Performance improvement initiative: prevention of surgical site infection (SSI)

Abstract

Mafraq Hospital performs an average of 10,000 surgeries every year. The impact of having high volume high risk surgical procedures calls for the need to ensure safe surgery and a prevention of surgical site infection (SSI). SSI represents a significant portion of healthcare-associated infections (HAIs). The impact on morbidity, mortality, and cost of care has resulted in identifying the need to reduce SSI as a top priority to prevent healthcare associated infections. The good news is that the majority of SSIs are preventable.Mafraq Hospital performs a range of surgical procedures that covers 14 surgical specialties. The infection prevention and control team performs surveillance for SSI for all patients who undergo operative procedure included in Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Operative Procedure Category (40 surgical procedures). Out of the 40 CDC NHSN listed, 33 operative procedures were performed at Mafraq Hospital, of which 17 were reported with SSI for 2013 and 2014. Surgical site infection has implicated an increase average length of stay from seven to 10 additional postoperative hospital days and additional costs of AED 10,000 to AED 100,000/SSI depending on procedure and pathogen.A multidisciplinary team was formed to develop and implement measures to reduce/eliminate surgical site infection, as well as evaluate and monitor compliance. Hence a group of multidisciplinary teams were initiated to analyse the results, find out the gaps, and implement a quality improvement project to correct the deficits. Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care.

Randomized clinical trial of preoperative skin antisepsis with chlorhexidine gluconate or povidone–iodine

“…Various preventive managements, including perioperative antibiotics, mechanical bowel preparation, hand scrub, skin preparation with antiseptic agents, mechanical barrier film and irrigation of the surgical site, have been tested. As it is well known that a patient's skin is a major source of pathogens, preoperative skin preparation with antiseptic agents is important for decreasing the risk of postoperative SSI.…”

Scope of a weekly infection control team rounding in an acute-care teaching hospital: a pilot study

“…Although several previous studies related to ICTR have been conducted, these studies investigated the benefits of incorporating leadership rounding into infection prevention and focused on the association between infection control activities with rounding and one specific type of infection [2,[4][5][6][7][8]. These assessments indicated that ICTR was successful in the studied context; nonetheless, these studies lack a comprehensive perspective on the mechanisms of rounding.…”

“…The following nine categories of infection control and prevention items were included: (1) hand hygiene (8 items); (2) safety injection practice (9 items); (3) isolation (10 items); (4) strategies to prevent occupationally acquired infections (6 items); (5) practices to prevent catheter-related (central, urine catheter), surgical site infection and pneumonia (16 items); (6) decontamination, disinfection, and sterilization (19 items); (7) linen and laundry management (6 items); (8) environmental prevention of infection (8 items); and (9) maintaining negative/positive pressure (3 items) as shown in Supplemental Table 1 [6].…”

Scope of a weekly infection control team rounding in an acute-care teaching hospital: a pilot study

“…Although several previous studies related to ICTR have been conducted, these studies investigated the bene ts of incorporating leadership rounding into infection prevention and focused on the association between infection control activities with rounding and one speci c type of infection. 2,4,5,6,8,9 These assessments indicated that ICTR was successful in the studied context; nonetheless, these studies lack a comprehensive perspective on the mechanisms of rounding. In contrast, our study evaluated monitoring of infection control activities based on the entire infection prevention protocol, with a grade-based assessment of infection control activities.…”