Initiative helps neurosurgical infections drop more than 80% in two years at Pittsburgh hospital

When excess surgical site infections (SSIs) were detected among neurosurgery patients at University of Pittsburgh Medical Center (UPMC) Mercy in 2019, infection preventionist Katie Palladino, MPH, CPH, CIC, partnered with a hospital neurosurgeon on a multidisciplinary quality and process improvement initiative that led to a steep drop in infection rates over a two-year period. Their successful initiative is being presented at the Association for Professionals in Infection Control and Epidemiology's (APIC's) Annual Conference in Orlando Florida, June 26-28.

Palladino and the surgeon began the initiative by reviewing the path of a surgical patient—from the first pre-op 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 pre-surgical instructions for patients and found ways to improve information about chlorhexidine gluconate (CHG) bathing, nasal decolonization, 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—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," said Palladino. "Getting patients on-board in their own infection prevention also proved to be a critical step in reducing SSIs and readmissions," she added.

Their effort resulted in an 87% drop in the surgeon-specific standardized infection ratio (SIR) from 2019 and 2021. The facility neurosurgery SIR decreased by 82% and neurosurgery-related 90-day and 30-day readmission rates decreased by 46% and 74%, respectively. Correspondingly, the hospital rating score improved from 55.9% to 60.2%. The hospital 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 RN, MA, CIC, FAPIC. "UPMC Mercy's success is a testament to the power of multidisciplinary collaboration to achieve the best outcomes for patients."