Preventing Surgical Site Infection the Providence Health Care

Preventing Surgical Site Infection the Providence Health Care Experience Dr Ahmer Karimuddin Meghan Mac. Leod Dr Alex Seal PHC Surgical Program University of British Columbia February 19 th, 2015 University of British Columbia

Disclosure There are no conflicts of interest and nothing to disclose

Outline 1. Why this is important 2. Our approach to this challenging problem 3. Bundle 4. Results 5. the FUTURE

THANK YOU

SSI Prevention TEAM • • • • Jock Reid Jim Abel Ahmer Karimuddin Victor Leung Chris Prabhakar Meghan Mac. Leod Lisa Toback Elisa Lloyd-Smith Stephen Parker Michelle Bech Thelma Velasco • • • Randy Rae Jin-So Pao Alice Lee Flavia Mandic Sharon Bisson Paul Smith Howard Green Barry Schafer Lu Oviatt Tamara Younger Lia Randell Lona Cunningham Sandy Grimwood Rupinder Khotar Alex Seal . . . all of SPH and MSJ

THANK YOU SPH & MSJ Team SSI’s

Background • • Why do this? Opportunity to improve the care of patients • • Individual Service Site City, province, etc. . .

Background

DATA NSQIP Risk Adjusted Data Surgical Site Infection All Cases reviewed July 2011 – June 2012 SPH MSJ

Goal of Working Group Ultimately Reduction in Rates of SSI**

Goal of Working Group 1. ID the problem 2. Explore the process 3. Build the Team 4. ID root causes/best practice 5. Select and test solutions

EPIC Approach • Will it be EPIC? • E - Easy to implement • P - Permanent • I - Impact High • C - Cost effective

Best Practice Brainstorm

Strategies for Prevention

Brainstorm

Looked at Other Centres Example initiative: • • Northwestern experience: OR closing bundle (colorectal) • New gloves • New instruments

PHC = FOCUS Bundle • F - Focused • O - Opportunities of • C - Care • U - Utilizing • S - Standards

PHC SSI Prevention Bundles

Example: Pre-op Antibiotics

PHC approach based on best practice 1. Risk Assessment 2. Creation of key preventative strategies 3. Adherence to key strategies 4. Active surveillance • = REDUCTION IN RATES

PHC SSI Prevention Bundle • Areas for Education Opportunities 1. Pre-Admission Clinic ✓ 2. Pre-OP ✓ 3. SPH OR ✓ 4. MSJ OR ✓ 5. PAR ✓ 6. Wards ✓

Appropriate OR Dress Attire

PHC SSI Prevention Bundle Intra Operative FOCUS I pity ‘da fool who dresses like me in da OR

How are we doing now? • S

SPH

MSJ

NSQIP data: Out of the pink!

Implementing a Bundle

SQAN Summer Student AUDIT • Best compliance with bundle intraoperative components

Bundle Compliance AUDIT

SPH

MSJ

FUTURE • Opportunity for improvement • Focus on areas from audit where lower compliance • • • Pre-OP warming Pre-OP surgical site chlorhexidine prep by patient Pre-OP site shave in Daycare

FIN