The New Crystal Ball – Can Hospitals Use Risk Prediction Tools to Get Ahead of SSI?

Here’s a topic that I “predict” will become increasingly important as hospitals evaluate, implement, and optimize surgical site infection prevention bundles:  the use of predictive tools to customize wound care practices based on a patient’s risk for infection. It is thought by using these predictive tools that surgical operating room and infection prevention teams can provide better patient outcomes and reduce the overall cost of health care.

While there is much discussion around what makes a robust predictive tool, a recent study by Weiser et al took on a bigger question: what do operating room teams actually do with the knowledge they gain from those tools?

The study looked at the efficacy of an SSI prevention bundle in patients undergoing colorectal surgery at a cancer center. The bundle included 13 components involving preoperative, intraoperative, and postoperative care.  A unique component of the bundle was using a custom risk prediction tool to provide surgeons with an estimated risk of SSI the day prior to surgery. It was hypothesized that providing the predicted SSI risk might influence the surgeons’ decisions regarding wound care and method of wound closure. In addition to a significant reduction in SSI with implementation of the overall bundle, the authors observed that wound closure modifications were used in a larger proportion of the patients compared to baseline (43.2% versus 24.9%). These interventions included: use of an overlying surface vacuum dressing (17.2% vs. 1.4% at baseline) or leaving the wound partially open (13.2% vs. 6.7% at baseline).1

While the study does not contribute causality of the reduction in SSI to any particular component of the bundle, it does show us the potential of using predictive information to optimize postoperative wound care for mitigating risk of SSI in high risk patients. Similarly, we should consider how these predictive tools can be used to modify intraoperative wound care, where the threat of wound contamination is at its highest.

These early efforts at prediction and personalized care bundles are promising as hospitals work toward zero preventable SSI rates. As newer interventions continue to be developed as part of that goal, and brought into patient care, such as CleanCision, it will be important for these prediction models to update and adjust regularly in order to account for the effects of these interventions.

References

1 Weiser MR, Gonen M, Usiak S, et al. Effectiveness of a multidisciplinary patient care bundle for reducing surgical-site infections. Br J Surg. 2018.