Surgical Infection Prevention
Public Health Importance
Surgical site infections (SSI) occur in 2-5% of clean extra-abdominal
surgeries and up to 20% of intra-abdominal surgeries. Each infection is
estimated to increase a hospital stay by an average of 7 days and add
over $3,000 in charges (1992 data). Patients who develop surgical site
infections in the hospital are 60% more likely to spend time in an ICU,
5 times more likely to be readmitted to the hospital and have twice the
incidence of mortality. Despite advances in infection control practices,
SSIs remain a substantial cause of morbidity and mortality among
hospitalized patients. A variety of studies prove different techniques
to be successful in reducing the amount of SSIs.
Project Status
The
project team met for the kickoff meeting in September 2004. Team leaders
were identified to meet monthly; the whole team meets quarterly.
Goals
The
SIP team decided to concentrate first on meeting 100% compliance to
proven antibiotic preventive measures. These include:
-
Giving the right antibiotic (Choice)
-
Giving the antibiotic 1 hour before incision (Timing)
-
Discontinuing the antibiotic within 24 hours after surgery (Duration)
Baseline data on these measures was collected for 3rd quarter 2004 for
total hip replacement, total knee replacement, CABG and CABG + valve
surgeries.
Status Update -
Data
The
range and means of process compliance for all three surgeries combined
are listed in the table below:
| |
Baseline |
Baseline
Mean |
4th Q
2004 |
4Q Mean
|
|
Choice |
95.8-100% |
99% |
96.2-100% |
99.4% |
|
Timing |
27.1-96.9% |
79.3% |
47.7-100% |
80.6% |
|
Duration |
0-100% |
57.4% |
10-91.2% |
72.6% |
The largest improvement
is found in discontinuing the antibiotic within 24 hours, a 26% increase
in compliance.
1st Q 2005 data is
being collected now and will be reported in May.
Status Update - Implementation
In
order to increase compliance with the antibiotic standards, Madison
hospitals have implemented the following improvements:
-
Standardized pre-printed order sets
-
Created physician memos and scheduling team meetings with OR staff
-
Revised guidelines
-
Utilized computer technology to standardize antibiotic administration
times
-
Coordinated antibiotic start time with a pre-procedure milestone (ex:
giving the antibiotic at the time the
tourniquet is
placed)
-
Coordinated antibiotic arrival time with pharmacy staff
-
Distributed current literature and antibiotic recommendations to
surgeons
-
Focused on interdisciplinary teams to help drive improvement
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