Reducing Surgical Site Infections at a Pediatric Academic Medical Center

doi:10.1016/S1553-7250(09)35026-6

The Joint Commission Journal on Quality and Patient Safety

Volume 35, Issue 4, April 2009, Pages 192-198

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https://doi.org/10.1016/S1553-7250(09)35026-6 Get rights and content

Article-at-a-Glance

Background

Surgical site infections (SSIs) remain a substantial cause of morbidity, mortality, increased length of stay, and increased hospital costs. Cincinnati Children’s Hospital Medical Center (CCHMC) used reliability science to dramatically reduce the rate of surgical site infections.

Methods

Key activities included the development and implementation of strategies to enhance the proportion of patients who receive timely antibiotic administration, a pediatric surgical site infection–prevention bundle, and procedure-specific pediatric surgical site infection–prevention bundles. Measures are presented in monthly reports and annotated control charts that are shared with the improvement team and organizational leadership and that are also posted on the hospital’s patient safety intranet site.

Results

The Class I and II SSI rate decreased from 1.5 per 100 procedure days at baseline to 0.54 per 100 procedure days, a 64% reduction. The process has remained stable (within control limits) since August 2007. There were 33 fewer surgical site infections in fiscal year (FY) 2006 than in FY 2005, and 21 fewer in FY 2007 than in FY 2006. By December 2007, 91% of eligible same-day surgery patients received antibiotics within 60 minutes before a procedure, and 94% of patients undergoing inpatient surgery received antibiotics within 60 minutes prior to incision.

Discussion

Pediatric surgical patients can now expect a safer, more efficient experience with CCHMC’s care system and reduced variation in care across CCHMC’s surgeons and procedures. Sharing data on individual and collective provider performance was important in recruiting provider support. Examining data on any failures each day allowed assessment and correction, facilitating rapid-cycle improvement. Making the right thing to do the easy thing to do facilitated the behavior changes required.

Section snippets

Improvement Focus

Starting in September 2003, we focused on reducing infections in Class I (clean) and Class II (clean-contaminated) surgical wounds.⁵ In accordance with criteria established by the Centers for Disease Control and Prevention in its National Nosocomial Infections Surveillance (NNIS) system,6., 7. for nonsurgical-implant cases, an SSI was defined as occurring within 30 days after the operation. When an implant was placed (for example, a pacemaker, ventriculoperitoneal shunt, orthopedic hardware),

SSIs

The decrease in SSIs is shown in Figure 4 (page 197). During the baseline period of January through December 2004, the Class I and II SSI rate was 1.5 per 100 procedure days. Since then, the SSI rate has been 0.54 per 100 procedure days, a 64% reduction. The process has remained stable (within control limits) since August 2007 (FY 2008).

There were 33 fewer SSIs in FY 2006 than in FY 2005, and 21 fewer in FY 2007 than in FY 2006. For patients undergoing neurosurgical ventriculoperitoneal shunt

Discussion

Successful system redesign requires coordinating and managing a complex set of changes across multiple system levels. Important features include support, vision, and guidance by senior and middle-level leaders; supportive information management and performance appraisal systems; effective use of improvement and learning techniques; and mobilization of the commitment and energy of health professionals responsible for implementing key changes.¹² Our pediatric surgical patients can now expect a

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Reducing Surgical Site Infections at a Pediatric Academic Medical Center

Article-at-a-Glance

Background

Methods

Results

Discussion

Section snippets

Improvement Focus

SSIs

Discussion

Pediatr Clin North Am

Am J Infect Control

Jt Comm J Qual Patient Saf

Nosocomial infections in pediatric intensive care units in the United States

Pediatrics

Financial impact of failing to prevent surgical site infections

Qual Manag Health Care

Guideline for prevention of surgical site infections, 1999. Centers for Disease Control and Prevention (CDC) Hospital Control Practices Advisory Committee

Am J Infect Control