Working Towards Eliminating Surgical Site Infections
Download as PPTX, PDF1 like837 views
The document discusses a project by Sunrise Health Region aimed at reducing surgical site infections (SSI) through improved temperature management and antibiotic administration in surgical patients. Key improvements included implementing a temperature monitoring policy, standardizing antibiotic protocols, and trialing new wound dressings, resulting in significant reductions in infection rates. The trials demonstrated substantial clinical benefits and cost savings, enhancing patient care and recovery post-surgery.
![Disclosure of Commercial Support
• This program has received in-kind support from [3M Canada] in the form of
[Educational training and warming equipment for trial]
• This program has received in-kind support from [Convatec] in the form of
[Educational training and two boxes of dressings for the trial]
Potential for Conflict(s) of Interest:
• [3M Canada and Convatec][developed/licenses/distributes/benefits from the
sale of] a product that will be discussed in this program: [Bear Hugger Warmers
and AQUACEL Surgical Dressings]](https://image.slidesharecdn.com/workingtowardseliminatingpowerpoint-140528163537-phpapp01/85/Working-Towards-Eliminating-Surgical-Site-Infections-3-320.jpg)
Working Towards Eliminating Surgical Site Infections
- 1. Working Towards Eliminating Surgical Site Infections Jason Parkvold RN, BSN and Diane McDougall RN BA, BSN SUNRISE HEALTH REGION www.qualitysummit.ca #QS14
- 2. Faculty/Presenter Disclosure Faculty: Jason Parkvold RN, BSN and Diane McDougall RN BA, BSN Relationships with commercial interest: • Warming Devices for trial (3M) • Dressings for Trail (Convatec)
- 3. Disclosure of Commercial Support • This program has received in-kind support from [3M Canada] in the form of [Educational training and warming equipment for trial] • This program has received in-kind support from [Convatec] in the form of [Educational training and two boxes of dressings for the trial] Potential for Conflict(s) of Interest: • [3M Canada and Convatec][developed/licenses/distributes/benefits from the sale of] a product that will be discussed in this program: [Bear Hugger Warmers and AQUACEL Surgical Dressings]
- 4. Mitigating Potential Bias • No financial incentive has been provided to either of the presenters. Only the equipment or supplies used during the trial were provided to the health region by either company. Contracts are in place to purchase any supplies found beneficial after the trials ended.
- 5. Who are we? •We are a medium sized health provider in Eastern Saskatchewan. •We service a population of approximately 60,000 people within the health region. •We also provide surgical services to a large area of Western Manitoba.
- 6. Why did Sunrise undertake this the Surgical Site Infection (SSI) project • We set out to reduce the issues of time and suffering that patients endure with a post surgical infection. • As well we wanted to look at ways to reduce the unnecessary use of health region resources to treat people who develop a Surgical Site Infections by stopping them from occurring.
- 7. How do you Identify the issues? • We used the Canadian Patient Safety Institute SSI bundle. • SSI indicators that were being used to identify infections Provincially, Nationally and Internationally. • Set up surveillance standards based on the criteria found in this research. • Talked with Staff and Physicians.
- 8. Where did we begin? • We picked the two high risk surgeries noted in the literature that we perform. Colorectal surgery and Caesarian Sections. • We did a 6 month retrospective data analysis of all of these surgeries from 2010 so that we could have a baseline to compare our ongoing surgical data. • We began monthly auditing of all cases in these two surgical categories.
- 9. What did we find? • We found trends that needed work: • Inter-operative temperatures were being recorded infrequently and many of our patients were hypothermic after surgery • Rates of infection were higher in our clean (little or no bacterial contamination) surgical cases than our dirty (Moderate to High contamination ) surgical cases • We rarely gave patients prophylactic antibiotics within the hour prior to the initial cut being performed
- 10. What did this lead us to do? • We first focused on our temperature readings • We instituted a policy that stated any surgery over 30 minutes would require an inter-operative temperature to be taken. • We provided the surgical team with esophageal temperature probes • With the data from these successes we were then able to assess that approximately 20-25 percent of our patients were hypothermic in any given quarter of the year.
- 11. • We then looked at what we were doing to keep these patients warm • We gave warmed fluids • Covered them with warmed blankets • The temperature of the theaters is very difficult to regulate so it tends to vary through out the year depending on the external temperature • We had a warming blanket placed on the table under the patient’s back
- 12. • None of these interventions was enough to stop 20-25% of our patient population from coming out of the theater cold • We looked at what other systems were available to help us keep the patients warm • We found that the current company whose equipment we had in the theater made a total body warming device “Bear Paws units” • We decided to trial it to see what kind of difference it would make 25 75 Hypothermic Patients Throughout the Surgical Procedure Hypothermic
- 13. • We ran a trial on 30 clients • We used our normal temperature monitoring protocol on all of these clients • These clients could be warmed prior to surgery, while surgery occurred and post surgery
- 14. • What we found was that 90% of clients maintained normal body temperature 36-38 degrees • Of the 10% that did not maintain normal body temperature only one client was hypothermic through out the inter-operative period • All clients (100%) prior to leaving recovery had returned to the normal body temperature range 10 90 Normothermia during the Surgical Procedure Hypothermia Normothermic
- 15. Antibiotics within 60 minutes • We also focused in on timely antibiotic administration • This was noted to be an issue and was the focus of one of our first Mistake Proofing Projects • What was found was that we were providing antibiotic prophylaxis to our surgical patients within 60 minutes to less than 30% of our patients 30 70 Prophylactic Antibiotics Within 60 Minutes Outside 60 Minutes
- 16. Why was this? • Well it was a combination of issues • Different standing order sets from our surgeon’s • The use of multiple antibiotics prior to surgery • No consistent method of informing the unit preparing the patient of the time patient would enter the theater
- 17. What did we do? •We standardized order sets for Colorectal and C-Section procedures for all surgeons •We tried multiple PDSAs on the best method of communicating when patient will be entering theater •We started using surgical pause to ensure antibiotic started prior to incision
- 18. • We did multiple sets of staff and physician education on why it was important to have the antibiotics delivered within 60 minutes • We had pharmacy research appropriate drug administration rates for the staff so that they could meet the time requirements with multiple drugs • As of Dec 2013 our rate of appropriate antibiotic prophylaxis is now 93% and we continue to look at ways to improve this number. 93 7 Propholactic Antibiotic Rate Within 60 Minutes Outside 60 Minutes
- 19. Wound Management • Our final improvement process has been to trial alternate dressings for our C-Section patients • The reason for this is that a C-Section should never be a dirty procedure • This surgical category consistently had our highest rate of Surgical infections • The majority of these infections were superficial infections
- 20. • Looking at the indicators for this procedure it became clear that two indicators showed up on the majority of the SSI cases • The indicators were weight above 70 KG and removal of dressing within 24 hours • As well most of these cases were discharged home within 48 hours of the procedure occurring
- 21. • Since most of the infections occurred within 7-10 days of the procedure what could we do? • Our current practice at the time was to apply a standard dressing and generally remove it at 24 hours • This wound would then be cleaned and have a dressing spray applied • The patient would then generally be discharged home
- 22. • A search of the current literature was done as well as discussions with other health regions around the province • What was found was that there was no set protocol for wound management within the literature let alone the province • Through the search of the literature what was found was a dressing that allowed good mobility, was waterproof and provided a physical barrier
- 23. How could we change this process? • We could look for a dressing that stayed intact for a longer time period • One that was an active barrier to bacteria and waterproof so that it would allow the patients to have an active lifestyle once discharged • A trial of the “Aquacel” dressing was planned
- 24. • One surgeon trialed the dressing while the other two Obstetricians decided to maintain their current practice • They provided us with wonderful groups to compare the results • In the trial group we had 15 surgeries. Out of this group we had 1 infection and this dressing we had difficulties getting proper adhesion of the dressing. • In the current practice group we had 17 surgeries and 3 infections. 1 14 Trial Patients Infections Total Cases 3 14 Current Practice Infections Total Cases
- 25. • The difference in the rate between the two surgical groups was 62% more surgical infections for the current practice. • Since running this trial we have had a second Obstetrician and a locum Obstetrician start using this dressing. • As well we have had interest in our General Surgery program in starting to use this dressing in our abdominal cases with an open incision.
- 26. What has been the impact of these changes? • We have had comments from patients: • “I have never before came out of surgery and been warm” • “I couldn’t even tell where my incision was as there was no redness along the spot where they cut” • “ The dressing allowed me to shower when ever I wanted to once I got home”
- 27. • Staff comments: • “The dressings are easy to use” • “The warming device is easy to control and can be turned off once patient maintains normal temperature in the recovery period” • “I am seeing good wound bed healing in my office on follow up visits” • System improvements: • Noted reduction of C-Section infections in the quarter the dressing trial was conducted
- 28. Cost savings for treatment of each one of those infections: • The reduction of at least one antibiotic prescription • The reduction of at least one Physician/Outpatient visit • Not needing Home Care Services providing wound care • Not incurring a readmission and/or a possible further OR procedure • 2 Dollars – 380 Dollars Per Prescription • 33.20 Dollars – 230 Dollars Per visit • 20 Dollars – 300 Dollars Per visit • 418 Dollars – 1319 Dollars Per bed day (not including treatments) • All Costs are ranges: actual cost will vary
- 29. Sooner Safer Smarter – Patient First : • Saving to the patient: • No Extra lost work time for the patients due to an infection after surgery • No costly trips for additional health care services • No additional stress about the ongoing healing process
- 30. Questions? Contact Me: Jason Parkvold Sunrise Health Region Clinical Improvement Facilitator jason.parkvold@shr.sk.ca www.qualitysummit.ca #QS14
Editor's Notes
- #29: The lowest cost of possibly treating a SSI would be $35 - 40: this would be for 1 inexpensive prescription and 1 physician office visit. The other side of the scale can be in a 6 figure range (100,000 +) with readmission into an ICU with Multiple drugs and months of time to treat . The average uncomplicated superficial wound generally involves at least two visits to see a physician and at least one antibiotic. The average complicated superficial wound will require one possibly two antibiotics multiple physician visits and home care treatment. The severely complicated superficial wound will require multiple antibiotics, Home Care, possible readmission and OR intervention. Deep and Organ space wounds generally require multiple antibiotics, readmission, and OR intervention and are much more costly.