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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) 523-2106agabasan@chpnet.org

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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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