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Institution of the Steiros Algorithm® Outpatient Surgical Protocol Reduced Orthopedic Surgical Site Infections (SSI) Rates

Paper presented at Nebraska Orthopedic Society Annual Meeting, Lincoln, NE, April 2011

By Paul Watson MDa, Luke Watson MDb and Alfonso Torress-Cook Dr PHb

a-Lakeside Orthopedics, Omaha, Nebraska; b- Pacific Hospital of Long Beach, Long Beach, California ,B.

Abstract

Control of surgical site infections (SSI) is imperative for the safety of our patients. As orthopedic surgeons we strive to have the lowest infection rate possible for all our surgical procedures. This study evaluates the effects of a simple outpatient peri-operative patient cleaning protocol (The Steiros Algorithm® Outpatient Surgery Protocol) on SSI rates. We retrospectively reviewed the hospital’s infection rate database for all procedures from July 2005 until February 2011 performed by one orthopedic surgeon (PAW) within one hospital system. The Steiros Algorithm® Outpatient Surgery Protocol was instituted on January 1st, 2009. We calculated and compared the deep and superficial SSI rate for orthopedic surgeries performed before and after the Outpatient Protocol was instituted. Lowest previously published estimated costs for SSI were used for a cost analysis ($17,708). The July 1st, 2005 through December 31st, 2008 SSI rate was 1.0% (13/1292). From January 1st, 2009 through February 28th, 2011 the SSI rate was zero (0/875). The SSI rates decreased 100%. Due to the reduction in SSI, the hospital saved a minimum of $154,059 over a 2 year period. In this retrospective review, the Steiros Protocol dramatically reduced the overall SSI rate to zero and saved money.

Shea Papers 2010

Paper #2706

The Cost Effectiveness of The Steiros Algorithm® in a Long Term Acute Care Hospital (Mesquite Specialty Hospital, Ernest Healthcare)

Submitted for presentation at SHEA Decennial International Conference on Healthcare-Associated Infections (March 18-22 2010)

Chinhnam Hathuc, MS41, Luke Robert Watson, MD2, Paul Andrew Watson, MD, MS3 and Alfonso Torress-Cook, DrPH2, (1)Touro University, Mare Island, CA, Vallejo, CA, (2)Pacific Hospital of Long Beach, Long Beach, CA, (3)Lakeside Orthopedics, Omaha, NE

 

Abstract Text

Background: Hospital acquired infections (HAIs) are a problem for patient safety and a significant financial burden for all health care facilities. Previous CDC guidelines for preventing HAIs are minimally effective in reducing infections or costs. On October 1st, 2008 the Department of Health and Human Services stopped paying for catheter-associated urinary tract infections, vascular catheter-associated infections, and mediastinitis after coronary artery bypass graft surgery. In this regard both patients’ and hospitals’ best interest involve finding ways to reduce HAIs.

Objective: Our prospective study evaluates the effectiveness of a novel global hospital environmental cleaning algorithm, the Steiros Algorithm ®, on reducing HAI’s and their associated costs in a long term acute care hospital (Mesquite Specialty Hospital, Ernest Healthcare).

Methods: We compared the number of urinary tract infections (UTIs), ventilator associated pneumonias (VAP), central line infections (C-Line), multi-drug resistant organism infections (MDRO) and isolation rates for three months prior to and twelve months after initiating the Steiros Algorithm TM. Using a cost-cost analysis, the real hospital estimated material costs (RHEC) as determined by the chief financial officer of Mesquite Specialty Hospital and costs estimated by the Centers for Disease Control (CDC) for these HAIs, were compared to each other pre- and post use of the Steiros Algorithm®.

Results: The Steiros Algorithm® dramatically reduced the number of HAIs in the acute care hospital setting. During the three months prior to starting the Steiros Algorithm TM there were five VAPs, ten UTIs, three C-line, eight MRDO infections and 1170 isolation days. In the twelve months after instituting the Steiros Algorithm ®, there were zero VAPs, ten UTIs, five C-line, three MDRO infections and 540 isolation days. Under the parameters of the study, cost savings per month based on the CDC estimates was $122,185, and cost savings per month based on the RHEC was approximately $47,500.

Conclusions: The Steiros Algorithm® dramatically reduced the number of HAIs and costs in the Long Term Acute care hospital setting. The reduced number of HAIs translated into CDC estimated saving of $4000 per bed per month and a RHEC of $1500 per bed per month. We believe the Steiros Algorithm TM should be considered for all hospitals interested in reducing HAI and costs associated with these infections.

Paper #1679

The Steiros Algorithm® Reduced Orthopedic Surgical Site Infection Rates and Associated Costs

Paul Andrew Watson, MD, MS1, Luke Robert Watson MD2 and Alfonso torress-Cook, DPH2, (1)Lakeside Orthopedics, Omaha, NE, (2)Pacific Hospital of Long Beach, Long Beach, CA
Submitted for presentation at SHEA Decennial International Conference on Healthcare-Associated Infections (March 18-22 2010)

Abstract Text

Background: Control of hospital acquired surgical site infections (SSI) and their costs are imperative for the safety of our patients. As infection control practitioners we strive to have the lowest infection rate possible for all surgical procedures. An easily instituted whole hospital infection control algorithm would greatly enhance patient care and lower hospital costs. Objective: This study evaluates the effects of a novel environmental cleaning and decontamination algorithm (Steiros Algorithm®) on spinal fusion (SF), total hip (THA) and total knee arthroplasty (TKA) SSI rates.

Methods: The hospital’s procedure and infection rate database was reviewed for all total hip arthroplasty (THA), total knee arthroplasty (TKA) and spinal fusion (SF) procedures from 2005-2008 at one institution. A standardized SSI surveillance program was used throughout the study period. We calculated and compared the SSI rate performed before and after the Steiros Algorithm® was instituted on January 1st 2006. The overall infection and methicillin resistant Staphylococcus Aureus (MRSA) rates were reviewed for each type of procedure. Previously published estimated costs for these SSI were used for analysis (TKA and SF infections cost $27,000 and $12,447 respectively).

Results: Overall, the SSI rates decreased 58% (23/750 to 35/2752)(P=0.0017) and the MRSA rate decreased 82% (9/750 to 6/2752)(P=0.0024). There were no THA infections during the study period. The TKA overall infection rate decreased 68% (11/331 to10/935)(P=0.01) and the MRSA rate decreased 82% (4/331 to 2/935)(P= 0.044). The SF infection rate and MRSA rate decreased 66% (12/290 to 25/1749) (P=0.0036) and 83% (5/290 to 9/1749)(P=0.038) respectively. Due to the reduction in SSIs, the hospital saved $907,971 over a 3 year period.

Conclusions: We believe that the Steiros Algorithm®, a global environmental cleaning protocol for hospitals, is a very safe and effective way to reduce orthopedic SSI and hospital costs by eliminating bacteria from the hospital and patient environment. In this retrospective review, the institution of the Steiros Infection Control Algorithm dramatically reduced the overall and MRSA specific orthopedic SSI rates.

Paper #2099

Institution Of The Steiros Algorithm® Dramatically Reduces Hospital Acquired Methicillin-resistant Staphylococcus Aureus Rates

Paul Andrew Watson, MD, MS1, Luke Robert Watson, MD2 and Alfonso Torress-Cook, DPH2, (1)Lakeside Orthopedics, Omaha, NE, (2)Pacific Hospital of Long Beach, Long Beach, CA
Submitted for presentation at SHEA Decennial International Conference on Healthcare-Associated Infections (March 18-22 2010)

Abstract Text

Background: Control of hospital acquired methicillin-resistant staphylococcus aureus (MRSA) infections are imperative for the safety of our patients. As infection control practitioners we strive to have the lowest hospital acquired infection (HAI) rate possible for all drug resistant organisms. An easily instituted whole hospital infection control algorithm which simultaneously controls all HAIs would greatly enhance patient care and lower hospital costs.

Objective: This study evaluates the effects of a novel global environmental cleaning algorithm (Steiros Algorithm®) on hospital acquired MRSA rates.

Methods: The hospital’s procedure and infection rate database was reviewed for all hospital acquired MRSA cases from October 1st, 2005 through September 30th, 2009 at one acute care teaching hospital. A standardized MRSA surveillance program was used throughout the study period. We calculated and compared the MRSA rate per 1000 discharges before and after the Steiros Algorithm® was instituted on January 1st, 2006. The Center for Disease Control (CDC) MRSA rates were reviewed for comparison. Previously published costs associated with hospital acquired MRSA infections of $6,916 dollars per infection were used for the cost estimates. Results: The MRSA rates went from 1.97 per 1000 discharges (22/11174) before to 0.11 per 1000 discharges (19/170,072) after institution of the Steiros Algorithm® for a statistically significant drop of 94% (P<0.0001) In comparison to the expected CDC reported MRSA rate of 4.8 per 1000 discharges, the Steiros Algorithm® reduced hospital acquired MRSA infections by over 97%. Due to the reduction in MRSA infections, the hospital saved $2,282,280 over a 3 3/4 year period.

Conclusions: We believe that the Steiros Algorithm®, a global environmental cleaning protocol for hospitals, is a very safe and effective way to reduce hospital acquired MRSA infections and hospital costs by eliminating bacteria from the hospital and patient environment. In this retrospective review, the institution of the Steiros Infection Control Algorithm dramatically reduced the hospital acquired MRSA rates and their associated costs.