the providence health care experience dr ahmer karimuddin meghan macleod dr alex seal phc surgical...
TRANSCRIPT
the Providence Health Care Experience
Dr Ahmer KarimuddinMeghan MacLeod
Dr Alex Seal
PHC Surgical ProgramUniversity of British Columbia
February 19th, 2015University of
British Columbia
Preventing Surgical Site Infection
Disclosure
There are no conflicts of interest and nothing to disclose
Outline
1. Why this is important
2. Our approach to thischallenging problem
3. Bundle
4. Results
5. the FUTURE
THANK YOU
SSI Prevention TEAM• Jock Reid• Jim Abel• Ahmer Karimuddin• Victor Leung• Chris Prabhakar• Meghan MacLeod• Lisa Toback• Elisa Lloyd-Smith• Stephen Parker• Michelle Bech• Thelma Velasco• Lona Cunningham• Sandy Grimwood• Rupinder Khotar• Alex Seal
...all of SPH and MSJ
• Randy Rae• Jin-So Pao• Alice Lee • Flavia Mandic• Sharon Bisson• Paul Smith• Howard Green• Barry Schafer• Lu Oviatt• Tamara Younger• Lia Randell
THANK YOU SPH & MSJ Team
SSI’s
Background
• Why do this?
• Opportunity to improve the care of patients
• Individual
• Service
• Site
• City, province, etc...
Background
DATA
NSQIP Risk Adjusted DataSurgical Site Infection
All Cases reviewed July 2011 – June 2012
SPH MSJ
Goal of Working Group
Ultimately Reduction in Rates of SSI**
Goal of Working Group
1. ID the problem
2.Explore the process
3.Build the Team
4. ID root causes/best practice
5.Select and test solutions
EPIC Approach
• Will it be EPIC?
• E - Easy to implement
• P - Permanent
• I - Impact High
• C - Cost effective
Best Practice Brainstorm
Strategies for Prevention
Brainstorm
Looked at Other Centres• Example initiative:
• Northwestern experience: OR closing bundle (colorectal)
• New gloves
• New instruments
PHC = FOCUS Bundle• F - Focused
• O - Opportunities of
• C - Care
• U - Utilizing
• S - Standards
PHC SSI Prevention Bundles
Example: Pre-op Antibiotics
PHC approach based on best practice
1. Risk Assessment
2. Creation of key preventative strategies
3. Adherence to key strategies
4. Active surveillance
• = REDUCTION IN RATES
PHC SSI Prevention Bundle• Areas for Education Opportunities
1. Pre-Admission Clinic
2. Pre-OP
3. SPH OR
4. MSJ OR ✓
5. PAR ✓
6. Wards ✓
✓✓
✓
Appropriate OR Dress Attire
PHC SSI Prevention Bundle
I pity ‘da foolwho
dresses like mein da OR
Intra Operative FOCUS
How are we doing now?
• S
SPH
MSJ
NSQIP data: Out of the pink!
Report Period SPH SSI MSJ SSI
07/11-06/12 2.02H 1.64H01/12-12/12 1.70H 1.75H04/12-03/13 1.49H 1.72H07/12-06/13 1.36H 1.56H10/12-09/13 1.30 1.46H01/13-12/13 1.18 1.1404/13-03/14 1.19 0.93
Implementing a Bundle
SQAN Summer Student AUDIT
• Best compliance with bundle intra-operative components
Bundle Compliance AUDITPreoperative
Surgical Day CareIntraoperativePostoperative
SPH
MSJ
FUTURE
• Opportunity for improvement
• Focus on areas from audit where lower compliance
• Pre-OP warming
• Pre-OP surgical site chlorhexidine prep by patient
• Pre-OP site shave in Daycare
FIN