2 results
Improved Postoperative Outcomes By Utilizing A Comprehensive Perioperative Surgical Site Infection (SSI) Reduction Bundle
- Aarikha D’Souza, Joan Ivaska
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s286
- Print publication:
- October 2020
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Background: Surgical site infections (SSIs) can be attributed to increased patient morbidity and mortality, prolonged hospital stays, and overall increased healthcare costs. The Surgical Care Improvement Project (SCIP) was implemented in 2002 but has made limited impact on SSI rates across our facilities, which has led to the creation of a bundled approach of current evidence-based strategies. Methods: In January 2019, a comprehensive SSI prevention bundle of strategies was implemented across a multihospital health system. The bundle was comprised of 8 interventions focusing on the preoperative, intraoperative, and postoperative continuum of care, and refining documentation in the electronic medical record. From January to September 2019 (preointervention period), data were collected from 7,163 adult inpatient and observation elective patients undergoing colon surgery (COLO), abdominal hysterectomy (HYST), hip arthroplasty (HPRO), knee arthroplasty (KPRO), and cardiac bypass graft (CBGB/CBGC). The preintervention period for SSI standardized infection ratios (SIRs) and retrospective review of process measures was set as January–December 2018 (postintervetnion period). Each process measure had outlined targets along with primary outcome measures of overall SSI SIRs and SIRs for each of the 5 reported procedure categories. SSIs were validated to meet CDC and NHSN surveillance case definitions. Secondary outcomes evaluated included length of stay (LOS), readmission rates, and mortality. Results: Overall SIR for all 5 monitored surgical categories decreased by 5% to 1.131 from January to September 2019, compared to SIR of 1.190 in 2018. Hip and knee arthroplasties demonstrated 40% and 38% reductions after the intervention, respectively. Completion of 7 or 8 interventions of the SSI bundle were correlated with lower readmission rates (P = .0488). When any portion of the bundle was used, this was correlated with shorter LOS (P < .0001). Adherence to standardized antimicrobial prophylaxis was associated with decreased mortality (P = .017), for all 5 surgical categories. Conclusions: With the implementation of a focused SSI reduction bundle, our institution has realized reductions in surgical readmissions, length of stay, and mortality. Additionally, SSI rates in certain procedure categories have shown marked improvement. The initial success of this bundle has garnered development of additional procedure focused supplemental strategies for the future year.
Funding: None
Disclosures: Aarikha D’Souza, Banner Health
Direct Data Mining from the Electronic Medical Record to Assess and Improve Compliance With Infection Prevention Bundles
- Janet Conner, Joan Ivaska
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s32-s33
- Print publication:
- October 2020
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Background: Bundles have been proven to reduce the risk of healthcare-associated infections and to provide for rapid recognition and response for the best outcome in patients with sepsis. Each element alone does not provide the statistical significance that all elements together allow. Providing near real-time compliance with bundle measures to clinical staff can drive performance improvement with the bundle during the patient’s hospital stay, resulting in improved clinical care and prevention of infection. Methods: In 2019, 3 clinical initiatives were chartered that applied evidence-based bundles for early identification and treatment of sepsis, prevention of healthcare-associated pneumonia (HAP), and prevention of surgical site infection. The bundle included the following elements: assessment of sepsis, measurement of lactic acid, collection of blood culture, timely administration of antibiotics. The HAP bundle included the following elements: assessment of aspiration risk, elevation of the head of the bed, oral care twice daily and preoperatively, and incentive spirometry postoperatively. And the SSI bundle included the following elements: preoperative CHG bath, appropriate preoperative antibiotic, perioperative glucose control, and perioperative temperature control. A multidisciplinary team developed and implemented dashboards that extracted bundle elements from the electronic medical record (EMR) nightly. Bundle compliance was calculated at the individual element level as well as the aggregate. Bundle failure data were available at the patient level as well as in aggregate by care location and provider, allowing for real-time feedback to staff and creation of improvement plans. An unanticipated benefit was the identification and correction of charting inconsistencies. Results: Collection, aggregation, and analysis of bundle compliance data were displayed in a system dashboard, and data were refreshed nightly. This approach allowed us to display overall bundle compliance at the facility and system level, including a heat map showing each facility’s compliance with the bundle and each associated element. Utilization of an EMR dashboard allowed for performance review on 100% of eligible patients rather than a sample, as occurs with manual review and abstraction processes. Routine review of performance via the dashboards with frontline staff, clinical leaders, medical staff, and executives has resulted in month-by- month improvement in bundle compliance. Conclusions: Direct data mining, data aggregation and analysis, followed by direct feedback to frontline staff, has resulted in steady improvement in overall bundle compliance, compliance with individual bundle components, and standardization of charting in the EMR. This approach has ultimately resulted in better outcomes for sepsis patients, reduction in healthcare-associated pneumonia, and reduction in surgical site infections.
Funding: None
Disclosures: None