Toward a Safety Culture: Preventing Surgical Site Infections

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Toward a Safety CulturePreventing Surgical Site
Infections
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Surgical Site Infections injure patients and add
cost

• Post-op hospital LOS ? by 7-10 days
• Hosp. charges ? 2,000 4,500
• SSI primary cause of death in over 75 of pts.
  with SSI

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Menu for reduction of surgical site infections
Operative
Preoperative
3. Normothermia

• Prophylactic
• antibiotics

2. Hair Removal
Perioperative
4. Hyperoxia
5. Normalization of glucose
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Pre-op antibiotics
60 eligible cases are treated
Pre-op antibiotics consistently reduce Surgical
site infections

Infection rate
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Pre-op antibiotics What How much
In PEN Allergic Use clindamycin
aminoglycoside Use clindamycin or
flouroquniolone
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Peri-operative Oxygen 80 FiO2 during surgery
2 hours post op
Grief et al, NEJM 2000, 500 cases, colorectal
surgery, multi center randomized
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Normothermia and SSI
Kurz et al, NEJM 1996, 200 patients colectomy,
multi center warmed gases, fluids vs usual care
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Surgery and continuous insulin
Funary 1999, CABG community hospital, 2467 DM
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Barriers to implementing evidence based practices
Interventions tried
Barriers

• Guideline Dissemination 43 provider education
  programs,48,49
• Comprehensive efforts by an infection control
  team.50
• Computerized decision support,23,39-42
• Delegate the administration of prophylactic
  antibiotics to the anesthesia team or the holding
  room nursing staff.22, 25, 48
• Chart audit with feedback,38
• Comprehensive efforts by an infection control
  team.50

• Knowledge of evidence
• System problems
• Equipment/ supply access (cost trade-off)
• Convenience (time trade-off)
• Memory aids at time of use
• Team performance issues
• role, distributed authority, cross checking
• Individual performance
• Time
• Skill set
• Buy-in
• Accountability