Operating Room Attire Policy and Healthcare Cost: Favoring Evidence over Action for Prevention of Surgical Site Infections
| Autor: | Adham Elmously, Anthony C. Watkins, Alfons Pomp, Fabrizio Michelassi, Michael D. Kluger, Cheguevara Afaneh, Katherine D. Gray, Arash Salemi |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Operating Rooms medicine.medical_specialty MEDLINE Clothing 03 medical and health sciences 0302 clinical medicine Health care Surgical site Hospital-acquired infection medicine Humans Surgical Wound Infection Aged business.industry Incidence (epidemiology) Perioperative Middle Aged medicine.disease Organizational Policy 030220 oncology & carcinogenesis Emergency medicine Propensity score matching Female 030211 gastroenterology & hepatology Surgery business Medicaid |
| Zdroj: | Journal of the American College of Surgeons. 228:98-106 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2018.06.010 |
| Popis: | Background The Association of Perioperative Registered Nurses (AORN) released new guidelines for operating room attire in 2015 in an attempt to reduce surgical site infections (SSIs). These guidelines have been adopted by the Centers for Medicare and Medicaid Services. We aimed to assess the relationships among operating room attire, SSIs, and healthcare costs. Study Design In March 2016, our center introduced the AORN attire policy. National Health Safety Network data from our hospital were collected on general surgery, cardiac, neurosurgery, orthopaedic, and gynecology procedures from January 2014 to November 2017. The SSI rates and microbiological culture data for 30,493 procedures before and after policy implementation were compared using propensity score matching. The associated costs of the AORN policy were analyzed. Results After 1:1 propensity score matching, 12,585 matched pairs spanning the policy change were included (25,170 patients total); before policy change (BC group) and after policy change (AC group). The rate of SSIs did not differ between groups (1.0% AC group vs 1.1% BC group; p = 0.7). There was no difference in the incidence of Staphylococcal species cultured from wounds (19.3% AC group vs 16.8% BC group; p = 0.6). Multivariable analyses demonstrated that wound classification and emergent procedures were the strongest independent predictors of SSIs. The cost of attire for 1 person entering the operating room increased from $0.07 to $0.12 before policy change to $1.11 to $1.38 after policy change. Use of the mandated operating room long-sleeved jackets alone in our institution was associated with an added cost of $1,128,078 annually, which translates to an estimated $540 million per year for all US hospitals combined. Conclusions Implementation of the AORN guidelines has not decreased SSIs and has increased healthcare costs. |
| Databáze: | OpenAIRE |
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