1. Change Presentation MARY CECCO

2. Surgical Site Infections We own them!

3. 30 Days  This table shows the definitions of Surgical Site Infections (SSI’s)  Each of the levels of infection is defined as occurring within 30 days of surgery. Superficial Incisional SSI Deep Incisional SSI Organ/Space SSI Involves only skin or subcutaneous tissue Involves deep soft tissue Involves any part of the anatomy other than the incision that was opened

4. HOW DO WE KNOW THERE IS A PATIENT WITH AN SSI  Patients return to the emergency room or their doctors with pain, redness, wound discharge or other symptoms.  The infection prevention and control office monitors all cultures taken by the doctors.  Surgical site infections are reported back to the institution where the surgery occurred.  They are also reported to the Centers for Disease Control (CDC).

5. Systems Issue to Change  Implementation of a new discharge educational tool for cesarean section (c-sec) patients.

6. Change Theory  Lewin’s Force-Field Model of Change  Unfreezing  Moving  Refreezing

7. Cesarean Section Surgeries are Increasing Nationally  Approximately 2-3% of total c-sec will be complicated by a SSI  The national benchmarks for c-sec is 2.8 per 1000

8. This Organization 2012:  4 SSI’s out of 467 C-sections  Translates to 8.6 SSI’s per 1000 C-sections

9. Not Meeting Institutional Goals for Infection Rates  Our infection rates puts us in less than the 50 th percentile as published by the CDC and the National Safety Network (NHSN)  Increasing our hospital length of stay rates  Increasing hospital readmissions within thirty days

10. What Does This Mean?  SSI’s cause substantial morbidity and additional healthcare costs  Patients are being harmed  Patient satisfaction suffers  Potential lost revenue from unreimbursed costs  Potential lost patients since the information on SSI’s are available to the public  Potential lawsuits

11.  With short hospital stays with C-SEC’s many infections may not be detected until after their discharge from the hospital.  Anywhere from 27-95% of infections occur after their discharge from the hospital  It is imperative that patients are able to identify potential infections early to obtain treatment.  There is no standardized surgical site prevention and identification education provided to patients and families during their stay and on discharge.

12. Solution  Prioritizing incisional care during the patients hospital stay and on discharge.  Including the patient and the family  Develop a teaching checklist specifically for c- sec patients  Implementation on day one

13. Moving How to make it better  During a staff meeting make clear what the issue is through a thorough review of the literature and the statistics of the organization  Make it known that it can be made better with each person acting as a member of the team  Make a commitment to patient safety by  Going back to basics  Educating ourselves about SSI  Identifying patients at increased risk  Follow the standards of care  EDUCATE OUR PATIENTS  Form a smaller group to form a teaching tool  Give staff information via posters and meetings  Give a specific start date

14. Refreezing  Make the changes permanent  Keep statistics  Obtain feedback  Give positive reinforcement

15. Barriers  Staff resistance  More paperwork  Getting everyone on the same page

16. Possible Outcomes  Win Win!!!!  Decrease in infection rates  Less harm to patients  Increased patient satisfaction  Less lost revenue  Less potential lawsuits

17. References  Conroy, K., Koenig, A. F., Yu, Y., Courtney, A., Lee, H., & Norwitz, E. R. (2012). Infectious Morbidity After Cesarean Delivery: 10 Strategies to Reduce Risk. Obstetrics & Gynecology, 5(2), 69-77.  Porter-OGrady, T., & Malloch, K. (2011). Quantum Leadership (3rd ed.). Sudbury, MA : Jones & Bartlett.  Roussel, L. (2013). Management and leadership for nurse administrators. 6th ed. Burlington,Ma: Jones & Bartlett Learning.