1. 1 Western Node Collaborative Northeast HSDA (NH) Surgical Site Infection Reducing SSI in Orthopedics, Colorectal & Gynecology Surgery Updated September 2006

2. 2 Background ) The Northeast HSDA is the smallest HSDA within Northern Health and has two acute care hospitals: –Dawson Creek & District Hospital –Fort St.John Hospital and Health Centre Population approx. 68,000 (northern/rural BC) Infection control surveillance measures already underway used for SSI (hysterectomy, hips & knees plus colorectal surgery)

3. 3 Aim Purpose To prevent surgical site infections through implementation of 3 known components of care that are supported by medical literature; a) appropriate use of antibiotics b) appropriate hair removal c) maintenance of post operative normothermia for colorectal surgery

4. 4 Aim Goals & Objectives or Aim Statements 1. To improve prophylactic antibiotic timing by administering the antibiotic between >1 to 60 minutes prior to surgical incision;  To 75% of all surgical cases by May 1, 2006  To 95% of all surgical cases by Dec. 31, 2006

5. 5 Aim 2. To achieve normothermia for all colorectal surgical patients by:  Recording the temperature of patients either on leaving the OR or entering the PAR 100% of the time by May 1, 2006  Addressing the issue of patients with temperatures of less than 36.0 by Dec. 31, 2006

6. 6 Aim 3. To achieve appropriate hair removal on all surgical patients by:  Documenting hair removal 100% of the time in all surgical cases  Eliminating any inappropriate hair removal (e.g. shaving) by Dec. 31, 2006

7. 7 Results – Baseline measures only 1. Appropriate antibiotic prophylaxis (n=40) 95% 2. Appropriate timing of prophylactic 61% antibiotics (n=38/some documentation issues) 3. Appropriate hair removal (n=40) 0% (issue is no documentation) 4. Normothermia (colo-rectal only n=10/some documentation issues) 40% * Hip (10) & Knee (10) Replacements, Hysterectomy (10) & Colo-rectal Surgery (10)

8. 8 Changes Tested NE QI Toolbox includes –11 Commandments for Team Success – Team member roles/responsibilities Documentation issues addressed immediately by revision of related forms to trigger documentation of : Hair removal techniques, or indication of no hair removal Time of antibiotic administration Temperature on discharge from OR/arrival in PARR

9. 9 Changes Tested Education/awareness of 3 key components SHCN SSI initiative to appropriate personnel (e.g. Anesthetists, Surgeons, Operating Room Staff, etc.) Brief presentation to communicate broadly Official communication to key positions and groups (e.g. Chief of Staffs, Chief of Anesthesia, Medical Director, COO, HSAs, etc.)

10. 10 Data Collection Data for all of 2005 was collected retrospectively with assistance of Health Records staff and showed some variance from the small baseline data originally collected. Data up to July 31, 2006 was collected both retrospectively and concurrently (also by Health Records staff) to see if the improvement goals set had been achieved.

11. 11 SSI for Hips in NE (2005 n = 62 and 2006 n = 32)

12. 12 SSI for Knees in NE (2005 n = 60 and 2006 n = 40)

13. 13 SSI for Hysts in NE (2005 n = 32 and 2006 n = 50 - both sets of data incomplete)

14. 14 SSI for Colorectals in NE (2005 n = 25 and 2006 n = 14)

15. 15 Challenges Old forms making their way back into system (impacting data collection) New anesthetists and surgeons New nursing staff Limited resources to collect and analyze data in a timely way (e.g. monthly) Limited resources to attend to follow-up processes

16. 16 Key Learnings Method to educate/inform new staff and physicians must be implemented Follow-up is required on a regular basis to both data collection staff and care providers Feedback must be frequent and constant in order to reinforce learning and sustain improvements

17. 17 Team Members & Contact Information Core team members: Lexie Gordon – NE SHCN Team Lead (Lexie.gordon@northernhealth.ca)Lexie.gordon@northernhealth.ca) Angela DeSmit, RN, DON, FSJH&HC Bernada Clark, RN, ICP, FSJH&HC Brenda DeVuyst, RN, ICP, DCDH Kathyrn Peters, RN, Unit Mgr OR, FSJH&HC Kyla Chruikshanks, RN, DCDH Louise Bougie, RN, FSJH&HC Sponsor = NE Surgical Care Team (Chaired by General Surgeons) Updated September 2006