Sustaining Improvement: Implementation and Spread of a Surgical Site Infection Bundle

2018 ◽  
Vol 84 (10) ◽  
pp. 1665-1669 ◽  
Author(s):  
Tara A. Russell ◽  
Hallie Chung ◽  
Christina Riad ◽  
Sarah Reardon ◽  
Kevork Kazanjian ◽  
...  
Keyword(s):  
General Surgery ◽  
Odds Ratio ◽  
Surgical Site Infections ◽  
Surgical Patients ◽  
Infection Rates ◽  
Process Measures ◽  
Quality Metric ◽  
Effective Implementation ◽  
Acs Nsqip ◽  
Significant Challenge

Surgical site infections (SSIs) are considered a quality metric across surgical specialties and are a major cause of increased readmissions and overall costs to surgical patients. Bundled interventions have demonstrated efficacy in reducing SSIs in various surgical fields, yet the ability to sustain and spread interventions while continuing to reduce infection rates is a significant challenge. This study assessed the implementation and sustainability of an SSI bundle, which was initially piloted within the colorectal surgery division and then spread to additional general surgery services. Outcomes (risk-adjusted ACS-NSQIP odds ratio and observed to expected (O:E) SSI rates) and process measures were monitored on run charts throughout the course of the intervention. By the end of the study period, ACS-NSQIP risk-adjusted odds ratios for SSIs decreased from 1.22 to 0.95 for colorectal procedure targeted and 1.32 to 1.04 for all general surgery procedures ( P < 0.05). O:E ratios showed similar reductions. SSI reductions were associated with process measure compliance. This study demonstrates that effective implementation within a single surgical division provides the foundation for spread of a SSI bundle, which results in continued and sustained reductions in SSI rates.

scholarly journals Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols

2009 ◽  
Vol 30 (10) ◽  
pp. 964-971 ◽  
Author(s):  
Brian R. Swenson ◽  
Traci L. Hedrick ◽  
Rosemarie Metzger ◽  
Hugo Bonatti ◽  
Timothy L. Pruett ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
General Surgery ◽  
Isopropyl Alcohol ◽  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Skin Preparation ◽  
Improvement Project ◽  
Period 2

Objective.To compare the effects of different skin preparation solutions on surgical-site infection rates.Design.Three skin preparations were compared by means of a sequential implementation Design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% Chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.Setting.Single large academic medical center.Patients.All adult general surgery patients.Results.The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% Chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001).Conclusions.Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to Chlorhexidine for this purpose in general surgery patients.

Surgery for the Very Old: Are Nonagenarians Different?

2020 ◽  
Vol 86 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Tanner I. Kim ◽  
Anand Brahmandam ◽  
Laura Skrip ◽  
Timur Sarac ◽  
Alan Dardik ◽  
...  
Keyword(s):  
Hospital Stay ◽  
General Surgery ◽  
Postoperative Hospital Stay ◽  
Surgical Patients ◽  
Perioperative Mortality ◽  
Very Old ◽  
Acs Nsqip ◽  
Acs Nsqip Database ◽  
The Impact

Octogenarians and nonagenarians are considered the “very old” and are often viewed as one group. Americans are aging, with the proportion of the very old expected to increase from 1.9 per cent of the population to 4.3 per cent in 2050. This study aimed to underscore the differences in surgical trends, demographics, and outcomes between octogenarians and nonagenarians. The ACS-NSQIP database (2007–2012) was used to derive the type of surgeries, demographics, and outcomes of octogenarian and nonagenarians undergoing nonemergent vascular, orthopedic, and general surgery procedures. Between 2007 and 2012, nonagenarians accounted for an increasing percentage of surgeries (85 to 121 per 10,000 surgeries, relative risk = 1.42; 95% CI: 1.30–1.54) across surgical specialties, including vascular, general, and orthopedic surgery, whereas the percentage of octogenarians undergoing surgery remained unchanged. Nonagenarians had a higher 30-day perioperative mortality and a longer hospital stay than octogenarians after vascular, orthopedic, and general surgery procedures. Nonagenarians are a rapidly growing group of surgical patients with significantly higher perioperative mortality and longer postoperative hospital stay. The impact of surgery on the quality of life of nonagenarians needs to be studied to justify the increasing healthcare costs.

Risk factors related to surgical site infections among surgical patients in developing world: a systematic review

2020 ◽  
pp. 1984-1992
Author(s):  
Faihan Alotaibi ◽  
Faisal Alnemari ◽  
Alwaleed Alsufyani ◽  
Aisha Al-sanea ◽  
Abeer Al-Nashri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Developing World ◽  
Surgical Site Infections ◽  
Surgical Patients

Independent Operating by General Surgery Residents: An ACS-NSQIP Analysis

2021 ◽  
Author(s):  
Karen J Dickinson ◽  
Barbara L Bass ◽  
Edward A Graviss ◽  
Duc T Nguyen ◽  
Kevin Y Pei
Keyword(s):  
General Surgery ◽  
Acs Nsqip

58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Mistry ◽  
B Woolner ◽  
A John
Keyword(s):  
Surgical Site Infection ◽  
Open Cholecystectomy ◽  
Surgical Site Infections ◽  
Standard Operating Procedure ◽  
Site Infection ◽  
Infection Rates ◽  
Local Evidence ◽  
Audit Data ◽  
The Impact ◽  
To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

scholarly journals Persistently higher serum sCD40L levels are associated with outcome in septic patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yingjian Liang ◽  
Chengrui Zhu ◽  
Yini Sun ◽  
Zhiliang Li ◽  
Liang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Odds Ratio ◽  
Cd40 Ligand ◽  
Surgical Patients ◽  
Soluble Cd40 Ligand ◽  
Icu Admission ◽  
Time Changes ◽  
And Control ◽  
Type Of Surgery

Abstract Background Soluble CD40 ligand (sCD40L) exhibits proinflammatory and procoagulant effects. Recent data indicated that sCD40L plays a significant role in septic patients. The aim of the present study was to determine sCD40L changes in surgical patients without sepsis (SWS) and surgical sepsis patients (SS) during the first 3 days after intensive care unit (ICU) admission and to observe the association between sCD40L and mortality. Methods Time changes in sCD40L levels were assessed for 3 days after ICU admission in 49 patients with SS and compared with those in 19 SWS patients. Serum sCD40L concentration was detected by ELISA. Survival at 28 days served as the endpoint. Results SS had significantly higher sCD40L levels than SWS and control patients. We observed an association between sCD40L levels ≥1028.75 pg/mL at day 2 and 28-day mortality (odds ratio = 7.888; 95% confidence interval = 1.758 to 35.395; P = 0.007). We could not discover any significant differences in sex, presence of septic shock, site of infection, length of stay in the ICU, PaO2/FiO2 ratio, incidence of AKI, ARDS, or type of surgery between nonsurvivors and survivors. Conclusions Septic patients show persistently higher circulating sCD40L levels in the first 3 days after ICU admission, and serum sCD40L levels are associated with the mortality of patients with sepsis. Thus, serum sCD40L may be used as a reliable biomarker and therapeutic target in sepsis.

scholarly journals Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

2020 ◽  
Vol 18 ◽  
pp. 205873922096054
Author(s):  
Faiz Ullah Khan ◽  
Yu Fang ◽  
Zakir Khan ◽  
Farman Ullah Khan ◽  
Zafar Iqbal Malik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transurethral Resection ◽  
Surgical Site Infections ◽  
Exploratory Laparotomy ◽  
Cross Sectional Study ◽  
Surgical Patients ◽  
Related Factors ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Associated Risk Factors

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

scholarly journals Trends in orthopaedic antimicrobial prophylaxis in the UK between 2005 and 2011

2013 ◽  
Vol 95 (7) ◽  
pp. 495-502 ◽  
Author(s):  
RS Aujla ◽  
DJ Bryson ◽  
A Gulihar ◽  
GJ Taylor
Keyword(s):  
Orthopaedic Surgery ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Elective Surgery ◽  
Antimicrobial Prophylaxis ◽  
Trauma Surgery ◽  
Surgical Site Infections ◽  
Freedom Of Information ◽  
Infection Rates ◽  
Freedom Of Information Act ◽  
The Uk

Introduction Antimicrobial prophylaxis remains the most powerful tool used to reduce infection rates in orthopaedics but the choice of antibiotic is complex. The aim of this study was to examine trends in antimicrobial prophylaxis in orthopaedic surgery involving the insertion of metalwork between 2005 and 2011. Methods Two questionnaires (one in 2008 and one in 2011) were sent to all National Health Service trusts in the UK using the Freedom of Information Act. Results In total, 87% of trusts that perform orthopaedic surgery responded. The use of cefuroxime more than halved between 2005 and 2011 from 80% to 36% and 78% to 26% in elective surgery and trauma surgery respectively. Combination therapy with flucloxacillin and gentamicin rose from 1% to 32% in elective and 1% to 34% in trauma surgery. Other increasingly popular regimes include teicoplanin and gentamicin (1% to 10% in elective, 1% to 6% in trauma) and co-amoxiclav (3% to 8% in elective, 4% to 14% in trauma). The majority of changes occurred between 2008 and 2010. Over half (56%) of the trusts stated that Clostridium difficile was the main reason for changing regimes. Conclusions In 2008 a systematic review involving 11,343 participants failed to show a difference in surgical site infections when comparing different antimicrobial prophylaxis regimes in orthopaedic surgery. Concerns over C difficile and methicillin resistant Staphylococcus aureus have influenced antimicrobial regimes in both trauma and elective surgery. Teicoplanin would be an appropriate choice for antimicrobial prophylaxis in both trauma and elective units but this is not reflected in its current level of popularity.

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