CSTS – SSI reporting for CABG

Armstrong Institute for Patient Safety and Quality

Presented by:

Kathleen Speck, MPH

Lisa Maragakis, MD, MPH

SSI Reporting for CABGObjectives

1. To review the types of SSIs involved in CABG

2. To review the criteria for determination of SSI

3. To discuss the reporting of SSIs to CSTS

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NHSN DefinitionSSI

• 3 types of SSIs1. Superficial

2. Deep Incisional

3. Organ/Space

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NHSN DefinitionOperative Procedure

• NHSN operative procedure– Takes place during a single trip to the OR– The surgeon makes at least one incision

through the skin– The incision is closed before the patient

leaves the OR

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SSI DefinitionsSuperficial: 3 criteria

1. Occurs within 30 days of operative procedure

2. Involves only skin and subcutaneous tissue of the incision

3. (On next slide)

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SSI-Definitions (cont)Superficial: 3 criteria

3. Patient has at least one of the following:

a) Purulent drainage from the superficial incision

b) Organisms are isolated from fluid or tissue from that site

c) At least one of the following signs or symptoms of infectiona) Pain or tenderness

b) Localized swelling

c) Redness

d) Heat

e) Superficial incision is opened by surgeon and is culture positive or not-cultured

f) Diagnosis of superficial infection is made by surgeon or attending

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SSI DefinitionsSuperficial: 2 types

1. Superficial Incisional Primary (SIP)a) Primary incision from operation with more

than 1 incision (in this case, chest incision for CABG)

2. Superficial Incisional Secondary (SIS)a) Secondary incision from operation with

more than one incision (in this case, donor site [leg] incision for CABG)

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SSI Definitionsnon-reportable superficial events

• Stitch abscesses

• Cellulitis

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SSI DefinitionsDeep Incisional: 3 criteria

1. Infection occurs within 30 days of operative procedure (if no implant is left in place) or 1 year (if implant is in place and infection appears to be related to operative procedure AND

2. Infection involves deep soft tissues (e.g., fascial and muscle layers) AND

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SSI DefinitionsDeep Incisional: 4 criteria (Cont.)

3. Patient has at least one of the following:a) Purulent drainage from the deep incision but not

from the organ space component of the surgical site

b) Deep incision spontaneously dehisces or is opened by the surgeon and is culture positive or not cultured and the patient has:

i. Fever (>38⁰C)ii. Localized pain or tenderness

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SSI DefinitionsDeep Incisional: 4 criteria (cont.)

d) An abscess or other evidence of deep infection found

i. On direct examination

ii. During recuperation

iii. By histopathologic or radiologic examination

e) Diagnosis of a deep incisional SSI by surgeon or attending

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SSI DefinitionsDeep incisional: 2 types

1. Deep Incisional Primary (DIP)a) Primary incision from operation with more

than 1 incision (in this case, chest incision for CABG)

2. Deep Incisional Secondary (DIS)a) Secondary incision from operation with

more than one incision (in this case, donor site [leg] incision for CABG)

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SSI DefinitionsOrgan/Space: 3 criteria

1. Infection occurs within 30 days of operative procedure (if no implant is left in place) or 1 year (if implant is in place and infection appears to be related to operative procedure AND

2. Infection involves any part of the body, excluding the skin incision, fascia or muscle layers, that is opened or manipulated during the operative procedure AND

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SSI DefinitionsOrgan/Space: 3 criteria (cont.)

3. Patient has at least one of the followinga) Purulent drainage from a drain that is placed through

a stab wound into the organ/space

b) Organisms are isolated from an aseptically obtained culture of the fluid of tissue in the organ/space

c) An abscess or other evidence of infection involving the organ space is found by direct examination, during reoperation, or by histopathologic or radiologic examination

d) Diagnosis of an organ/space SSI by surgeon or attending

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• SSIs will be reported by the following

SSI Reporting for CSTS

Numerators DenominatorsCBGB: Coronary artery bypass graft with donor incision(s)

1 # of patients with Superficial Incisional Primary (SIP) infections

1 # of patients >age 18 having CABG with donor incision(s)

2 # of patients with Superficial Incisional Secondary (SIS) infections

3 # of patients with Deep Incisional Primary (DIP) infections

4 # of patient with Deep Incisional Secondary (DIS) infections

5 # of patients with Organ/Space infections

CBGC: Coronary artery bypass graft, chest incision only

6 # of patients with Superficial Incisional Primary (SIP) infections

2 # of patients >age 18 having CABG, chest incision only

7 # of patients with Deep Incisional Primary (DIP) infections

8 # of patients with Organ/Space infections

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