• Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2008. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2007 Dec. 776 p.

Does not apply to this measure

This measure is used to assess the percentage of superficial incisional surgical site infections (SSIs) in femoro-popliteal bypass procedures performed, during the 6 month time period.

The rate of SSIs is expressed per 100 procedures.

The National Strategy to Address Health Care Associated Infections, July 2003 suggests that between 2% to 13% of patients suffer from surgical site infections (SSIs). The attributable and human costs of SSI are therefore significant.

The risk of acquiring a SSI is dependent on a number of factors - some extrinsic e.g., the surgical procedure itself, and some intrinsic factors, such as the severity of an underlying illness. Surgical patients who contributed to a clinical indicator should be of similar risk for infection so that the rate of infection reflects the level of patient safety in like-type patient groups and infections are not contributed by a small number of patients with very different risk. The resultant recording of the clinical indicator rates for SSIs will be surgical procedure specific and should include revision procedures (e.g., revision of hip prosthesis).

Health care organisations that perform, routinely, at least 100 surgical procedures of the same type per year, may evaluate patient safety by reporting on the frequency of infection and related issues. A higher volume of procedures will produce a more statistically reliable rate. Timely investigation of higher than expected rates of infection may identify issues relating to preventative factors for documentation and corrective action. For example, errors may have occurred in administration of the correct type, dose route and timing of antimicrobial prophylaxis in surgical patients.

Femoro-popliteal bypass procedure; superficial incisional surgical site infection (SSI)

Total number of femoro-popliteal bypass procedures* performed, during the 6 month time period

*Refer to the original measure documentation for International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) procedure codes for femoro-popliteal bypass.

Total number of superficial incisional surgical site infections (SSIs) in femoro-popliteal bypass procedures performed, during the 6 month time period (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A formal consensus procedure involving experts in relevant clinical, methodological, and organizational sciences

Use of this measure to improve performance

• Australian Council on Healthcare Standards (ACHS). Australian clinical indicator report 1998-2006. Determining the potential to improve quality of care: 8th edition. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2007. 564 p.

Current routine use

Internal quality improvement

Hospitals

Physicians

Single Health Care Delivery Organizations

Unspecified

Either male or female

Unspecified

See the "Rationale" field.

Unspecified

Unspecified

Unspecified

Unspecified

Getting Better

Effectiveness
Safety

Users of care only

Femoro-popliteal bypass procedures performed, during the 6 month time period

Patients associated with provider

Inclusions
Total number of femoro-popliteal bypass procedures* performed, during the 6 month time period

*Refer to the original measure documentation for International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) procedure codes for femoro-popliteal bypass.

Exclusions
Unspecified

All cases in the denominator are equally eligible to appear in the numerator

Institutionalization
Therapeutic Intervention

Time window brackets index event

Inclusions
Total number of superficial incisional surgical site infections (SSIs)* in femoro-popliteal bypass procedures performed, during the 6 month time period

*Refer to the original measure documentation for additional information on SSI and for International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) procedure codes.

Note: Diagnoses of surgical wound infection that are made following readmission of a patient within 30 days of surgery are considered to be 'in-hospital' diagnoses for the purpose of this indicator and should be included in the numerator.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Medical record

Not Individual Case

Adverse Outcome

Unspecified

Rate

Better quality is associated with a lower score

Risk adjustment devised specifically for this measure/condition

There are many extrinsic and intrinsic risk factors that increase the likelihood of a surgical patient acquiring an infection, with some contributing only in presence of others. Risk factors that have been identified as being important contributors to infection include the duration of the surgical procedure, the American Society for Anaesthesiology (ASA) score and degree of contamination of the surgical site. Large data bases may be able to have the risk factors statistically adjusted so that the resulting rates reflect a patient population with similar risk for infection or calculate several rates for different levels of risk. Most healthcare facilities do not perform the same type of surgical procedure frequently enough to examine their rates of infection for several categories of risks. However, it is recommended that healthcare facilities collect the presence or absence of several risk factors for each of the surgical patients contributing to the denominator of their clinical indicator.

The frequency of these risk factors will then be used to describe the level of risk for the majority of surgical patients in each surveillance period. This documentation will determine whether risk of infection has changed. Recommended risk factors include the ASA score, the duration of procedure, emergency / unplanned and prophylaxis.

External comparison at a point in time
External comparison of time trends
Internal time comparison

Unspecified

Indicator area 1: infection surveillance CI 1.11.

Australian Council on Healthcare Standards

Funding is direct Australian Council on Healthcare Standards (ACHS) funding sourced through our membership. ACHS does not receive external funding from the government or other sources.

Our terms of reference dictate the composition of the working parties that develop our indicators and include the following:

• Two Clinicians -- nominated by the relevant specialty college/association/society, one nominated to be the chair of the working party
• Private Hospital Representative -- nominated by the Australian Private Hospital Association
• Consumer Representative -- nominated by the Consumer Health Forum of Australia
• Coding Representative -- nominated by the National Centre for Clinical classification on Health
• Quality Health New Zealand, nominated by QHNZ (if applicable)
• Epidemiological/Clinical Research Representative, Director of Health Services Research Group, University of Newcastle
• Australian Council on Healthcare Standards (ACHS) Representatives -- Clinical Director, Coordinator, Administrative Assistant
• Other Expert Stakeholders, as required

None

These indicators have been replicated with permission, from the New South Wales (NSW) Health Department Infection Control Program Quality Monitoring Indicators Version 2.

The Australian Council on Healthcare Standards (ACHS) Infection Control Indicators were developed in accordance with the standard set of definitions published by the Australian Council for Safety and Quality in Health Care's, Health Care Associated Infections Advisory Committee (HCAIAC) and Surveillance Working Party. The definitions were originally developed by the National Advisory Board of the Australian Infection Control Association based on the National Nosocomial Infections Surveillance Systems, the Nosocomial Infection National Surveillance System and from the Public Health Laboratory Service of the UK (PHLS).

2002 Jan

2007 Dec

This is the current release of the measure.

• Australian Council on Healthcare Standards (ACHS). ACHS clinical indicator users' manual 2008. ULTIMO NSW: Australian Council on Healthcare Standards (ACHS); 2007 Dec. 776 p.

This NQMC summary was completed by ECRI Institute on September 19, 2008.

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from The Australian Council on Healthcare Standards (ACHS).