1. 1 Reducing Colon Surgical Site Infections: A Quality Improvement Initiative of Two Hospitals Angela Gabasan, RN, MSN,CIC Barbara A. Smith, RN, MPA, CIC Eloisa Santos, RN, MA, CIC Emilia Mia Sordillo, MD, PhD Raymond Wedderburn, MD Lester Gottesman, MD Richard Whelan, MD Bruce Polsky, MD St. Luke’s-Roosevelt Hospital Center, NY, NY Financial Disclosure: None

2. 2 Issue: We’re in the RED 2008SSI RateNYS HAIRNHSN St. Luke’s Site 16.3 per 100 procedures 4.9 per 100 procedures 5.6 per 100 procedures Roosevelt Site 7.8 per 100 procedures 4.9 per 100 procedures 5.6 per 100 procedures 2008 NYS Hospital-Acquired Infection Report (NYS HAIR) published in June 2009 -PHL 2819 mandatory reporting of select HAI -use NHSN for reporting Colon SSI rate exceeded state and national rates

3. 3 The Project: Reduce Colon SSI Multidisciplinary team surgical team OR team infection control team Review of the Hospital’s Guidelines for Antimicrobial Prophylaxis in Surgery colon pre-op antibiotic current, no need to change Retrospective review of cases 2008 cases n=225 2009 1 st and 2 nd Qtr cases n=98 Communicate strategy to the stake holders

4. 4 Retrospective Review: Analysis of 2008 and 2009 Cases No change in practice or deviations in operating room or surgical techniques Good compliance with post-op temperature and clipping of the surgical site Betadine skin prep is used in majority of cases and found adequate No unusual pathogens Operating Room environment not implicated

5. 5 Selection and timing Weight-based dosing: obese>100Kg/130% IBW SL site 33% given increased dose RH site 44% given increased dose Redosing for procedure >4h duration SL site 44% redosed RH site 23% redosed Retrospective Review: Analysis of 2008 and 2009 Cases Room for Improvement: Pre-op antibiotics

6. 6 Plan of Action Re-emphasize adherence to Hospital Guidelines for Antimicrobial Prophylaxis in Surgery Focus on 4 indicators covered in the Guidelines 1. antibiotic selection 2. timing of antibiotic administration 3. weight-based dosing 4. redosing for procedures >4 hours

7. 7 Plan of Action Designate a point surgeon at each facility to: communicate recommendations to the surgical team assist in SSI case review White board in each OR suite reminder to the OR and surgical team time of procedure time antibiotic is administered surgeon orders, anesthesiologist administer

8. 8 Results: Colon procedure SSI rates and Antimicrobial Prophylaxis Guideline Adherence Roosevelt SiteSSI rate Adherence to Antimicrobial Prophylaxis Guidelines Selection (%) Timing (%) Weight- based Dosing (%) Redose proc.> 4h (%) 20087.88070 Not collected Not collected 20097.88197.444.423 20104.6296 8475 2011 1 st Q5.7100 87

9. NHSN 5.6

10. 10 Results: Colon procedure SSI rates and Antimicrobial Prophylaxis Guideline Adherence St. Luke’s siteSSI rate Adherence to Antimicrobial Prophylaxis Guidelines Selection (%) Timing (%) Weight- based Dosing (%) Redose proc. > 4h (%) 200816.397.587.5 Not collected Not collected 200910.3895.71003344 20108.4795.6100 71 2011 1 st Q6.692100 67

11. 11 NHSN 5.6

12. 12 Results: Summary Colon SSI rates decreased as adherence to Antibiotic Prophylaxis Guidelines improved 2008 to 2010 SSI rate reduction 48% @ St. Luke’s site 40% @ Roosevelt site Combined cost avoidance >$400,000.00* * APIC Dispelling the Myths: The true cost of Healthcare Associated Infections

13. 13 Lessons Learned Compliance was gradual, and depended on the cooperation of the surgeons Increased accountability of the surgical team led to better adherence with all 4 indicators Designation of a point surgeon at each hospital facilitated cooperation and communication among stakeholders Our Goal: continue to reduce SSI rates to at or below the State and National level

14. Thank You! Angela Gabasan, RN Nurse Epidemiologist, St. Luke’s-Roosevelt Hospital 1111 Amsterdam Avenue New York, NY 10025 (212) 523-4563 or (212) 523-2106 agabasan@chpnet.org 14

15. 15 OR White Board

16. 16 GUIDELINES FOR ANTIMICROBIAL PROPHYLAXIS IN SURGERY GUIDELINES FOR ANTIMICROBIAL PROPHYLAXIS IN SURGERY ST. LUKE’S-ROOSEVELT REVISED February 2010

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