Sound the alarm: An SSI early warning system shows promise

Reviewed by Erica Stohs, MD, MPH, University of Nebraska

Investigators employed optimized statistical process control (SPC), a surgical site infection (SSI) surveillance system, in a multicenter, stepped wedge, cluster randomized controlled trial conducted in a network of US hospitals.  SPC is an analytic surveillance tool that prospectively reviewed facility SSI data in real-time. When the process detected signals, blinded epidemiologists reviewed SSI data to determine the need for further SSI investigation. If intervention was required, a study epidemiologist became unblinded to facilitate local facility investigation.

This study took place in a network of 29 community hospitals in southeastern US examining patients undergoing 13 types of common surgical procedures between March 2016 and February 2020. These hospitals and procedures were divided into clusters randomized to 12 groups that sequentially moved from control (or traditional surveillance) to intervention (or SPC) over the study period. The primary outcome was overall SSI prevalence rate (SSIs/100 procedures). Secondary outcomes were SSI outbreaks and investigations. 

Ultimately, the SSI prevalence rate did not improve, but the SPC intervention group did identify significantly more SSI investigations conducted and deficiencies identified. Among the reasons for lack of SSI rate difference with the intervention included an already low baseline SSI rate of <1% across the study hospital network. 


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