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Western Node Collaborative. Northeast HSDA (NH) Surgical Site Infection Reducing SSI in Orthopedics, Colorectal & Gynecology Surgery. Updated September 2006. Background ). The Northeast HSDA is the smallest HSDA within Northern Health and has two acute care hospitals:

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western node collaborative
Western Node Collaborative

Northeast HSDA (NH)

Surgical Site Infection

Reducing SSI in Orthopedics, Colorectal & Gynecology Surgery

Updated September 2006

background
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)
slide3
Aim

Purpose

To prevent surgical site infections through implementation of 3 known components of care that are supported by medical literature;

  • appropriate use of antibiotics
  • appropriate hair removal
  • maintenance of post operative normothermia for colorectal surgery
slide4
Aim

Goals & Objectives or Aim Statements

  • 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
slide5
Aim
  • 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
slide6
Aim
  • 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
results baseline measures only
Results –Baseline measures only
  • Appropriate antibiotic prophylaxis (n=40) 95%
  • Appropriate timing of prophylactic 61%

antibiotics (n=38/some documentation issues)

  • Appropriate hair removal (n=40) 0% (issue is no documentation)
  • Normothermia (colo-rectal only n=10/some

documentation issues) 40%

* Hip (10) & Knee (10) Replacements, Hysterectomy (10) & Colo-rectal Surgery (10)

changes tested
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
changes tested1
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.)
slide10

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.
ssi for hips in ne
SSI for Hips in NE

Goal Met

(2005 n = 62 and 2006 n = 32)

ssi for knees in ne
SSI for Knees in NE

Goal Met

Goal Met

(2005 n = 60 and 2006 n = 40)

ssi for hysts in ne
SSI for Hysts in NE

(2005 n = 32 and 2006 n = 50 - both sets of data incomplete)

ssi for colorectals in ne
SSI for Colorectals inNE

Some Progress on all criteria

(2005 n = 25 and 2006 n = 14)

challenges
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
key learnings
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
team members contact information
Team Members & Contact Information

Core team members:

  • Lexie Gordon – NE SHCN Team Lead ([email protected])
  • 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

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