08/25/2004 - NEW YORK HOSPITALS TAKE AIM AT SURGICAL INFECTIONS; NEW NATIONAL GUIDELINES POINT THE WAY

In Breakthrough Consensus Statement, 20 National Medical Organizations Endorse Antibiotic Use Guidelines; NY Pilot Effort Will Go Statewide

Lake Success, NY, August 25, 2004 - New York hospitals are expected to take a leading role in adopting new national guidelines that address the prevention of surgery-related infections. The guidelines, which represent unprecedented consensus among 20 of the nation's largest surgical, medical and hospital associations, are the result of a year-long effort by these groups to identify best practices for preventing surgical site infections. Approximately 780,000 operations are complicated by surgical site infections each year in the United States, causing a significant amount of patient injury, mortality and often-avoidable costs.

"We believe this consensus statement will lead to greater clarity for health professionals on proper antibiotic use, and will help in our quality improvement efforts," says Charles E. Stimler, MD, MPH, Medical Officer, IPRO. "We will leverage this consensus as we continue to work with the New York Surgical Infection Prevention Collaborative and the state's hospitals to save lives and reduce unnecessary hospitalizations."

Dr. Stimler and the IPRO quality improvement team are leading the Collaborative as part of Medicare's National Surgical Infection Prevention (SIP) Project, an ongoing, three-year-old initiative co-sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Center for Disease Control and Prevention (CDC). The SIP Project's goal is to reduce the occurrence of post-operative infection by improving the selection and timing of preventative antibiotic administration. Twenty-two New York hospitals recently completed an initial year-long SIP project, and now IPRO is about to begin a larger statewide initiative to improve infection prevention in such widely performed procedures as hip replacement, hysterectomy and coronary artery bypass graft (CABG) surgery.

In its initial infection prevention project, IPRO collected self-reported discharge data for surgeries conducted between April 2003 and March 2004 at 22 hospitals in New York. The effort focused on surgical procedures among the Medicare population, including coronary artery bypass graft, colon surgery, hip and knee replacement (arthroplasty), abdominal and vaginal hysterectomy, and selected vascular procedures, such as arterial bypass. Once IPRO identified areas for improvement, the hospitals and IPRO worked cooperatively to establish and implement procedures to improve care.

To further reduce the incidence of surgical infection and foster quality improvement in a range of other clinical areas, IPRO will launch a New York State hospital collaborative beginning in August 2004. The expanded effort will incorporate aspects of the Institute for Health Care Improvement's (IHI) Breakthrough Series Collaborative, a model used in IPRO's initial infection prevention collaborative. Throughout the year, IPRO will host monthly conference calls highlighting program development models, clinical updates and intervention strategies. IPRO will provide assistance to New York hospitals to effectively use learnings from the project, and will create a Web-based information exchange tool.

New Consensus on Infection Prevention

In 2003, the National SIP Project brought together the authors of all current major American surgical infection prevention guidelines and the leadership of 20 professional organizations involved in surgical care to develop and adopt new surgical infection prevention guidelines. Among these 20 groups were the American Academy of Orthopaedic Surgeons, American College of Surgeons and Society of Thoracic Surgeons - three of the largest surgical specialty societies and academies. The result was a joint advisory statement on infection prevention entitled, "Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project." The statement, published earlier this summer in the journal Clinical Infectious Diseases, recommends that prophylactic antibiotics be used for no more than 24 hours after surgery, that the initial dose of a prophylactic antibiotic be infused within the hour before surgery, and that specific antibiotics be used in certain situations.

According to the medical literature, each surgical infection increases a patient's hospital stay by an average of seven days. Patients who develop surgical site infections are 60% more likely to spend time in the Intensive Care Unit, five times more likely to be readmitted to the hospital and twice as likely to die. In addition, surgical site infection complications add more than $1 billion annually to the nation's health-care bill.

With nearly 20 years of experience in health care quality evaluation, IPRO holds major contracts with state and federal governments to review the cost and quality of services provided to Medicaid recipients, Medicare beneficiaries, and patients enrolled in managed care organizations. Based in Lake Success, New York, IPRO also holds contracts with private-sector clients to improve the quality of privately financed services.

For information on the New York Surgical Infection Prevention Collaborative, please log on to www.ipro.org/sip. For more on the National Surgical Infection Prevention Project and the advisory statement, visit www.medqic.org/sip.