our electronic health record. The focus has turned
to preoperative preparation of in-house surgical
patients and comprehensive wound care instructions
for patients and caregivers upon discharge.
Using the NSQIP return on investment
calculator, Stony Brook has had an average of
22 fewer infections annually, saving the hospital
$616,000 dollars per year or a total of $4,928,000
since the inception of our SSI reduction strategy.
Suggestions for other institutions
Some guidelines for other institutions considering
the implementation of an SSI reduction system as
described in this column include the following:
•Convene a monthly SSI committee
•Implement data tracking for process measures and bundle
compliance, power plan use
•Institute a root-cause analysis tool with a brief case
summary and bundle compliance
•Create a surgical service preoperative power plan and
comprehensive wound care discharge order set
•Review real-time data whenever possible, including both
Centers for Disease Control and Prevention National
Healthcare Safety Network and ACS NSQIP events as
FIGURE 4A AND 4B.
DELAYED WOUND CLOSURE
V102 No 1 BULLETIN American College of Surgeons
ACS NSQIP BEST PRACTICES CASE STUDIES
1. Tang R, Chen HH, Wang YL, et al. Risk factors
for surgical site infection after elective resection of
the colon and rectum: A single center prospective
study of 2809 consecutive patients. Ann Surg.
2. Wick EC, Shore AD, Hirose K, et al. Readmission
rates and cost following colorectal surgery. Dis Colon
Rectum. 2011;54( 12):1475-1479.
3. Mahmoud NN, Turpin RS, Yang G, Saunders WB.
Impact of surgical site infections on length of stay
and costs in selected colorectal procedures. Surg Infect
(Larchmt). 2009; 10( 6):539-544.
4. Thompson KM, Oldenburg WA, Deschamps C,
et al. Chasing zero: The drive to eliminate surgical site
infections. Ann Surg. 2011;254( 3):430-436.
5. Cheng KP, Roslani AC, Sehha N, et al. ALEXIS
O-Ring wound retractor vs conventional wound
protection for the prevention of surgical site infections
in colorectal resections. Colorectal Dis. 2012; 14( 6):e346-
6. Bratzler DW, Hunt DR. The surgical infection
prevention and surgical care improvement projects:
National initiatives to improve outcomes for patients
having surgery. Clin Infect Dis, 1. 2006; 43( 3):322-330.
7. Kurz A, Sessler DI, Lenhardt R. Perioperative
normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J
8. New York State Department of Health. Hospital-Acquired Infections, New York State 2013. Available
hospital_acquired_infections/. Accessed November