The effect of Surgical Care Improvement Project measures on national trends on surgical site infections in open vascular procedures

Dua A, Desai SS, Seabrook GR, Brown KR, Lewis BD, Rossi PJ, Edmiston CE, Lee CJ

"Implementation of SCIP guidelines has made no significant effect on the incidence of in-hospital SSIs in open vascular operations; rather, an increase in SSI rates in open [abdominal aortic aneurysm] repairs was observed. Patient-centered, bundled approaches to care, rather than current SCIP practices, may further decrease SSI rates in vascular patients undergoing open procedures."

Surgical site infection after arthroplasty: Comparative effectiveness of prophylactic antibiotics: Do Surgical Care Improvement Project guidelines need to be updated?

Ponce B, Raines BT, Reed RD, Vick C, Richman J, Hawn M

"Current SCIP guidelines address antibiotic timing but not antibiotic dosage. (The generally accepted recommendation for vancomycin is 15 mg/kg.) Although vancomycin is a narrower-spectrum antibiotic than either cefazolin or clindamycin, our finding of higher SSI rates following prophylaxis with vancomycin only may suggest a failure to use an appropriate dosage rather than an inequality of antibiotic effectiveness."

Prevention of surgical site infection: Beyond SCIP

Anderson DJ

"Most hospitals have achieved great successes in improving adherence to the basic quality measures recommended by SCIP. Yet, patients continue to have SSIs. Evidence-based strategies—optimizing antimicrobial prophylaxis dosing, preparing the colon with mechanical bowel preparation and oral antibiotics, optimizing tissue oxygenation, and using a surgical safety checklist—can help high performing hospitals and health care providers move beyond SCIP to ensure that they provide the best care possible to their surgical patients and decrease the rate of SSI."

Surgical care improvement project and surgical site infections: Can integration in the surgical safety checklist improve quality performance and clinical outcomes?

Tillman M, Wehbe-Janek H, Hodges B, Smythe WR, Papaconstantinou HT

"Implementation of an integrated SSC can improve compliance of SSI reduction strategies such as SCIP Inf performance and maintenance of normothermia. This did not, however, correlate with an improvement in overall SSI at our institution. Further investigation is required to determine other factors that may influence SSI at an institutional level."

Antibiotic choice is independently associated with risk of surgical site infection after colectomy: A population-based cohort study.

Hendren S, Fritze D, Banerjee M, Kubus J, Cleary RK, Englesbe MJ, Campbell DA Jr.

"In Michigan, several perioperative care practices are independently associated with decreased risk of SSI after colectomy, including SCIP-2-compliant prophylactic antibiotics, postoperative normothermia, glucose control, and oral antibiotics. Furthermore, specific prophylactic antibiotic choices are associated with lower risk of SSI. These results account for patient factors and unmeasured hospital effects, suggesting that dissemination of these perioperative care practices may decrease SSI rates."

Report Card on Surgical Care Improvement Project (SCIP): Nationwide Inpatient Sample Infection Data 2001-2006

Davis JM, Kuo Y-H, Ahmed N, Kuo Y-L

A retrospective cohort study evaluating whether SCIP had an effect on surgical site infections evaluated post-operative infections in patients undergoing cholecystectomies and colectomies from 2001 to 2006. The data indicated that the effect of reducing the infection rate in elective surgical procedures has not been realized since the initiation of the SCIP directives.

The Surgical Care Improvement Project and Prevention of Post-Operative Infection, Including Surgical Site Infection

Rosenberger LH, Politano AD, Sawyer RG

This article reviews the 7 SCIP initiatives applicable to the perioperative period as published in the Specifications Manual for National Inpatient Quality Measures. It concludes that there is strong evidence that implementation of protocols that standardize practices reduces the risk of surgical infection. Surgeons and scientists should be active in the investigation of clinical questions, writing of protocols, and implementation and execution of process measures.

Diminishing surgical site infections after colorectal surgery with surgical care improvement project: is it time to move on?

Larochelle M, Hyman N, Gruppi L, Osler T

A cohort of consecutive patients undergoing open colon resection with anastomosis were prospectively monitored by a multidisciplinary committee consisting of a surgeon, an anesthesiologist, nurses and quality specialists who implemented a 5-year multidisciplinary program aimed to improve compliance with the 4 infection-related components of the SCIP program. The study concluded that their 4-year multidisciplinary effort failed to improve either compliance with the SCIP infection measures or to decrease the rate of SSI for colon resection at their academic medical center.

Association of Surgical Care Improvement Project Infection-Related Process Measure Compliance with Risk-Adjusted Outcomes: Implications for Quality Measurement

Ingraham AM, Cohen ME, Bilimoria KY, Dimick JB, Richards KE, Raval MV, Fleisher LA, Hall BL, Ko CY

A cross-sectional study including hospitals participating in the Surgical Care Improvement Project and the American College of Surgeons National Surgical Quality Improvement Program found that better adherence to infection-related process measures over the observed range was not significantly associated with better outcomes with one exception: appropriate antibiotic prophylaxis; this measure was a significant predictor of risk-adjusted SSI and overall morbidity.

Adherence to Surgical Care Improvement Project Measures and the Association With Postoperative Infections

Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM

A retrospective cohort study including 405,720 patients from Premier Inc's Perspective Database found that a global all-or-none composite infection-prevention score was associated with a lower probability of developing a postoperative infection; however, individual measures were not significantly associated with a decreased probability of infection.

An Increase in Compliance With the Surgical Care Improvement Project Measures Does Not Prevent Surgical Site Infection in Colorectal Surgery

Pastor C, Artinyan A, Varma MG, Kim E, Gibbs L, Garcia-Aguilar J

A multidisciplinary task force analyzed data for 491 consecutive patients undergoing elective colorectal resections and concluded that there was no reduction in surgical site infections with an increase in compliance with the Surgical Care Improvement Project.