Surgical Site Infections – the Drive to Zero Tolerance

Every year, surgical site infections plague hospitals. It is well known that a hospital is one of the most dangerous places on earth as it can harbor the most deadly, antibiotic resistant pathogens. The risk of a healthcare acquired infection (HAI) is one of the great concerns facing any patient about to undertake surgery. In 2010, the CDC stated that there were an estimated 16 million operative procedures performed in the US1. Hospital acquired infections affect about 5% of these patients. Surgical site infections represents the lion’s share as they account for 31% of the total HAI count2 or 1.9% of patient procedures. Surgical site infections therefore affect over 300,000 patients annually in the US. At an average cost of over $20,000 3 per surgical site infection case, the means that the cost of surgical site infections is over $6 billion annually before the cost of the loss of employment days or quality of life factors on the patient or their families.

The CDC also suggests that a significant portion of HAIs are preventable, possibly as much as 30%. Given the enormous financial burdens to health care systems and negative consequences to the patients’ quality of life, it is disappointing that more work is not undertaken to make a serious dent in reducing these infection rates. The culprit, I will suggest, is the silo’d budgeting process of most health care systems today. Infection control is often a separate budgetary entity. Prevention measures usually result in additional costs accruing to these departments, while the cost savings accrue to other departments e.g. drugs, nursing, beds etc. There is often the wrong incentive system in place to generate the kinds of HAI prevention potential from being realized. Incentives however will not change unless there is greater public pressure on public and private health care providers to reduce their rates of infections. In fact, a case can be made that US hospitals actually make more money per patient if these patients acquire infections and require further hospitalization days (which can be on average up to 9 more days).  If we ever truly hope to reduce or eliminate surgical site infections and other hospital acquired infections rates, then we need to both promote a ‘zero HAI tolerance’ across patients and clinicians alike, as well as implementing appropriate systems of compensation, rewards and penalties.

1 Data from the National Hospital Discharge Survey. Retrieved from
2  Magill SS, Hellinger W, et al. Prevalence of healthcare-associated infections in acute care facilities. Infect Control Hospital Epidemiol 2012;33(3):283-91.
3 de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009 Jun;37(5):387-97. doi: 10.1016/j.ajic.2008.12.010. Epub 2009 Apr 23

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