eP141 - Surgical Site Infection and Wound Classification Documentation – Areas of Improvement at a Tertiary Care Center

Purpose/Background: Surgical site infections (SSI) account for 20% of all healthcare associated infections (HAIs). They have been shown to increase mortality rates, extend length of stay (LOS), and increase costs an average of $20,000 per admission. Surgical wound class (SWC) is one method to determine the risk of SSIs, however wound class is often documented incorrectly. Some studies have shown wounds are misclassified as often as 85-92% of the time, though the range is very broad: 9-92%. Documentation of surgical wounds and level of contamination present at the time of surgery is important for reimbursement of hospital stays in the setting of HAIs. At the time of the study, our center had a 19% year-to-date misclassification rate of colon cases and a higher than state average rate of colon case-related SSIs. The aim of the study was to evaluate providers knowledge of SWC and SSI documentation at baseline, provide a targeted education, and evaluate the effectiveness of the education.Methods/Interventions: A single-group pretest-posttest design to measure SWC and SSI knowledge at baseline and then after a 45-minute lecture at the Department of Surgery Grand Rounds. A Qualtrics survey consisting of 25 multiple-choice questions was distributed to the department of surgery attendings, residents, and medical students as the pretest-posttest. All incompletely finished quizzes were excluded. Subsequently, all colon cases 60 days prior to the grand rounds and 60 days post-grand rounds were evaluated for wound classification errors, comparing intraoperative classification to operative reports.Results/Outcomes: Of the 50 individuals who finished the pretest, the mean score was 53.2% (95% CI 48.4-57.9) compared to the 29 individuals who finished the post-test with a mean of 73.1% (95% CI 67.6-78.5)(p < 0.001). There was no significant difference in intraoperative wound misclassification in the 60 days prior to and 60 days post-education (p=0.366).Conclusion/

Discussion: The grand rounds education statistically significantly improved the accuracy of wound class identification and level of contamination documentation present at the time of surgery on post-test. The greatest score improvement was seen in medical students and residents (22-percentage point increase in both groups). This single educational opportunity did not translate into improved intraoperative wound classification. Future directions include an end-of-case time out procedure and a mandatory annual education module for operating room nurses, residents, fellows, and attendings.Figure 1: Boxplot of Total Percent Correct Pre and Post-Education, All Users