Evidence-Based Practice Poster Session (Posters #1-#10)
2 - Decreasing SSIs Using a Bundled Approach
Description: The Standardized Infection Ratio (SIR) for SSIs utilizes logistic regression to calculate expected versus actual infection rates (NHSN, 2018). Depending on inclusion criteria (for example, a clean versus a clean-contaminated case) infections are weighted; if the case meets exclusion criteria from the denominator, it is excluded from the numerator (NHSN, 2016). The national benchmark for SSI SIR is 0.96 (NHSN, 2018). For calendar years 2017 and 2018, the raw number of SSIs per month at the facility described varied from a low of 0 to a high of 10, for a total of 105 events at an average of 4.375 events per month while the SSI SIR varied from a low of 0 to a high of 2.446, for an average of 0.921 (Puckett, January 2019). During 2018, a bundled set of practice changes were made in an effort to decrease SSIs. The changes included: Reminding staff to have a high level of diligence in observing new staff and providers. (The significant increase in September each year coincides with the summer cohorts of new staff and medical residents moving from class setting into the Operating Rooms (OR). Decreasing volume of Immediate Use Steam Sterilization (IUSS) instrumentation from an average of 40% of cases down to less than 5% Adding timing of antibiotics and anticipated re-dosing time to the World Health Organization (WHO) Safety ChecklistMoving pre-operative hair clipping for fusion and laminectomy procedures from the OR out to the pre-operative area. Re-educating all staff who perform immediate liquid sterilization for instrumentation re-use. Sending all new Operating Room Assistants (ORAs) through a standardized Environmental Services (EVS) certified training program and bring all current ORA staff through an abbreviated training program to address gaps and inconsistency in room preparation.Increasing “nose to toes” SSI prevention program from strictly colon cases to all cases.These practice changes saw the raw number of SSIs per month vary from a low of 2 (prior low was 0) to a high of 6 (prior high was 10), for a total of 26 events at an average of 3.25 events per month, a decrease in the average by 1.125 events (Cisar, August 2019). SSI SIR varied from a low of 0.509 (prior low was 0) to a high of 1.259 (prior high was 2.446) for an average of 0.841, a decrease in average by 0.08 (Cisar, August 2019). Further practice change in process at the end of 2019 is adding use of a closing mayo for bowel cases.
References: Cisar, H.. (2019, August 22) Renown surgical site infection data. Presented at Surgical Site Infection Prevention Committee, August 22, 2019. National Healthcare Safety Network (2018). The NHSN standardized infection ratio: A guide to the SIR. Centers for Disease Control. Retrieved from https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdfPuckett, A. (2019, January 31) Renown surgical site infection data. Presented at Surgical Site Infection Prevention Committee, January 31, 2019.
Co-Authors: Lisa Carney, Kathleen Lowry, Heather Cisar