Mandatory Surgical Site Infection Reporting in New Hampshire Ambulatory Surgery Centers

BACKGROUND:  Surgical site infections (SSIs) cause an estimated 244,385 infections annually in the United States. Increasing awareness and public concern in recent years have resulted in numerous states and the federal Centers for Medicare and Medicaid Services to require reporting of SSIs. Due to a relative healthy patient population, outpatient setting, and limited resources, ambulatory surgery centers (ASC) are often excluded from federal and state mandates for reporting SSIs. In New Hampshire (NH), ASCs are required to report SSIs, antibiotic timing using National Quality Forum (NQF) endorsed measures, and healthcare personnel (HCP) influenza vaccination rates.

METHODS:  Beginning July 1, 2011, ASCs reported SSIs following hernia (HER), open reduction of fracture (FX), and breast (BRST) procedures using the National Healthcare Safety Network (NHSN). Due to small numbers of procedures performed, not all ASC data can be reported publicly to avoid inaccurate interpretation of sparse data. Standardized infections ratios (SIRs) and corresponding 95% confidence intervals (CI) were calculated in NHSN for each procedure type. SSI data reported in 2012 were internally validated using NHSN data quality capabilities.

RESULTS:  Among 28 ASCs in NH, 12 (43%) ASCs performed procedures selected for mandatory reporting and were required to enroll in NHSN. All facilities struggled with NHSN enrollment and reporting due to their relative small size, administrative support, staffing, and resources compared to hospitals. Healthcare-associated infection program staff provided trainings and visited facilities for additional technical support. In 2012, 1,460 procedures were entered in NHSN (920 BRST, 366 HER, and 174 FX procedures) and four BRST cases met criteria for SSI (1 deep and 3 superficial infections). Data for SSIs were not robust enough to present facility specific data. Overall, the statewide SIR was 0.00 (CI: 0.0, 2.5) and a similar number of SSIs were observed as expected based on national data. 

CONCLUSIONS:  NH ASCs have participated in mandatory SSI reporting since 2011, the data from which will be included in a public report planned for August 2013. ASCs have fewer resources available for SSI reporting, which requires development of creative alternative methods and additional technical support for NHSN. ASC data reported in NHSN has limitations due to inconsistent surveillance methods and lack of experience with NHSN definitions; emphasizing the need for investment in availability of more automated data reporting systems, an ASC NHSN module, and data validation tools specific to outpatient settings.