title: Surgical site infection prevention: time to move beyond the surgical care improvement program.
abstract: OBJECTIVE
  The objective of this study was to evaluate whether the Surgical Care Improvement Project (SCIP) improved surgical site infection (SSI) rates using national data at the patient level for both SCIP adherence and SSI occurrence.
  
  
  BACKGROUND
  The SCIP was established in 2006 with the goal of reducing surgical complications by 25% in 2010.
  
  
  METHODS
  National Veterans' Affairs (VA) data from 2005 to 2009 on adherence to 5 SCIP SSI prevention measures were linked to Veterans' Affairs Surgical Quality Improvement Program SSI outcome data. Effect of SCIP adherence and year of surgery on SSI outcome were assessed with logistic regression using generalized estimating equations, adjusting for procedure type and variables known to predict SSI. Correlation between hospital SCIP adherence and SSI rate was assessed using linear regression.
  
  
  RESULTS
  There were 60,853 surgeries at 112 VA hospitals analyzed. SCIP adherence ranged from 75% for normothermia to 99% for hair removal and all significantly improved over the study period (P < 0.001). Surgical site infection occurred after 6.2% of surgeries (1.6% for orthopedic surgeries to 11.3% for colorectal surgeries). None of the 5 SCIP measures were significantly associated with lower odds of SSI after adjusting for variables known to predict SSI and procedure type. Year was not associated with SSI (P = 0.71). Hospital SCIP performance was not correlated with hospital SSI rates (r = -0.06, P = 0.54).
  
  
  CONCLUSIONS
  Adherence to SCIP measures improved whereas risk-adjusted SSI rates remained stable. SCIP adherence was neither associated with a lower SSI rate at the patient level, nor associated with hospital SSI rates. Policies regarding continued SCIP measurement and reporting should be reassessed.
authors.affiliation: Center for Medical, Surgical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, Alabama, USA. mhawn@uab.edu
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Vick
authors.forename: Joshua
authors.initials: J
authors.lastname: Richman
authors.forename: William
authors.initials: W
authors.lastname: Holman
authors.forename: Rhiannon J
authors.initials: RJ
authors.lastname: Deierhoi
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006787:Hospitals, Veterans; D006801:Humans; D017053:Infection Control / Q000379:methods; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology