J. Sharma1, S. Perez1, J. Sweeney1 1Emory University School Of Medicine,Surgery,Atlanta, GA, USA
Introduction:
In 2009, ACS-NSQIP was subscribed at our institution and surgical site infection (SSI) was identified as an area of needed improvement. A multidisciplinary Wound Infection Group (WIG) was tasked to reduce SSI rates and a wound infection prevention process (WIPP) was developed with a focus on colorectal surgery.
Methods:
Between June’2011 and June’2014, NSQIP semiannual reports were queried for O/E ratios for SSI rates. Compliance was measured for 15 elements in WIPP at initiation and then at 12 months in 711 patients. Compliance to each element was reported in 3 categories; Good (>80% of patients), Fair (31-79%) and Poor (<30%). Elements in WIPP were glycemic control; antibiotics timing, re-dosing and appropriateness; skin prep; MRSA screening and treatment; hospital scrubs; double-gloving; use of hair clippers; and patient temperature.
Results:
O/E ratios for SSI in colorectal surgery improved from 1.61 to 0.78; and SSI rates were reduced from 18.2% to 8.2% (p=0.032). Initial measure of compliance to elements in WIPP was 8/15, 5/15 and 2/15 in Good, Fair and Poor categories, respectively; and in 3 elements compliance was in >90% of patients. At 12 months, compliance was 11/15, 3/15 and 1/15 in their respective categories; and in 6 elements compliance was in >90% of patients. Areas with lowest compliance were glycemic control and patient temperature.
Conclusion:
Utilizing ACS-NSQIP, identifying areas of quality improvement, organizing multidisciplinary groups such as WIG, and then developing an institutional best practice such as WIPP can be effective in reducing SSI. Elements with poor compliance can serve as targets of focused quality improvement.