BACKGROUND - IHI

[Pages:1]Reducing Surgical Site Infections in Plastic Surgery Cases

By Reducing Variation in Intra-Operative Care

BACKGROUND

After experiencing an increase in surgical site infections in Plastic Surgery cases from fiscal year 2015 to fiscal year 2016, and reaching special cause variation in March of 2016, the Plastic Surgery division at Children's Hospital of Philadelphia decided to utilize the intra-operative checklist that was being used for implant cases and expand it to all Plastic Surgery cases, along with implementing tests of change for the standardization of the checklist.

SMART Aim

Aim

Zero Surgical Site Infections

Reduce Surgical Site infections by 40%

Outcome

Implemented Intra-Op

Checklist for Implant

Procedures

Implemented Pre-Op Bathing

Checklist

Expanded IntraOp Checklist to all Procedures

Rates per 100 Procedures

FY 15 Rate

0.56

FY 16 Rate

0.77

FY 17 Rate

0.15

Reduced Surgical Site infections by 80%!

INTERVENTIONS

October 2015: The standardized intra-operative checklist originally developed by the neurosurgery division was implemented in Plastic Surgery implant cases

June 2016: After seeing success in rate reduction for implant cases, the intra-operative checklist was expanded to be used in ALL Plastic Surgery cases

September 2016: A standardized pre-operative bathing checklist was created and implemented for all Plastic Surgery patients

October 2016: Tests of change around personal items in the OR and prepping of patient prior to draping were done and added to the checklist

May 2017: Changes in intra-op antibiotic coverage were revised based on wound classification

Skin Prep

?Hair removed with clippers (if applicable) ?Adequate skin prep material used ?Dry time > 3 minutes ?Site cleaned from incision to periphery ?Patient prepped prior to being draped

Surgical Attire

?All hair fully covered ?All clothing contained within surgical attire ?Masks worn appropriately and for the entirety of procedure

Room Traffic

?All entries from sterile core hallway ?"No Entrance Barrier" for implant cases ?No personal effects present in OR

Intra-Operative Compliance

Jesse Taylor MD Gregory Heuer MD, PhD Julia Sammons MD, MSCE

Sonja Jones RN, MSM Talene Metjian Pharm. D Kelly O'Shea BS, LSSGB

OUTCOMES

After reducing the variation in care and preparation in the OR by implementing a standardized checklist, surgical site infection rates for Plastic Surgery patients were reduced by close to 80%. This resulted in 8 fewer patients being harmed between fiscal year 2016 and fiscal year 2017.

CONCLUSIONS

Children's Hospital of Philadelphia has developed an effective intra-operative checklist designed to reduce variation in intraoperative care and prevent surgical site infections in the patient population.

Francesca Drake RNFA, BSN, CNOR Cherie Sun RN, BSN, M.Ed., CNOR Lauren Farrell MS, MLS(ASCP)CM, CIC

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