181 - LITE It Up: Lowering Infections Through Team Engagement
Description: Clinical Issue -- Inova Fairfax Medical Campus (IFMC) saw an increase in deep and organ space C-Section surgical-site infections (SSIs) in 2017 with a total of 10 infections as compared to the baseline of 3 in 2016.
Description of Team: A multidisciplinary team of physicians, residents, nurses, anesthesia providers, surgical first assistants, surgical technologists and clinical technologists came together to create a team approach to reducing obstetrical surgical site infections.
Preparation and Planning: A review of infections from 2017 identified that a majority of infections occurred in unscheduled surgeries. In searching for a common reason, it was discovered that 70% occurred in patients with the diagnosis of chorioamnionitis or suspected chorioamnionitis. Opportunities were found in several areas including education of SSI prevention strategies, prophylactic antibiotic administration, and the recognition of signs and symptom of chorio, plus inadequate antibiotic treatment of chorio/suspected chorio or the presence of factors for increased risk of infection, and inconsistent compliance with surgical aseptic techniques. A multidisciplinary approach was taken to address knowledge gaps with particular emphasis on the incidence of C/S SSIs, SSI reduction techniques, antibiotic selection, administration and documentation, and the recognition and treatment of chorioamnionitis . AssessmentMajor problems identified: 1) Decreased awareness of SSI issues and knowledge of current ACOG recommended antibiotic protocols for surgical prophylaxis and chorioamnionitis treatments 2) Education and knowledge gap and lack of compliance with current AORN and ACOG recommendations for infection prevention strategies during surgery.
Implementation: 1) Team in-service to provide education to multidisciplinary team on recognition of S/S of chorio and ACOG recommended treatment of chorio through antibiotic administration and intra-op. Standard Work change for physicians and team for chorio/suspected chorio. Having everyone join together, collaborate on the issue, and very visually hold a “LITE It Up” campaign kick-off led by both physician and nursing leadership using TeamSTEPPS tools enabled all team members to feel involved in the issue, to focus on the SSI reduction strategy recommendations and to feel empowered to speak up regardless of position to help improve the health and safety of our patients. 2) Nurses performed audits of 1,120 unscheduled C/S cases between June – December 2018 to identify barriers in the SSI reduction bundle implementation process
Outcome: Through the teamwork and multidisciplinary strategies implemented, the team was able to achieve a 70% reduction in deep and organ space post-cesarean surgical site infections from 10 in 2017 to 3 in 2018.
Implications for Perioperative Nursing: Multidisciplinary teamwork and improved communication are important strategies to utilize in providing safe, effective patient care and reducing surgical-site infections.