1. Performing an SSI Investigation Deb Hobson, RN BSN 1

2. What is your current role? Surgeon Quality improvement practitioner Infection preventionist OR nurse OR technician Anesthesiologist OR manager Educator Other Polling Question

3. DRAFT Pending AHRQ approval Performing an SSI Investigation 3 Objectives Distinguish between process and outcome data. Describe how the SSI Investigation Tool can guide improvement work even when SSI rates are low. Adapt an SSI Investigation Tool to reflect the care processes in your SSI Prevention Bundle.

4. DRAFT Pending AHRQ approval Performing an SSI Investigation 4 SUSP Readiness Bridge  Are your frontline SUSP team members aware of the SUSP project?  Have you completed a safety culture survey (e.g. HSOPS) and debriefed your frontline SUSP team members?  Has your staff received the Science of Safety Training?  Have you collated Perioperative Staff Safety Assessment responses from your staff?  Have you held your Executive Safety Rounds Kickoff meeting?

5. DRAFT Pending AHRQ approval Performing an SSI Investigation 5 Assess Your Performance Collect process and outcome data to assess current performance and progress towards improving patient care. Process DataOutcome Data What we do to patientsWhat happens to patients Depends on your local SSI Prevention Bundle Every hospital in SUSP is tracking the same outcome data e.g. Percentage of patients receiving appropriate antibiotic re- dosing e.g. SSI Rate

6. DRAFT Pending AHRQ approval Performing an SSI Investigation 6 Getting SSI Data from the SUSP Website Log onto the SUSP Website Locate the SSI Data Registry Access your SSI Data Report

7. DRAFT Pending AHRQ approval Performing an SSI Investigation 7 Login to the SUSP Website https://armstrongresearch.hopkinsmedicine.org/login.aspx

8. DRAFT Pending AHRQ approval Performing an SSI Investigation 8 Locate the SSI Data Registry

9. DRAFT Pending AHRQ approval Performing an SSI Investigation 9 Access your SSI Data Report

10. DRAFT Pending AHRQ approval Performing an SSI Investigation 10 Sample SSI Data Report

11. DRAFT Pending AHRQ approval Performing an SSI Investigation 11 Always Room for Improvement

12. DRAFT Pending AHRQ approval Performing an SSI Investigation 12 A Single Organ Space SSI Means… 4.9% mortality rate $14,448 additional cost of care 24 additional length of stay

13. DRAFT Pending AHRQ approval Performing an SSI Investigation 13 Because a multitude of factors influence outcome, it is not possible to know for certain, even after extensive adjustments for differences in case mix are made, the extent to which an observed outcome is attributable to an antecedent process of care. Confirmation is needed by a direct assessment of the process itself…” Avedis Donabedian (1998)

14. DRAFT Pending AHRQ approval Performing an SSI Investigation 14 Uncover Defects with SSI Investigation Tool Identify lapses in infection prevention processes that may have contributed to your SSI case. Assess adherence to your local SSI Prevention Bundle.

15. DRAFT Pending AHRQ approval Performing an SSI Investigation 15 Patient or Provider Factors

16. DRAFT Pending AHRQ approval Performing an SSI Investigation 16 Normothermia Maintenance

17. DRAFT Pending AHRQ approval Performing an SSI Investigation 17 Glucose Control

18. DRAFT Pending AHRQ approval Performing an SSI Investigation 18 Antibiotic Redosing

19. DRAFT Pending AHRQ approval Performing an SSI Investigation 19 Adapt the SSI Investigation Tool Johns Hopkins Hospital clinicians designed this tool to assess adherence to their local SSI Prevention Bundle. – Your team may want to investigate care processes that are not included in this tool. – This tool may include processes that your team does not use. Please modify this tool to best fit your team’s needs.

20. DRAFT Pending AHRQ approval Performing an SSI Investigation 20 What Your Team Can Do Abstract this information from the patient’s chart. Use SSI Audit tools to dig deeper into your care delivery system. Present process data to the team at a routine SUSP meeting. Share investigation results monthly or quarterly with your frontline staff and OR leadership.

21. DRAFT Pending AHRQ approval Performing an SSI Investigation 21 Next Steps Complete an SSI investigation of your most recent SSIs. Share your findings on your next coaching call.

22. DRAFT Pending AHRQ approval Performing an SSI Investigation 22 What Questions Do You Have? Remember you have a support network – Post questions any time on MedConcert – Ask questions during coaching calls – Contact the SUSP helpdesk at susp@jhmi.edu

23. DRAFT Pending AHRQ approval Performing an SSI Investigation 23 Content Call Evaluation We want to ensure that the content calls provide useful and pertinent information for the SUSP teams. For this reason we request that you complete a brief evaluation following each call. The evaluation may be found at the following link: https://www.surveymonkey.com/s/cohort_5_onboarding