1. the Providence Health Care Experience Dr Ahmer Karimuddin Meghan MacLeod Dr Alex Seal PHC Surgical Program University of British Columbia February 19 th, 2015 University of British Columbia Preventing Surgical Site Infection

2. Disclosure There are no conflicts of interest and nothing to disclose

3. Outline 1.Why this is important 2.Our approach to this challenging problem 3.Bundle 4.Results 5.the FUTURE

4. THANK YOU

5. SSI Prevention TEAM Jock Reid Jock Reid Jim Abel Jim Abel Ahmer Karimuddin Ahmer Karimuddin Victor Leung Victor Leung Chris Prabhakar Chris Prabhakar Meghan MacLeod Meghan MacLeod Lisa Toback Lisa Toback Elisa Lloyd-Smith Elisa Lloyd-Smith Stephen Parker Stephen Parker Michelle Bech Michelle Bech Thelma Velasco Thelma Velasco Lona Cunningham Lona Cunningham Sandy Grimwood Sandy Grimwood Rupinder Khotar Rupinder Khotar Alex Seal Alex Seal...all of SPH and MSJ Randy Rae Randy Rae Jin-So Pao Jin-So Pao Alice Lee Alice Lee Flavia Mandic Flavia Mandic Sharon Bisson Sharon Bisson Paul Smith Paul Smith Howard Green Howard Green Barry Schafer Barry Schafer Lu Oviatt Lu Oviatt Tamara Younger Tamara Younger Lia Randell Lia Randell

6. THANK YOU SPH & MSJ Team SSI’s

7. Background Why do this? Opportunity to improve the care of patients Individual Service Site City, province, etc...

8. Background

9. DATA NSQIP Risk Adjusted Data Surgical Site Infection All Cases reviewed July 2011 – June 2012 SPH MSJ

10. Goal of Working Group Ultimately Reduction in Rates of SSI**

11. Opportunities for Improvement Prevention of SSI - ACS NSQIP best practice Guidelines 290,000 SSI in US (2002) – 8,207 deaths – 7-10 increase hospital days – morality rate (2-12x) – $3.45-$10.07 billion (2007)

12. Goal of Working Group 1. ID the problem 2. Explore the process 3. Build the Team 4. ID root causes/best practice 5. Select and test solutions

13. EPIC Approach Will it be EPIC? E - Easy to implement P - Permanent I - Impact High C - Cost effective

14. Best Practice Brainstorm

15. Strategies for Prevention

16. Brainstorm

17. Looked at Other Centres Example initiative: Northwestern experience: OR closing bundle (colorectal) New gloves New instruments

18. PHC = FOCUS Bundle F - Focused O - Opportunities of C - Care U - Utilizing S - Standards

19. PHC SSI Prevention Bundles

20. Example: Pre-op Antibiotics

21. PHC approach based on best practice 1.Risk Assessment 2.Creation of key preventative strategies 3.Adherence to key strategies 4.Active surveillance = REDUCTION IN RATES

22. PHC SSI Prevention Bundle Areas for Education Opportunities 1.Pre-Admission Clinic 2.Pre-OP 3.SPH OR 4.MSJ OR ✓ 5.PAR ✓ 6.Wards ✓ ✓ ✓ ✓

23. Appropriate OR Dress Attire

24. PHC SSI Prevention Bundle I pity ‘da fool who dresses like me in da OR Intra Operative FOCUS

25. How are we doing now? S

26. SPH

27. MSJ

28. NSQIP data: Out of the pink!

29. Implementing a Bundle

30. SQAN Summer Student AUDIT Best compliance with bundle intra- operative components

31. Bundle Compliance AUDIT

32. SPH

33. MSJ

34. FUTURE Opportunity for improvement Focus on areas from audit where lower compliance Pre-OP warming Pre-OP surgical site chlorhexidine prep by patient Pre-OP site shave in Daycare

35. FIN