scholarly journals Quality Improvement Initiative: Reducing Surgical Site Infections in Medical Facility Serving the Underserved Population

2020 ◽  
Author(s):  
Chukwuemeka Mbagwu
Keyword(s):  
Quality Improvement ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative ◽  
Underserved Population ◽  
Medical Facility

66 - Impact of Postoperative Neurosurgery Order Sets on Glycemic Control and Surgical Site Infections: A Quality-Improvement Initiative

2019 ◽  
Vol 43 (7) ◽  
pp. S26
Author(s):  
Dena Sommer ◽  
Barbara Mcarthur ◽  
Mahsa Sadeghi ◽  
Mary Rozmanc ◽  
Avery Nathens ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Glycemic Control ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative ◽  
Order Sets

Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 47-53 ◽  
Author(s):  
David Parizh ◽  
Enrico Ascher ◽  
Syed Ali Raza Rizvi ◽  
Anil Hingorani ◽  
Michael Amaturo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Vascular Surgery ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative ◽  
Site Infection ◽  
Surgical Site Infection Rate ◽  
Patient Demographics ◽  
Revascularization Procedures

Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. Summary background data: In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p < 0.005). Conclusions Preventative measures, in the form of a standardized protocol, to decrease surgical site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

scholarly journals Improving intraoperative administration of surgical antimicrobial prophylaxis: a quality improvement report

2020 ◽  
Vol 9 (3) ◽  
pp. e001042
Author(s):  
Victoria Haney ◽  
Stephan Maman ◽  
Jansie Prozesky ◽  
Dmitri Bezinover ◽  
Kunal Karamchandani
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Prophylaxis ◽  
Surgical Care ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative ◽  
Antibiotic Administration ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Surgical Antimicrobial Prophylaxis ◽  
Care Improvement

Despite widespread adoption of the Surgical Care Improvement Programme, the incidence of surgical site infections (SSIs) remains high. It is possible that lapses in appropriate administration of antimicrobial prophylaxis may play a role. We noted significant discordance with national guidelines with regards to intraoperative antibiotic administration at our institution, leading to implementation of a quality improvement initiative using multidisciplinary education and reminder-based interventions to improve prescribing practices and increase compliance with national guidelines. We observed a significant improvement in adherence to all aspects of antibiotic administration guidelines as a result of such interventions. Targeted multidisciplinary interventions may help improve prescribing practices of surgical antimicrobial prophylaxis and provide an opportunity to potentially decrease the burden of SSI and the related morbidity and mortality.

scholarly journals Decreasing Surgical Site Infections after Ventral Hernia Repair: A Quality-Improvement Initiative

2017 ◽  
Vol 18 (7) ◽  
pp. 780-786 ◽  
Author(s):  
Deepa V. Cherla ◽  
Julie L. Holihan ◽  
Juan R. Flores-Gonzalez ◽  
Debbie F. Lew ◽  
Richard J. Escamilla ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative

scholarly journals 1096. Reducing Unnecessary Postoperative Antibiotic Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S389-S390
Author(s):  
Talene A Metjian ◽  
Jeffrey Gerber ◽  
Adam Watson ◽  
Caroline Burlingame ◽  
Heuer Gregory ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antibiotic Prophylaxis ◽  
Adverse Drug Events ◽  
Tethered Cord ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Quality Improvement Initiative ◽  
National Guidelines ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background National guidelines for the prevention of surgical site infections (SSI) recommend against antibiotic prophylaxis following wound closure for clean and clean-contaminated surgical procedures. Prolonged antibiotic prophylaxis can lead to antibiotic resistance and adverse drug events without reducing SSI rates. The objective was to reduce the rate of antibiotic prophylaxis following surgical incision closure for specified procedures in the Divisions of Neurosurgery (NRS), Otolaryngology (OTO), and General Surgery (GS) at Children’s Hospital of Philadelphia (CHOP). Methods We identified all NRS, OTO, and GS procedures conducted at CHOP from July 1, 2016 to June 20, 2017. Collaborative meetings between surgical quality improvement team leads and the antimicrobial stewardship program (ASP) were convened to identify procedures most suitable for the intervention, including Chiari decompressions and tethered cord repair (NRS); tympanoplasty and tracheostomy (OTO); and laparoscopic and thoracoscopic procedures (GS). The intervention, started in March 2018, included (1) education of surgeons on perioperative prescribing guidelines, (2) order set modification, and (3) individualized monthly audit with feedback reports of inappropriate postoperative prescribing (via email copying all surgeons within the division). We monitored rates utilizing SPC charts of postoperative antibiotic use (defined as administration within 24 hours of procedure end) and evaluated SSI rates pre and post-intervention with a Poisson regression. Results Following the intervention, postoperative antibiotic use reached special cause resulting in a mean decline for laparoscopy (19.6% to 11.7%), thoracoscopy (35.6% to 17.9%), tympanoplasty (90.5% to 11.4%), tethered cord repair (95% to 25.5%), and Chiari decompression (97% to 45.9%). There was no mean shift in postoperative antibiotic use for tracheostomy (25.5%). 30-day SSI rates did not change pre- and post-intervention (P = 0.36). Conclusion A quality improvement initiative conducted to implement national guidelines recommending against postoperative antibiotic prophylaxis showed a significant reduction in postoperative antibiotic prophylaxis without a concomitant rise in SSI rates. Disclosures All authors: No reported disclosures.

scholarly journals Results of a quality improvement initiative reassessing an institutional lumbar drain infection prevention protocol

2018 ◽  
Vol 29 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Ariane Lewis ◽  
Aaron Rothstein ◽  
Donato Pacione
Keyword(s):  
Quality Improvement ◽  
Surgical Site Infections ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Quality Improvement Initiative ◽  
Median Cost ◽  
Lumbar Drain ◽  
Period 2 ◽  
Drain Removal ◽  
Daily Sampling

OBJECTIVEThe objective of this study was to determine the effects of a quality improvement initiative in which daily antibiotics and daily sampling of cerebrospinal fluid (CSF) were discontinued for patients with lumbar drains.METHODSThe frequency of surgical site infections (SSIs), antibiotic-related complications (development of Clostridium difficile infection [CDI] and growth of resistant bacteria), and cost for patients with lumbar drains were compared during 3 periods: 1) prolonged prophylactic systemic antibiotics (PPSA) until the time of drain removal and daily CSF sampling (September 2013–2014), 2) PPSA and CSF sampling once after placement then as needed (January 2015–2016), and 3) antibiotics only during placement of the lumbar drain and CSF sampling once after placement then as needed (April 2016–2017).RESULTSThirty-nine patients were identified in period 1, 53 patients in period 2, and 39 patients in period 3. There was no change in the frequency of SSI after discontinuation of routine CSF testing or PPSA (0% in period 1, 2% in period 2, and 0% in period 3). In periods 1 and 2, 3 patients developed infections due to resistant organisms and 2 patients had CDI. In period 3, 1 patient had an infection due to a resistant organism. The median cost of CSF tests per patient was $100.68 (interquartile range [IQR] $100.68–$134.24) for patients in period 1 and $33.56 (IQR $33.56–$33.56) in periods 2 and 3 (p < 0.001). The median cost of antibiotics per patient was $26.32 (IQR $26.32–$30.65) in periods 1 and 2 and $3.29 ($3.29–$3.29) in period 3 (p < 0.001). The cost associated with growth of resistant bacteria and CDI was $91,291 in periods 1 and 2 and $25,573 in period 3.CONCLUSIONSAfter discontinuing daily antibiotics and daily CSF sampling for patients with lumbar drains, the frequency of SSI was unchanged and the frequency of antibiotic-related complications decreased.

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