160 - Working Together, the Power of Teamwork in Preventing Cesarean Section Surgical Site Infections
Description: ytefasWorking together, The Power of Teamwork in Preventing Cesarean Section Surgical Site InfectionsBackground In September 2017, the way data for Centers for Medicare & Medicaid Services (CMS) was tracked to identify problem areas for infection changed. Simultaneously, our Surgical Site Infection (SSI) rate increased. Whether this was actual increase in infections or the result of data evaluation changes, our prevention strategies needed review. We found cesarean section (C-section) surgical site infection (SSI) were significantly higher than the national benchmark. Problem It is difficult to find infection reduction information specific to c section. Association of Peri-Operative Registered Nurses (AORN), American College of Obstetricians and Gynecologists (ACOG), Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) and the state education pool were used. Practices not already in place were targeted for addition. Implementation A multidisciplinary team comprised of Nursing leadership, OB Medical Director and Infection Control drilled down and looked at the entire spectrum of care, especially high- risk patients with elevated Body Mass Index (BMI), diabetes and chorioamnionitis. Engaged staff audited processes throughout Antepartum, Labor & Delivery, and Postpartum. The team developed a SSI reduction pathway for all patients covering pre-hospital to discharge. CHG use was expanded beyond OR skin prep and silver dressings added to post-operative strategies. CHG product and information were given to mothers for pre-operative showering at home. Pre-anesthesia testing and community physicians distributed CHG for patients who live remote from hospital. For C section patients on the day of surgery, all elements such as skin prep, antibiotic prophylaxis including adding Azithromycin for laboring patients, glycemic management and normothermia were called out to insure compliance. All patients receive CHG application on admission to L&D and reapplied if laboring greater than 24 hours. Incisional closures were evaluated. Education on suture v. staples for closure was provided to surgeons using evidenced based literature. A silver dressing decision tree for high risk patients was created. Post op instructions for wound care standardized. The silver dressing was available to surgeons, but mandatory if patient met criteria. Patients showered with CHG post op prior to discharge. Education was completed by Perinatal Safety Officer & OB Medical Director and included simulations, daily staff huddles, staff meetings, 1:1 physician education, & daily patient rounding. ResultsSSIs reduced from 18 in 2018 to 2 year to date (YTD) in 2019: an 88% decrease. Compliance with components ranged between 92 and 100%. Staff feedback was positive on having a pathway to reinforce bundle. Surgeon’s suture use increased from 10% to 90% after physician education. Best practice and education played roles in decreasing infection & increasing safety.