3Mission StatementTo reduce surgical site infections for gastrointestinal and hernia operations in Department of Surgery by 50% over the period of 6 months.
4Rationale For Preventing SSI 2nd most common type of adverse events occurring in hospitalized patientsincrease :- mortality- readmission rate- length of stay- cost for patients40 to 60 % of clean and clean-contaminated wound infections are preventable
5DEFINITION OF SURGICAL SITE INFECTION TYPEDEFINITION OF SURGICAL SITE INFECTIONSuperficialIncisional SSIInfection occurs within 30 days after the operationandInfection involves only skin or subcutaneous tissue of incisionand at least one of the following:Purulent drainage, with or without laboratory confirmation, from the superficial incision.Organisms isolated from an aseptically obtained culture or fluid or tissue from the superficial incision.At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat and superficial incision is deliberately opened by surgeon, unless incision is culture-negative.Diagnosis of superficial incisional SSI by the surgeon or attending physicianDeepInfection occurs within 30 days after the operation if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operationInfection involves deep soft tissues (e.g. fascial and muscle layers) of the incisionPurulent drainage from the deep incision but not from the organ / space component of the surgical site.A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following signs or symptoms: fever (>38oC), localized pain, or tenderness unless site is culture-negative.An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiologic examination.Diagnosis of a deep incisional SSI by a surgeon or attending physician.Organ/ Space SSIInfection involves any part of the anatomy (e.g. organs or spaces), other than the incision, which was opened or manipulated during an operationPurulent drainage from a drain that is placed through a stab wound into the organ / space.Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ / space.An abscess or other evidence of infection involving the organ / space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination.Diagnosis of an organ / space SSI by a surgeon or attending physician.
8Bundle of Interventions Preoperative Hair Removal• Remove all razors• Work with the purchasing department• Use reminders (signs, posters)• Educate patients not to self-shavePost Operative Glucose Maintainence• Implement a glucose control protocol• Regular blood glucose levels check• Assign responsibility and accountabilityAppropriate Prophylactic Antibiotics• Change drug stocks to only standard drugs and dosage• Reassign dosing responsibilities• Involve pharmacy and infection control staffPost Operative Normothermia• Use warmed forced-air blankets and IV fluids• Increase the ambient temperature in the operating room• Use warming blankets under patients on the operating table• Use hats and booties on patients perioperatively
9Flow Chart of ProcessPatient selected – labeled “SSI Protocol” in OT Reservation SystemSurgical Site Infection Proforma Form - attached (pink)OT Attendants – Hair RemovalAnesthetists – AntibioticsPACU – Glucose & Temperature MonitoringICU/ HIGH D/ GENERAL WARD – Glucose MonitoringDay Surgery Ward– Glucose MonitoringSurgical Site Infection Proforma Form - CollectedHOMEPatient selected – labeled “SSI Protocol” in OT Reservation SystemSurgical Site Infection Proforma Form - attached (pink)OT Attendants – Hair RemovalAnesthetists – AntibioticsPACU – Glucose & Temperature MonitoringICU/ HIGH D/ GENERAL WARD – Glucose MonitoringDay Surgery Ward– Glucose MonitoringSurgical Site Infection Proforma Form - CollectedHOME
10Run ChartDiscussion beganStart of CPIPAverageTarget20052006
11Outcomes Clinical Cost Clean Clean-contaminated 0.35% 1.90% 0.00% Pre-implementation0.35%1.90%Post-implementation0.00%0.40%Percentage Improvement100.00%78.95%OVERALL = 82% (> target of 50%)CostWARDSUBSIDY PROVIDEDCOST SAVEDPrivateA0%$0.00B115%$335.90SubsidizedB235-40%$373.40C80%$603.40* Based on 10 days of hospitalization with surgical site infection
12Lessons LearnedStandardization of workflow enhances the delivery of quality care and patient safetyEach individual’s contribution has significant impact on patient safety.Quality initiatives are often welcomed when the outcome has significant impact on our patient safety.Patient safety is not no accident & not by accident.