Evidence-Based Practice Poster Session (Posters #21-#28)
25 - Reducing Surgical Site Infections: A Multifocal Approach
Description: Reducing Surgical Site Infections; A Multifocal Approach AuthorsKathleen Glaser, MSN, APRN-CNP, CNOR Staff Nurse Educator, The MetroHealth System, Cleveland OhioMelissa Times, MD, General Surgeon, The MetroHealth System, Cleveland OhioDebra Sparks, MSM, BSN, RN, CNOR, Director of Perioperative Services, The MetroHealth System, Cleveland OhioJill Murphy MSN, MHA, RN, CNOR, Service Line Administrator Perioperative Services, The MetroHealth System, Cleveland OhioDaniel Seabold, BSN, RN, CNOR, Operating Room Nurse Manager, The MetroHealth System, Cleveland OhioCynthia Williams, BSN, RN, CAPA, PACU Manager, The MetroHealth System, Cleveland OhioMelissa Snahnican, BSN, RN, PSE Team Leader, The MetroHealth System, Cleveland OhioClinical Problem/SignificanceSurgical site infections (SSI) are detrimental to the patient and the healthcare system, leading to increased hospital stays extensive healthcare interventions including, additional surgeries and antibiotic therapy. These infections are one of the most common preventable surgical complications, resulting in more than $10 billion per year, extended hospitalizations, and increased mortality rates (Rezapoor et al, 2017). BackgroundThroughout 2017, 39 SSIs at MetroHealth were linked to colon, spine, total hip, total knee, and cardiac procedures, a rate of 2.59 SSIs per 100 cases. Although focused efforts were placed on decreasing these rates, the statistics continued into first quarter 2018 with a rate of 2.47.Clinical QuestionWhat collaborative measures could be taken to reduce SSIs?Description of Evidenced-Based ProtocolEducate patients on hygiene and signs of SSI, including CHG bathing the night prior to and morning of surgery. Administer nasal iodine swabs within one hour prior to surgery to reduce nasal staphylococcus aureus. Implement surgical team re-gowning, re-gloving, re-draping, and utilization of new sterile table and instruments at surgical closure. Enhance environmental cleaning of operating rooms surfaces and equipment. Implementation of Evidenced-Based ProtocolThrough interdepartmental collaboration between pre-surgical evaluation (PSE), Pre-Op, Operating Room, and Environmental Services, the team began a multifaceted approach to decreasing SSI. PSE staff implemented standardized education regarding pre-surgical hygiene, including the use of CHG bathing. Pre-Op staff assisted patients with the self-administration of nasal swabs one hour prior to surgery. Operating Room (OR) staff implemented new procedure for colon surgeries in which the surgical team re-gowned, re-gloved, re-draped, and utilized a new sterile table and instruments at surgical closure. Auditing of CHG and iodine swabbing were completed daily to ensure compliance.To ensure adequate cleaning of ORs, regularly scheduled auditing was conducted. Using a transparent marker, high touch objects through the OR were marked at random prior to cleaning. After environmental cleaning was completed, marking locations were viewed under blacklight to assess effectiveness. Direct feedback and education was provided to environmental team staff in real-time. ResultsCHG and iodine nasal swab compliance increased from 61% in June 2018 to 90% in June 2019. Cleaning compliance rate improved from 48% in July 2018 to 96% in August 2019. SSIs rates decreased from 2.47 in the first quarter of 2018 to 1.33 in 2019.Conclusions/DiscussionThrough the implementation of evidence-based practices and interdepartmental collaboration, the system achieved a 46% reduction in SSI rates.Perioperative Nursing ImplicationsAdequate patient preparation through CHG bathing and iodine nasal swabs, coupled with redesigned surgical closure procedures and effective environmental cleaning can positively impact the rate of SSIs. Regular auditing of compliance measures adds to the effectiveness and assurance of high quality surgical outcomes.