Reduction in national orthopaedic and cardiac surgical site infection rates following sustained improvement in process measures

Nikki Grae1, Arthur Morris1, Sally Roberts1

1Health Quality & Safety Commission, Wellington, New Zealand


The Health Quality & Safety Commission’s national Surgical Site Infection Improvement (SSII) programme started in 2012. The programme aims to improve the standard of care by measuring compliance with interventions known to reduce the risk of surgical site infections (SSI). The SSII programme provides coordination, communication expertise, clinical leadership, and data analysis.


Performance with process measures (surgical antimicrobial prophylaxis (SAP) and skin antisepsis) were collected on all publicly funded hip and knee arthroplasty and cardiac procedures; approximately 12,500 procedures annually. Quality and Safety Markers (QSMs) were comprised of process and outcome measures. Process measures had a threshold set for expected DHB performance. The outcome measure was the SSI rate. Data was reported on an online, public-facing dashboard quarterly.


Between July 2013 and December 2018; over 56,000 hip and knee arthroplasty procedures were performed. A significant aggregated improvement in the QSM performance for the timing, choice and dose of SAP was achieved. A significant improvement in the outcome measure was achieved; the orthopaedic mean SSI rate  decreased from 1.23% to 0.93% (p = 0.0005).

Between July 2016 and December 2018, over 6800 adult and paediatric cardiac procedures were performed. The cardiac mean SSI rate decreased from 4.69% to 3.61% (p = 0.036).


The process measures for most orthopaedic and cardiac procedures achieved the QSM targets. Both orthopaedic and cardiac SSI rates have decreased. There has been a high level of engagement with the programme by both surgical services supported by timely feedback of process and outcome measures.


Nikki Grae has been the senior advisor for the infection prevention and control programme at the Health Quality & Safety Commission since 2016. She has 10 years of infection prevention, quality, and patient safety experience in the healthcare sector. Prior to working at the Commission, she managed and led the infection prevention and patient safety programmes for a health system in the U.S. Nikki has also worked as a research scientist in cancer biology and microbiology. She has a Master of Science degree in microbiology. Nikki relocated to New Zealand to enjoy the diverse culture and spectacular scenery while continuing her career in infection prevention and control.

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