Western Node Collaborative SURREY MEMORIAL HOSPITAL FRASER HEALTH AUTHORITY Surgical Site Infection Learning Session 3 October 2-3 2006 Penticton

Collaborative Team Members Linda Jennings – OR Nurse Karen Dinwoodie – OR Manager Felicia Laing – Infection Control Practitioner Kathy Ferguson – OR Educator (Peace Arch Hospital) Jane Mann,– Quality Improvement/Patient Safety Consultant Surrey Lori Hughes – Quality Improvement Patient Safety Consultant FHA Lorraine Gillespie – Executive Sponsor

Background Surrey Memorial Hospital – Surrey BC Fraser Health pilot site for SSI bundle 394 acute care beds 10 operating theatres 84 surgical beds Safer Healthcare Now! SSI Team Clinical services planning & delivery team Orthopedic and General surgeons Anaesthetists Infection Control Pharmacy Quality Improvement & Patient Safety

AIM Reduce surgical site infection rates by 50% in Hip & Knee Arthroplasty and Colorectal patients through: (1) optimal use of prophylactic antibiotics (2) appropriate hair removal (3) maintaining normothermia

Scope & Boundaries To spread improvements from hip & knees to other surgical populations in Surrey Memorial Hospital. Spread learnings from Surrey Memorial to 9 other surgical programs within FHA.

Hair Removal Successes March 2006 - clippers were not used for hair removal in the OR Successes Replaced razors with sufficient number of clippers Don’t forget to charge them…!! Clippers now routinely used in hip and knee arthroplasty when hair removal is required.

Hair Removal Challenges Pre-op teaching – Do not shave the operative site for 7 days prior to surgery. 90% of hip Arthroplasty and 79% of knee Arthroplasty patients had no hair removal. Challenges Surgeon personal preference to use razor when hair removal is required.

Prophylactic antibiotic administration Baseline 34% of hip & knee arthroplasty patients received prophylactic antibiotic administration on time. Successes “Hang and Hold” – Patient arrives in the OR with antibiotic ready for infusion. OR record - includes space to document the time the antibiotic is started.

Prophylactic antibiotic administration Challenges Pre-operative prophylactic antibiotic not always ordered. Who should consistently start the infusion?? 66.7% of the cases requiring Vancomycin did not meet the recommended timing for pre-op antibiotic administration.

Antibiotic discontinuation 24 hour discontinuation post-op has not occurred. Care Path for hip and knee Arthroplasty - discontinuation 48 hours post-op. Revisions to the Care Path to reflect best practice are in progress.

Normothermia Goal - maintain 36-38°C Audit - 30 colorectal surgical patients. 86% - temperature 36.0 or greater immediately post-op. Fluid and/or hot air warmer used in 25/30 procedures.

Proportion of Total Hip & Knee Arthroplasty Patients with Appropriate Hair Removal at SMH

Proportion of Total Hip & Knee Arthroplasty Patients Receiving Antimicrobial Prophylaxis on Time at SMH

Keys to Success and Lessons Learned Keys to success – involvement of front-line staff to senior leadership. Barriers – limited resources for data collection, analysis and reporting for all components of the SSI bundle. Lessons learned – Communication +++

Next Steps Pre-printed orders - Distribute and implement with orthopedic surgeons. Audit of all surgeries – Timing of pre-operative antibiotics. Guideline - for selection of antimicrobial prophylaxis for various surgical procedures

Spread within Surrey Clippers – first choice for hair removal in all the operating theatres. Communication – all ORs, Surgical and Maternity units regarding SSI bundle. Patient Safety Week - Highlight SSI Safer Health Care Now Activities.

Spread through Fraser Health Formulate a plan for spread to other surgical programs within Fraser Health during the SHN Western Collaborative Learning Session 3.

Contact Information jane.mann@fraserhealth.ca QI Patient Safety Consultant felicia.laing@fraserhealth.ca Infection Control Practitioner lorraine.gillespie@fraserhealth.ca Executive Sponsor