Post Procedural Infections: Clinical and Systems Reviews, Incident Analyses

Given the broad range of potential causes of hospital associated Post Procedural Infections, clinical and system reviews should be conducted to identify latent causes and determine appropriate recommendations.

Occurrences of harm are often complex with many contributing factors. Organizations need to:

• Measure and monitor the types and frequency of these occurrences.
• Use appropriate analytical methods to understand the contributing factors.
  Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
• Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the Hospital Harm Improvement Resources Introduction.

If your review reveals that your cases of Post Procedural Infections are linked to specific processes or procedures, you may find these resources helpful:

• American Journal of Health-System Pharmacy https://academic.oup.com/ajhp
• Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. doi:10.2146/ajhp120568 http://www.ajhp.org/content/70/3/195.long
• AORN - Association of Perioperative Registered Nurses www.aorn.org
• Association of periOperative Registered Nurses. Guidelines for Perioperative Practice. Published n.d. https://www.aorn.org/guidelines/about-aorn-guidelines
• Association for Professionals in Infection Control and EpidemiologY (APIC) apic.org
• Association for Professionals in Infection Control and Epidemiology. APIC Implementation Guide: Guide to Preventing Central Line-Associated Bloodstream Infections. APIC; 2015. https://apic.org/Resource_/TinyMceFileManager/2015/APIC_CLABSI_WEB.pdf
• Association for Professionals in Infection Control and Epidemiology. Guide to the Elimination of Infections in Hemodialysis. APIC; 2010. https://apic.org/wp-content/uploads/2019/02/APIC-Hemodialysis.pdf
• Association for Professionals in Infection Control and Epidemiology. Guide to the Elimination of Orthopedic Surgical Site Infections. APIC; 2010. https://apic.org/wp-content/uploads/2019/10/APIC-Ortho-Guide.pdf
• Association for Professionals in Infection Control and Epidemiology. Guide for the Prevention of Mediastinitis Surgical Site Infections Following Cardiac Surgery. APIC; 2008. https://apic.org/wp-content/uploads/2019/02/APIC-Mediastinitis-Elimination-Guide.pdf
• Canadian Journal of Infectious Diseases and Medical Microbiology https://www.hindawi.com/journals/cjidmm
• Chow AW, Evans GA, Nathens AB, et al. Canadian practice guidelines for surgical intra-abdominal infections. Can J Infect Dis Med Microbiol J Can Mal Infect Microbiol Medicale. 2010;21(1):11-37. doi:10.1155/2010/580340 Canadian Practice Guidelines for Surgical Intra-Abdominal Infections (hindawi.com)
• Canadian Nosocomial Infection Surveillance Program (CNISP) https://www.canada.ca/en/public-health/services/surveillance.html#a6
• Canadian Patient Safety Institute. CNISP Protocols. The Canadian Nosocomial Infection Surveillance Program (CNISP) Publications. https://www.healthcareexcellence.ca/en/resources/healthcare-associated-infection-surveillance/the-canadian-nosocomial-infection-surveillance-program-cnisp-publications/  
• Centers for Disease Control and Prevention https://www.cdc.gov/
• Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725
• Centers for Disease Control and Prevention (CDC). Central Line-associated Bloodstream Infection (CLABSI). Healthcare-associated Infections. Published April 19, 2019. https://www.cdc.gov/hai/bsi/bsi.html
• CIRCULATION https://www.ahajournals.org/journal/circ
• Nishimura Rick A., Carabello Blase A., Faxon David P., et al. ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis. Circulation. 2008;118(8):887-896. doi:10.1161/CIRCULATIONAHA.108.190377 http://circ.ahajournals.org/content/118/8/887.full.pdf
• Warnes Carole A., Williams Roberta G., Bashore Thomas M., et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease. Circulation. 2008;118(23):e714-e833. doi:10.1161/CIRCULATIONAHA.108.190690 http://circ.ahajournals.org/content/118/23/e714.full.pdf
• European Heart Journal https://www.escardio.org/Journals/ESC-Journal-Family/European-Heart-Journal
• Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2009;30(19):2369-2413. doi:10.1093/eurheartj/ehp285 http://eurheartj.oxfordjournals.org/content/30/19/2369.long
• Health and Human Services https://www.hhs.gov/
• Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. National HAI Action Plan. health.gov. Published July 24, 2020. https://health.gov/our-work/health-care-quality/health-care-associated-infections/national-hai-action-plan
• Institute for Healthcare Improvement (IHI) www.ihi.org
• Institute for Healthcare Improvement. How-to Guide: Prevent Surgical Site Infections. IHI; 2012. http://www.ihi.org/resources/pages/tools/howtoguidepreventsurgicalsiteinfection.aspx
• IHI. How-to Guide: Prevent Surgical Site Infection for Hip and Knee Arthroplasty. IHI; 2012. http://www.ihi.org/resources/pages/tools/howtoguidepreventssiforhipkneearthroplasty.aspx
• Journal of the American College of Surgeons https://www.journalacs.org/
• Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017;224(1):59-74. doi:10.1016/j.jamcollsurg.2016.10.029 a rel="noopener" href="https://www.journalacs.org/article/S1072-7515(16)31563-0/fulltext" target="_blank">https://www.journalacs.org/article/S1072-7515(16)31563-0/fulltext
• National Institute for Health and Care Excellence (NICE) www.nice.org.uk
• National Institute for Health and Care Excellence (NICE). NICE Surgical Site Infections: Prevention and Treatment. NICE; 2019. https://www.nice.org.uk/guidance/ng125
• National Institute for Health and Care Excellence (NICE). Prophylaxis against Infective Endocarditis: Antimicrobial Prophylaxis against Infective Endocarditis in Adults and Children Undergoing Interventional Procedures. NICE; 2008. https://www.nice.org.uk/guidance/cg64
• The Society for Healthcare Epidemiology of America (SHEA) https://www.shea-online.org/
• Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi:10.1086/676022 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267723/
• Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753-771. doi:10.1086/676533
• University of Toronto – Best Practice in Surgery http://bestpracticeinsurgery.ca/
• Bonnar P, Dhar P, Rotstein O, et al. Surgical Site Infection Prevention. University of Toronto; 2017. http://bestpracticeinsurgery.ca/wp-content/uploads/2017/11/SSI-BPS-CPG-Nov20.pdf
• World Health Organization www.who.int
• World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. World Health Organization; 2018. https://www.ncbi.nlm.nih.gov/books/NBK536404/pdf/Bookshelf_NBK536404.pdf