scholarly journals Adjustments to an Existing Colorectal Surgical Site Infection Prevention Bundle Lead to Fewer Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s111-s111
Author(s):  
Kathleen McMullen ◽  
Gaylene Dunn ◽  
Sheri McDuffie ◽  
Bradley Freeman
Keyword(s):  
Surgical Site Infections ◽  
Successful Implementation ◽  
Operating Room Personnel ◽  
Team Members ◽  
Notable Increase ◽  
Time Savings ◽  
Bundle Compliance ◽  
Patient Optimization ◽  
Evidence Based Guidelines ◽  
Professional Guidelines

Background: Surgical site infections (SSI) related to colorectal procedures are detrimental to patients and publicly reportable events. Our institution implemented a successful bundle of interventions to decrease SSI rates in 2014. In 2018, compliance started to wane, with a concurrent increase in infections. In an effort to enhance compliance and incorporate up-to-date information, we convened a multidisciplinary team to streamline this process. Methods: Our team evaluated published studies on successful bundle components and updates to professional guidelines for SSI prevention to determine adjustments. Modifications included allowing surgeon preference for (rather than mandating) wound protector use and simplification of clean closure protocol (determined by intraoperative contamination, leading to more efficient closure time). In addition, measures were added to achieve perioperative patient optimization (maintenance of normothermia, prevention of intraoperative hypoxia, tighter glucose control and postoperative bathing). The bundle was implemented in stages starting January 2019. SSI rates were monitored throughout the process using NHSN definitions, and rates were compared using χ2 analysis (Epi Info, CDC). Results: From 2015 to 2017, bundle compliance was 90%, and 8 SSIs (rate, 3.8 per 100 procedures) were detected (Table 1). In 2018, compliance was 82%, with 4 SSIs (rate, 6.6 per 100 procedures). From January through September 2019, SSI rates decreased to a rate of 4.8 per 100 procedures, with notable increase in superficial SSI, with zero cases of deep or organ-space infections. Feedback from operating-room personnel indicated their commitment to bundle compliance and perceived intraoperative time savings. Conclusions: Revamping an existing colorectal SSI bundle, including relaxation of time-intensive and expensive intraoperative measures and increased focus on evidence-based guidelines, resulted in decreased deep-organ space SSI rates, as well as increased satisfaction from procedural team members. Successful implementation of care pathways to prevent infections is an iterative process and requires the engagement of practitioners.Funding: NoneDisclosures: None

scholarly journals Validation of an algorithm for semiautomated surveillance to detect deep surgical site infections after primary total hip or knee arthroplasty—A multicenter study

2020 ◽  
Vol 42 (1) ◽  
pp. 69-74
Author(s):  
Janneke D. M. Verberk ◽  
Stephanie M. van Rooden ◽  
Mayke B. G. Koek ◽  
David J. Hetem ◽  
Annelies E. Smilde ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
High Probability ◽  
Surgical Site Infections ◽  
Data Interpretation ◽  
Routine Care ◽  
Successful Implementation ◽  
Subjective Data ◽  
Essential Information ◽  
Total Hip ◽  
Healthcare Associated

AbstractObjective:Surveillance of healthcare-associated infections is often performed by manual chart review. Semiautomated surveillance may substantially reduce workload and subjective data interpretation. We assessed the validity of a previously published algorithm for semiautomated surveillance of deep surgical site infections (SSIs) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) in Dutch hospitals. In addition, we explored the ability of a hospital to automatically select the patients under surveillance.Design:Multicenter retrospective cohort study.Methods:Hospitals identified patients who underwent THA or TKA either by procedure codes or by conventional surveillance. For these patients, routine care data regarding microbiology results, antibiotics, (re)admissions, and surgeries within 120 days following THA or TKA were extracted from electronic health records. Patient selection was compared with conventional surveillance and patients were retrospectively classified as low or high probability of having developed deep SSI by the algorithm. Sensitivity, positive predictive value (PPV), and workload reduction were calculated and compared to conventional surveillance.Results:Of 9,554 extracted THA and TKA surgeries, 1,175 (12.3%) were revisions, and 8,378 primary surgeries remained for algorithm validation (95 deep SSIs, 1.1%). Sensitivity ranged from 93.6% to 100% and PPV ranged from 55.8% to 72.2%. Workload was reduced by ≥98%. Also, 2 SSIs (2.1%) missed by the algorithm were explained by flaws in data selection.Conclusions:This algorithm reliably detects patients with a high probability of having developed deep SSI after THA or TKA in Dutch hospitals. Our results provide essential information for successful implementation of semiautomated surveillance for deep SSIs after THA or TKA.

scholarly journals Surgical Infections and Antibiotic Stewardship: In Need for New Directions

2019 ◽  
pp. 145749691989161 ◽  
Author(s):  
R. Andersson ◽  
K. Søreide ◽  
D. Ansari
Keyword(s):  
Surgical Site Infection ◽  
English Language ◽  
Medical Profession ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Health Economy ◽  
Site Infection ◽  
Remote Sites ◽  
Guidelines And Recommendations ◽  
Evidence Based Guidelines

Background and Aims: Patients undergoing surgery are prone to infections, either at the site of surgery (superficial or organ-space) or at remote sites (e.g. pneumonia or urinary tract). Surgical site infections are associated with substantial morbidity and mortality, increased length of hospital stay and represent a huge burden to the health economy across all healthcare systems. Here we discuss recent advances and challenges in the field of surgical site infections. Material and Methods: Review of pertinent English language literature. Results: Numerous guidelines and recommendations have been published in order to prevent surgical site infections. Compliance with these evidence-based guidelines vary and has not resulted in any major decrease in the surgical site infection rate. To date, most efforts to reduce surgical site infection have focused on the role of the surgeon, but a more comprehensive approach is necessary. Conclusion: Surgical site infections need to be addressed in a structured way, including checklists, audits, monitoring, and measurements. All stakeholders, including the medical profession, the society, and the patient, need to work together to reduce surgical site infections. Most surgical site infections are preventable—and we need a paradigm shift to tackle the problem.

scholarly journals Beyond Open Data Hackathons: Exploring Digital Innovation Success

Information ◽  
2019 ◽  
Vol 10 (7) ◽  
pp. 235 ◽  
Author(s):  
Fotis Kitsios ◽  
Maria Kamariotou
Keyword(s):  
Case Studies ◽  
Open Data ◽  
Problem Definition ◽  
Successful Implementation ◽  
Digital Innovation ◽  
Team Members ◽  
Effective Implementation ◽  
Entry Requirements ◽  
Preparation And Evaluation ◽  
Significant Factors

Previous researchers have examined the motivations of developers to participate in hackathons events and the challenges of open data hackathons, but limited studies have focused on the preparation and evaluation of these contests. Thus, the purpose of this paper is to examine factors that lead to the effective implementation and success of open data hackathons and innovation contests. Six case studies of open data hackathons and innovation contests held between 2014 and 2018 in Thessaloniki were studied in order to identify the factors leading to the success of hackathon contests using criteria from the existing literature. The results show that the most significant factors were clear problem definition, mentors’ participation to the contest, level of support to participants by mentors in order to launch their applications to the market, jury members’ knowledge and experience, the entry requirements of the competition, and the participation of companies, data providers, and academics. Furthermore, organizers should take team members’ competences and skills, as well as the support of post-launch activities for applications, into consideration. This paper can be of interest to organizers of hackathon events because they could be knowledgeable about the factors that should take into consideration for the successful implementation of these events.

The Adam Williams Initiative: Collaborating With Community Resources to Improve Care for Traumatic Brain Injury

2014 ◽  
Vol 34 (6) ◽  
pp. 39-47 ◽  
Author(s):  
Mary Kay Bader ◽  
Sonja E. Stutzman ◽  
Sylvain Palmer ◽  
Chiedozie I. Nwagwu ◽  
Gary Goodman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Treatment Guidelines ◽  
The United States ◽  
Brain Trauma ◽  
Successful Implementation ◽  
Team Members ◽  
Staff Members ◽  
Brain Trauma Foundation ◽  
The Brain

Background The Brain Trauma Foundation has developed treatment guidelines for the care of patients with acute traumatic brain injury. However, a method to provide broad acceptance and application of these guidelines has not been published. Objective To describe methods for the development, funding, and continued educational efforts of the Adam Williams Initiative; the experiences from the first 10 years may serve as a template for hospitals and nurses that seek to engage in long-term quality improvement collaborations with foundations and/or industry. Methods In 2004, the nonprofit Adam Williams Initiative was established with the goal of providing education and resources that would encourage hospitals across the United States to incorporate the Brain Trauma Foundation’s guidelines into practice. Results Between 2004 and 2014, 37 hospitals have been funded by the Adam Williams Initiative and have had staff members participate in an immersion experience at Mission Hospital (Mission Viejo, California) during which team members received both didactic and hands-on education in the care of traumatic brain injury. Conclusions Carefully cultivated relationships and relentless teamwork have contributed to successful implementation of the Brain Trauma Foundation’s guidelines in US hospitals.

Indications for Platelet Transfusions: How Well Do Physicians Comply with Professional Guidelines

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4402-4402
Author(s):  
Elena Katz ◽  
Malgorzata Klek ◽  
Randy L. Levine ◽  
Robert E Graham
Keyword(s):  
Medical Record ◽  
Platelet Transfusion ◽  
Quantitative Relation ◽  
Clinical Indication ◽  
Evidence Based ◽  
Step Down ◽  
Transfusion Guidelines ◽  
Evidence Based Guidelines ◽  
Professional Guidelines ◽  
Platelet Transfusions

Abstract Abstract 4402 Background: Professional, evidence-based guidelines are developed to help physicians implement best practice care. Unfortunately, guidelines are not followed. Platelet transfusion guidelines have recently changed to a prophylactic transfusion threshold of 10, 000/μ L from the older threshold of 20,000/μ L. We conducted a retrospective analysis at a metropolitan teaching hospital to assess how well physicians comply with the new professional guidelines as well as the older, less stringent criteria to administer platelet transfusions. Methods: All patients admitted to the medical service who received platelet transfusions over a two month period in 2010 were reviewed. These patients represented the following services: ICU, general medicine, medical step down, interventional cardiology, CCU, and the cardiac step down unit. The indication selected in the computerized physician order entry (CPOE) system was compared to the clinical indication found in the patients’ medical record. The medical record clinical indication was then evaluated against the American Society of Hematology (ASH) 2007 “Evidence-Based Platelet Transfusion Guidelines” (Slichter SJ. Hematology 2007): bleeding and platelets ≤50, 000/μ L, pre-invasive procedure and platelets ≤50, 000/μ L, prophylactic transfusion for platelets ≤10, 000/μ L and WHO bleeding grade ≥ 2. We also assessed how the patients’ clinical indication met the older less stringent prophylactic threshold for platelet transfusion of ≤20, 000/μ L laid forth by the landmark study by Gaydos LA. et. al. (The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med 1962). Results: A total of 108 patients received platelet transfusions; 29 were medicine patients to tally 95 platelet transfusions. The most common patient clinical indication was “platelets ≤ 20, 000/μ L without bleeding” (27%), while the clinical indication was not specified in 16% of cases. The CPOE documented indication coincided with the patient's clinical indication from the medical record in 23% of cases. Sixty five percent of the time the patient's clinical indication failed to meet the currently accepted 2007 ASH guidelines and 36% of cases failed to meet the older less stringent guidelines. Conclusions: A majority of platelet transfusions did not meet the current professional guidelines for indication. Our pilot study suggests the need for more physician education regarding evidence-based guidelines for platelet transfusions, and in a larger context, initiatives to enhance compliance. We are currently developing an educational intervention and plan to reassess compliance with indications pre and post intervention. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Dietitians' perceptions and experience of blenderised feeds for paediatric tube-feeding

2016 ◽  
Vol 102 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Janis Armstrong ◽  
Elaine Buchanan ◽  
Hazel Duncan ◽  
Kathleen Ross ◽  
Konstantinos Gerasimidis
Keyword(s):  
Clinical Practice ◽  
Tube Feeding ◽  
Infection Risk ◽  
Previous Experience ◽  
Evidence Based ◽  
Web Based ◽  
Commercial Feeds ◽  
Evidence Based Guidelines ◽  
Professional Guidelines

ObjectiveThere is an emerging interest in the use of blenderised food for tube-feeding (BFTF). This survey explored paediatric dietitians' perceptions and experiences of BFTF use.DesignA web-based questionnaire was distributed to the Paediatric group of the British Dietetic Association. The survey captured dietitians' personal opinions and experience supporting children on BFTF, and the perceptions of carers.ResultsOf the 77 respondents, 19 were aware of professional guidelines and 63 had never received training on BFTF. Thirty-four would not recommend BFTF and 11 would advise against its use; yet 43 would recommend it to supplement commercial feeds. Fifty-seven would change their perception about BFTF if there were evidence-based guidelines. Forty-four would feel confident to support a patient using BFTF. Forty-three had previous experience supporting a patient with BFTF. The main concerns perceived by dietitians, pertinent to the use of BFTF, were nutritional inadequacy (n=71), tube blockages (n=64) and increased infection risk (n=59) but these were significantly higher than those experienced by themselves in clinical practice (p<0.001 for all three). A reduction in reflux and vomiting and increased carer involvement were the main perceived and observed benefits by both dietitians and carers.ConclusionsThe use of these feeds for tube-fed children is increasingly being seen as a viable choice. Dietitians experienced significantly fewer issues with the use of BFTF in clinical practice compared with their self-reported apprehensions in the survey. Well-controlled studies are now needed to objectively assess the benefits, risks, costs and practicality of BFTF.

scholarly journals 899. Reduction of Surgical Site Infections Post Cesarean Section through Implementation of Novel Evidenced Based Bundle

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S483-S484
Author(s):  
Maria Vacca ◽  
Marilyn A Mapp ◽  
Ashlee Hiester ◽  
Nikunj M Vyas ◽  
Julia Burke ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Infection Control ◽  
Real Time ◽  
Surgical Site Infections ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Significant Drop ◽  
Bundle Compliance ◽  
Evidenced Based ◽  
Prospective Audit And Feedback

Abstract Background A frequent complication post cesarean section (C-section) is surgical site infections (SSI) which are associated with heightened maternal morbidity and mortality, decreased patient satisfaction, prolonged hospitalization, and increased costs. In Calendar Year 2019, our Infection Control Committee identified an increase in the incidence of post-operative C-section SSI rates over an 8 month period from January through August of 2019.. The purpose of this study was to develop, implement and measure the compliance and efficacy of a novel pre-operative bundle (POB) for patients undergoing C-section. Calendar Year 2019 Jan. through Aug. C-Section Infections Raw Numbers Methods In October 2019, our multidisciplinary team consisting of Infection Control, Pharmacy, Nursing, and Physicians developed and implemented POB for patients undergoing C-section. The POB included the following: 1. Mandatory interventions of vaginal cleansing using povidone iodine 2. Chlorhexidine (CHG) 2% wipes to abdomen 3. Addition of Azithromycin 500mg x 1 dose as pre-operative antibiotic. Primary endpoint of the study was to measure the overall C-section SSI incidence for 8 months period pre and 8 months post implementation of the POB. This Secondary endpoint of the study included POB compliance and efficacy of real-time prospective audit and feedback for non-compliance. Novel Preoperative Bundle Auditing Compliance Results There were total of 212 patients who received C-section in Pre-POB group and 182 in Post-POB group. Baseline characteristics between the groups were similar. Overall C-section rates Pre-POB was 3.8 % vs 0% in Post-POB group. We noted a bundle compliance of 97.9% since implementation of POB. Real time prospective audit and feedback was provided to total of 122 cases after implementation of POB. Comparison of C-Section Raw Numbers Calendar Year 2019 Pre and Post Novel Bundle Implementation Conclusion With implementation of POB, we noticed a significant drop in our C-section SSI. We observed a very high bundle compliance with implementation of prospective audit and feedback approach. This is the first study evaluating implementing a novel pre-operative bundle for patients undergoing C-section. Continued auditing and real time feed back of novel bundle will ensure continued success. Disclosures All Authors: No reported disclosures

scholarly journals Patient- and Family-Centered Video Rounds in the Pediatric Intensive Care Unit

2020 ◽  
Author(s):  
Ryan L. DeSanti ◽  
Diane H. Brown ◽  
Sushant Srinivasan ◽  
Tom Brazelton ◽  
Michael Wilhelm
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Successful Implementation ◽  
Care Providers ◽  
Team Members ◽  
Social Distancing ◽  
Work From Home ◽  
Family Centered

Objective: Management of the coronavirus disease 2019 (COVID-19) pandemic has required social distancing requirements and personal protective equipment shortages, which have forced hospitals to modify patient care rounds. We describe our process developing telemedicine rounds to maintain synchronous, multidisciplinary, pediatric intensive care unit rounds. By adapting available resources using rapid process improvement (PI), we were able to develop patient- and family-centered video rounds (PFCVR). Design: When rounding team members were forced to work from home, we adapted an existing telemedicine platform (VidyoConnect) to perform PFCVR. A quality improvement (QI) team developed an initial standard process, which underwent rapid PI using a small multidisciplinary team. Setting: A 21-bed, mixed medical/surgical/cardiac pediatric intensive care unit. Participants: Critical care patients, families, physicians, consultants, nurses, and ancillary staff. Interventions: The QI team initially met daily, then weekly, sought feedback from nurses, families, and other care providers, and utilized small tests of change to improve the rounding process. Results: We established standardized, socially distanced rounds using VidyoConnect to allow synchronous, multidisciplinary PFCVR. Implementation of a schedule and rounding script facilitated efficient and effective team communication, optimized participation by the entire team, and decreased interruptions. Conclusions: The COVID-19 pandemic compromised the feasibility of the previous rounding process. PFCVR is a safe and effective tool to facilitate communication while adhering to social distancing guidelines. Use of available platforms and team-based PI is critical for successful implementation.

Barriers to Implementation of Physical Activity in Danish Public Schools

2020 ◽  
pp. 1-10
Author(s):  
Sofie Koch ◽  
Jens Troelsen ◽  
Samuel Cassar ◽  
Charlotte Skau Pawlowski
Keyword(s):  
Physical Activity ◽  
Public Schools ◽  
School Management ◽  
Management Team ◽  
Successful Implementation ◽  
Socioecological Model ◽  
Team Members ◽  
Public School Reform ◽  
New Public ◽  
Barriers To Implementation

Purpose: In 2014, the Danish Government introduced a new public school reform, which included implementation of 45 min of daily physical activity (PA) within the academic classroom curriculum. The purpose of the present study was to explore school staff’s perceived barriers to implementation of a national PA policy. Method: A mixed-methods approach using a questionnaire and semistructured interviews was conducted. A total of 198 teachers and 26 school management team members (principals, deputy principals, and leading teachers) from 31 schools completed a questionnaire, and 11 school management team members were interviewed. The socioecological model was used as a theoretical framework to examine the results. Results: A total of 15 different barriers were identified and reflected within all levels of the socioecological model. Facilities, motivation, and time were the most prominent barriers identified. Conclusion: Development and deployment of a national PA policy needs to be done in cooperation with consumers from all levels within the socioecological model to ensure successful implementation.

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