Implementation of a Pediatric Orthopaedic Bundle to Reduce Surgical Site Infections

Abstract

Surgical site infections (SSIs) cost an estimated $27,288 per case. An analysis of the National Surgical Quality Improvement Program data at the University of Rochester Medical Center suggested that rates of SSIs could be lowered in comparison with both peers and baseline. The aim of this study was to reduce the number of SSIs to zero through the implementation of a "bundle" or a combination of practices. Meetings were held with the multidisciplinary care team that includes surgeons and staff from pediatric pharmacy, pediatric infectious diseases, anesthesia, and nursing to create a care bundle for all pediatric orthopaedic surgery patients. Bundle elements included use of chlorhexidine gluconate wipes the night before surgery and the day of surgery, use of preoperative nutrition screens, development and use of a prophylactic antibiotic dosing chart, use of methicillin-resistant Staphylococcus aureus screening, maintenance of normal patient temperature, and use of nasal swabs in the operating room. The SSI rate dropped from a baseline figure of 4% in 2013 (n = 154) and 3.2% in 2014 (n = 189) to 0.0% (n = 198) in 2015 after the bundles were implemented. Both compliance with the bundle and SSI rates must be monitored monthly. Staff and providers should be offered monthly feedback on SSI rates and care bundle compliance. If an SSI does occur, a root-cause analysis is performed with the multidisciplinary care team using a standardized review form.

Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

“…The patient cohort was exclusively “elective orthopedics” in 10 out of 13 studies. One study also included traumatologic patients/emergent surgery [ 23 ]; two studies dealt with pediatric orthopedic patients [ 21 , 24 ]. Two studies did not further specify their observed cohort and stated “orthopedic” [ 19 , 25 ].…”

“…The data extracted in the review cannot provide a quantification of the importance of each single implementation method, but some of the included studies reported what the authors stressed as important factors for success. Multidisciplinary team approach and interdisciplinary consensus were mentioned in 6 out of 11 successful studies [21,23,24,[27][28][29]. Other aspects mentioned as impactful were personal training [19,29], continuous training and feedback [24,29], monthly analysis [21], active involvement of every member and physician leadership [21,24] and patience [24].…”

“…Multidisciplinary team approach and interdisciplinary consensus were mentioned in 6 out of 11 successful studies [ 21 , 23 , 24 , 27 – 29 ]. Other aspects mentioned as impactful were personal training [ 19 , 29 ], continuous training and feedback [ 24 , 29 ], monthly analysis [ 21 ], active involvement of every member and physician leadership [ 21 , 24 ] and patience [ 24 ]. Implementation methods reaching the cognitive level only (education by posters in this case) were not followed by improvement, which fits established implementation research [ 30 ].…”

Método Bundle na redução de infecção do sítio cirúrgico: revisão sistemática

“…Austrália e Nova Zelândia 19 , Bélgica 20 , EUA (21)(22)(23)(24)(25)(26) , Holanda 27 , Itália 28 . Quanto ao desenho dos estudos encontrados, uma revisão sistemática 19 foi identificada, um ensaio clínico randomizado 24 e oito estudos observacionais [20][21][22][23][26][27][28] (seis antes-depois e dois de coorte), com publicações desde o ano de 2011 até 2018.…”

“…Austrália e Nova Zelândia 19 , Bélgica 20 , EUA (21)(22)(23)(24)(25)(26) , Holanda 27 , Itália 28 . Quanto ao desenho dos estudos encontrados, uma revisão sistemática 19 foi identificada, um ensaio clínico randomizado 24 e oito estudos observacionais [20][21][22][23][26][27][28] (seis antes-depois e dois de coorte), com publicações desde o ano de 2011 até 2018. A revisão sistemática foi incluída por fazer referência ao tema investigado e por trazer resultados de pesquisa relevantes para o presente estudo, porém o objetivo é avaliar a ocorrência do uso pré-operatório de descolonização nasal e / ou cutânea em qualquer bundle.…”