-nothing composite S-INF-Core score also was associated with a decrease in postoperative infections, but the association did not reach statistical significance. Adherence to specific infection-prevention measures individually was not associated with a decreased risk of a postoperative infection.

"While the individual items may not imply quality differences, the overall ability to demonstrate adherence to multiple SCIP processes of care may. Improved methods for identification of quality of care are necessary to be able to define improvements in patient outcomes, and to justify the massive investment of time and money in tracking these processes of care," the authors write.

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