US centre achieves 87% drop in neurosurgical infection rates across two-year period


A US centre has achieved a steep drop in infection rates among its neurosurgery patients over a two-year period thanks to the implementation of a multidisciplinary quality and process improvement initiative—as per a recent presentation at the Association for Professionals in Infection Control and Epidemiology’s (APIC) annual conference (26–28 June, Orlando, USA).

In 2019, when excess surgical site infections (SSIs) were detected among neurosurgery patients at the University of Pittsburgh Medical Center (UPMC) Mercy (Pittsburgh, USA), infection preventionist Katie Palladino partnered with a hospital neurosurgeon on this initiative.

Palladino and the surgeon began by reviewing the path of a surgical patient—from the first preoperative meeting to the surgery, to the patient’s discharge from the hospital—observing practices and looking for opportunities where infections could arise. They also reviewed presurgical instructions for patients and found ways to improve information about chlorhexidine gluconate (CHG) bathing, nasal decolonisation, and other important infection prevention practices.

The next step was a literature review of best practices for SSI prevention, and the creation of a multidisciplinary team to engage around this initiative and determine the process measures that could be reported on a monthly dashboard.

“SSI prevention extends beyond the surgical suite,” said Palladino. “It was important for us to bring in the other groups like physical and occupational therapy, environmental services, and facilities management, so they could see their role in preventing infections, and then provide monthly updates on progress. Getting patients on board in their own infection prevention also proved to be a critical step in reducing SSIs and readmissions.”

Their effort resulted in an 87% drop in the surgeon-specific standardised infection ratio (SIR) from 2019 and 2021. The facility neurosurgery SIR decreased by 82%, while neurosurgery-related 90-day and 30-day readmission rates decreased by 46% and 74%, respectively. Correspondingly, the hospital’s rating score improved from 55.9% to 60.2%, and its recommendation score rose from 55.4% to 62.8%.

“Surgical site infections are among the most common healthcare-associated infections,” said 2023 APIC president Patricia Jackson (White Rock Medical Center, Dallas, USA). “UPMC Mercy’s success is a testament to the power of multidisciplinary collaboration to achieve the best outcomes for patients.”


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