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Reducing Colon Surgical Site Infections: A Quality Improvement Initiative of Two Hospitals. Angela Gabasan , RN, MSN,CIC Barbara A. Smith, RN, MPA, CIC Eloisa Santos, RN, MA, CIC Emilia Mia Sordillo , MD, PhD Raymond Wedderburn , MD Lester Gottesman , MD Richard Whelan, MD - PowerPoint PPT Presentation
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Reducing Colon Surgical Site Infections: A Reducing Colon Surgical Site Infections: A Quality Improvement Initiative of Two Quality Improvement Initiative of Two
HospitalsHospitals
Angela Gabasan, RN, Angela Gabasan, RN, MSN,CICMSN,CIC
Barbara A. Smith, RN, MPA, CICBarbara A. Smith, RN, MPA, CIC
Eloisa Santos, RN, MA, CICEloisa Santos, RN, MA, CIC
Emilia Mia Sordillo, MD, PhDEmilia Mia Sordillo, MD, PhD
Raymond Wedderburn, MDRaymond Wedderburn, MD
Lester Gottesman, MDLester Gottesman, MD
Richard Whelan, MDRichard Whelan, MD
Bruce Polsky, MDBruce Polsky, MD
St. Luke’s-Roosevelt Hospital St. Luke’s-Roosevelt Hospital Center, NY, NYCenter, NY, NY
Financial Disclosure: NoneFinancial Disclosure: None
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Issue: We’re in the Issue: We’re in the REDRED
2008 SSI Rate NYS HAIR NHSN
St. Luke’s Site
16.3 per 100 procedures
4.9 per 100 procedures
5.6 per 100 procedures
Roosevelt Site
7.8 per 100 procedures
4.9 per 100 procedures
5.6 per 100 procedures
2008 NYS Hospital-Acquired Infection Report (NYS HAIR) published in June 2009-PHL 2819 mandatory reporting of select HAI-use NHSN for reporting
Colon SSI rate exceeded state and national rates
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The Project: Reduce Colon The Project: Reduce Colon SSISSIMultidisciplinary team
surgical teamOR teaminfection control team
Review of the Hospital’s Guidelines for Antimicrobial Prophylaxis in Surgerycolon pre-op antibiotic current, no need to
changeRetrospective review of cases
2008 cases n=2252009 1st and 2nd Qtr cases n=98
Communicate strategy to the stake holders
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Retrospective Review: Retrospective Review: Analysis of 2008 and 2009 Analysis of 2008 and 2009
CasesCases
No change in practice or deviations in operating room or surgical techniques
Good compliance with post-op temperature and clipping of the surgical site
Betadine skin prep is used in majority of cases and found adequate
No unusual pathogensOperating Room environment not implicated
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Selection and timingWeight-based dosing: obese>100Kg/130%
IBW SL site 33% given increased dose RH site 44% given increased dose
• Redosing for procedure >4h duration• SL site 44% redosed• RH site 23% redosed
Retrospective Review: Retrospective Review: Analysis of 2008 and 2009 CasesAnalysis of 2008 and 2009 Cases
Room for Improvement: Pre-op Room for Improvement: Pre-op antibioticsantibiotics
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Plan of ActionPlan of ActionRe-emphasize adherence to Hospital
Guidelines for Antimicrobial Prophylaxis in Surgery
Focus on 4 indicators covered in the Guidelines1. antibiotic selection2. timing of antibiotic administration3. weight-based dosing4. redosing for procedures >4 hours
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Plan of ActionPlan of Action
Designate a point surgeon at each facility to:communicate recommendations to the surgical
teamassist in SSI case review
White board in each OR suite reminder to the OR and surgical team
time of procedure time antibiotic is administered
surgeon orders, anesthesiologist administer
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Results: Colon procedure SSI rates and Results: Colon procedure SSI rates and Antimicrobial Prophylaxis Guideline Antimicrobial Prophylaxis Guideline AdherenceAdherence
Roosevelt Site SSI rate
Adherence to Antimicrobial Prophylaxis Guidelines
Selection (%)
Timing (%)
Weight-based Dosing
(%)
Redose proc.>4h (%)
2008 7.8 80 70Not
collectedNot
collected
2009 7.8 81 97.4 44.4 23
2010 4.62 96 96 84 75
2011 1st Q 5.7 100 100 100 87
NHSN 5.6NHSN 5.6
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Results: Colon procedure SSI rates and Results: Colon procedure SSI rates and Antimicrobial Prophylaxis Guideline Antimicrobial Prophylaxis Guideline AdherenceAdherence
St. Luke’s
site SSI rate
Adherence to Antimicrobial Prophylaxis Guidelines
Selection (%)
Timing (%)
Weight-based Dosing
(%)
Redose proc. > 4h (%)
2008 16.3 97.5 87.5Not
collected
Not collecte
d
2009 10.38 95.7 100 33 44
2010 8.47 95.6 100 100 71
2011 1st Q 6.6 92 100 100 67
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NHSN 5.6NHSN 5.6
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Results: SummaryResults: SummaryColon SSI rates decreased as
adherence to Antibiotic Prophylaxis Guidelines improved
2008 to 2010 SSI rate reduction 48% @ St. Luke’s site40% @ Roosevelt site
Combined cost avoidance>$400,000.00*
* APIC Dispelling the Myths: The true cost of Healthcare Associated Infections
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Lessons LearnedLessons LearnedCompliance was gradual, and depended on
the cooperation of the surgeonsIncreased accountability of the surgical
team led to better adherence with all 4 indicators
Designation of a point surgeon at each hospital facilitated cooperation and communication among stakeholders
Our Goal: continue to reduce SSI rates to at or below the State and National level
Thank You!
Angela Gabasan, RNNurse Epidemiologist, St. Luke’s-Roosevelt Hospital1111 Amsterdam AvenueNew York, NY 10025(212) 523-4563 or (212) [email protected]
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OR White BoardOR White Board
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GUIDELINES FOR GUIDELINES FOR ANTIMICROBIAL PROPHYLAXIS ANTIMICROBIAL PROPHYLAXIS
IN SURGERYIN SURGERYST. LUKE’S-ROOSEVELT REVISED February 2010
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