SSIs are surgical site infections. Abdominal hysterectomy SSIs are an important source of post-surgical healthcare associated infections. Such surgery can be lifesaving, but germs introduced to the incision can cause infections and lead to serious complications and even death. Medical researchers developed a “bundle” of best practices and checklist for use before, during, and after surgery that can reduce such infections. Tracking such infections in acute care hospitals is beneficial to encourage the adoption of these best practices and to evaluate their effect.

The Standardized Infection Ratio (SIR) is the primary measure used to track healthcare associated infections by the Connecticut Department of Public Health. The ratio is the number of actual infections that occur in a given time (called the baseline period) divided by the number predicted. The baseline is 1.0, which means that the number of infections observed is the same as the number predicted. If the SIR is greater than 1.0, it indicates that more HAIs were observed than predicted; conversely, an SIR less than 1.0 indicates that fewer HAIs were observed than predicted. As the aim is to reduce SSIs associated with abdominal hysterectomies, we aim to reduce the SIR below 1 (the lower, the better).

In 2019, the Connecticut hysterectomy SSI SIR decreased to 1.02 from 1.41 in 2018, indicating that prevention efforts implemented since the increase in 2018 have been successful. In general, the number of abdominal hysterectomies being performed is decreasing, challenging hospitals to decrease the number of post-hysterectomy infections more to reduce the SSI rate.

Hospital medical and non-medical staff, especially infection prevention and control staff (infection preventionists and hospital epidemiologists). Surgeons and surgical specialty associations (e.g., the American College of Surgeons). Connecticut Hospital Association. Qualidigm, the Connecticut CMS Quality Improvement Organization (QIO). The Connecticut Healthcare Associated Infections Advisory Committee. The Connecticut Chapter of the Infectious Diseases Society of America (CIDS). Centers for Disease Control and Prevention, Division of Healthcare Quality and Prevention. National Healthcare Safety Network. Council of State and Territorial Epidemiologists. The Association of Professionals in Infection Control, Inc. The Society for Healthcare Epidemiology in America. Connecticut Department of Public Health.

To implement ”the bundle” to prevent infections associated with abdominal hysterectomies, healthcare facilities must track use of the best practices, and ensure that all staff involved in the preparation for surgery, the procedure, and post-surgical care rigorously adhere to them, despite the many competing priorities they address every day to care for patients. Dr. Peter Provonost and colleagues at Johns Hopkins University developed the “Comprehensive Unit-based Safety Program (CUSP).” This program can be adopted by acute care hospitals to ensure the routine use of surgical best practices to prevent infection. By doing so, changes in the culture of the organizations, and changes in logistics to support and maintain use of these best practices will occur. The ultimate goal is preventing SSIs, with the aim of eliminating them. The CUSP programs are developed and delivered in the overall infection control and prevention program of each healthcare facility.

Many facilities have adopted the best practices after participating in the CUSP programs. We will continue to monitor the SIR of abdominal hysterectomy SSIs to assess the effectiveness of this intervention.