1. Surgical Site Infections: The Impact of Culture, Teamwork, and Communication

2. Our Last Call Together Purpose of This Portion of the Call Series History of Infection Prevention Techniques Prophylactic Antibiotic Administration Weight-Based Dosing Re-Dosing Discontinuing Antibiotics

3. Todays Topics Three problems that sit at the core of surgical site infections The South Carolina Surgical Safety Checklist as a Drug

4. Three Problems Doing reliably what we know needs to be done Always being vigilant about keeping the patient safe Teamwork and Communication Teamwork and Communication

5. The Checklist As A Drug: Doing Reliably What We Know Needs To Be Done

6. Make sure that appropriate warming precautions are taken when necessary  Risk of hypothermia – operation > 1h ­Warmer in place

7. Anesthesia professional discusses if antibiotics are completely infused If needed, plan for re-dosing is discussed  Has antibiotic prophylaxis been given within the last 60 minutes? ­Plan for re-dosing discussed Practical Tip For Re-Dosing: Use a timer to help remind the team to re-dose antibiotics Practical Tip For Re-Dosing: Use a timer to help remind the team to re-dose antibiotics

8. Confirmation that all of the instruments are sterile  Sterility, including indicator results

9. The Checklist As A Drug: Teamwork and Communication

10. Communication and Teamwork Better Communication and Pre-Operative Briefings Can Reduce OR Traffic

11. The Checklist As A Drug: Vigilance

12. Surgical Conscience When individuals... –promote patient safety all of the time –hold themselves accountable for making sure the patient is safe and don’t hesitate to admit when the patient may be at risk –do not take shortcuts when it may put the patient at risk

13. Surgical Conscience in Everyday Life in the OR Scrubbing Gowning Gloving Instrument Sterility

14. Defending the Sterile Field

15. The Majority of Us Go Into the OR With the Intention of Doing What is Best For Our Patients The reality of the OR: –Pressure to move quickly –Individuals have to feel comfortable and safe to voice concerns

16. Realities of Speaking Up “I’m afraid” “I’m embarrassed” “I’m stupid” “They might yell at me” “I might be wrong” “The surgeon is mean” “They won’t listen anyway” “It is not that important”

17.  Please state your name and role Activates team members If someone says something at the beginning of the case they are more likely to speak up if they see something that may not be right

18. Sets the tone that anybody can say something during the case if they see something Invites people to speak up Surgeon says: “Does anybody have any concerns? If you see something that concerns you during this case, please speak up.”

19. Take Home Messages Preventing SSI’s is technical and cultural A well used checklist can help: –us reliably do what we know needs to be done for every patient –improve teamwork and communication, which sit at the core of surgical site infections and complications –us create a culture where everyone feels empowered to speak up if they feel that something isn’t right

20. ? ? Questions

21. Upcoming Calls Thursday, May 30 th 2:00-2:45 Preventing SSI’s When Preparing Our Patients for Surgery Thursday, June 13 th 2:00-2:45 Other Ways of Preventing Venous Thromboembolism

22. Office Hours: Wednesday 2:00-3:00

23. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu