141 - The OR and Beyond: Collaborating Across Multidisciplinary Teams to Reduce Cardiac Surgical Site Infections
Description: Surgical Site Infections (SSIs) require a multidisciplinary collaborative perspective in order to recognize best practices for reduction. Temple University Hospital’s key stakeholders wanted to assure its surgical, nursing and anesthesia teams were compliant with SSI prevention protocols. Healthcare Information System (HIS) application coordinators and report writers collaborated with key clinical stakeholders across the continuum to establish a comprehensive real-time reporting document to monitor protocol and prevention compliance. The OR Surgical Site Infection Report provided teams with a new sense of ownership in SSI prevention. Temple University Hospital’s cardiac surgery patients were experiencing a rise in surgical site infections (SSI) Without a SSI bundle in place, it was difficult to identify if deficits in care existed. We started our pursuit for answers by reviewing the prevention strategies we already had in place. Data collection proved time consuming as it required manual extraction of data from every phase of the patient’s care. An additional challenge was the preoperative, intraoperative and post-operative phases of care for our cardiac surgical patients occurred in silos. We formed a multidisciplinary team led by our chief of surgery and included multidisciplinary members from the pre-intra-and postop areas to determine causes for the increase in SSIs. Effective surgical site infection prevention required restructuring systems to eliminate silos and reducing risk factors that could lead to surgical site infections. Our goal was to optimize the evidence-based processes of care we already had in place through the development of a comprehensive electronic report. The OR Surgical Site Infection Report allowed us to determine if we were really doing what we said we were doing. The report captures all the components and data points needed for an SSI bundle deemed essential by the multidisciplinary team. These components consist of antimicrobial prophylaxis (timing, selection and duration of antibiotic therapy); chlorhexidine bathing both pre and post operatively; nasal decolonization, tight glycemic control, screening for high risk patient’s utilizing The Society of Thoracic Surgeon’s (STS) Risk Calculator; standardized surgical wound care and closure; Surgical Care Improvement Project (SCIP) measures; operating room UV light disinfection after each procedure; timely removal of central lines, epicardial wires and negative pressure wound therapy; normothermia maintenance; timely extubation; and adherence to established and standardized infection prevention protocols and practices. As a result of the establishment of this report which allowed us to monitor SSI protocol compliance in near real time, the total number of Surgical Site Infections decreased over the course of this performance improvement project from 11 in FY 2017 to 5 in FY 2018 to 2 in FY 2019. Additional benefits realized from this project include a Cardiac Surgical Pathway for CABG/Valve patients; a Time to Extubation report which aids in the timely extubation of our cardiac patients; and the acquisition of a blood glucose management tool which effectively addresses hyperglycemia and hypoglycemia with dosing recommendations for all patient types. Development of methods to maintain and reinforce a standardized approach to cardiac SSI prevention were established and resulted in greater adherence to best practice elements. Ease of data access to key stakeholders across multiple disciplines occurred along with improved quality and standards of care for our patients. Temple is innovating new ways to coordinate and improve the care of our surgical patient care in the OR and beyond.