1. Western Node Collaborative
SURREY MEMORIAL HOSPITAL
FRASER HEALTH AUTHORITY
Surgical Site Infection
Learning Session 3
October
Penticton

2. 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

3. 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

4. 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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

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

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

14. 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 +++

15. 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

16. 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.

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

18. Contact Information
QI Patient Safety Consultant
Infection Control Practitioner
Executive Sponsor