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Safer Healthcare Now Our Normothermia Surgical Site Infection Experience. Eating the SSI Elephant: A workshop to help Ontario Hospitals reduce SSI while meeting provincial reporting requirements March 12, 2009 Julie McBrien – Patient Care Manager PAC, SDC & PACU. Objectives.

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safer healthcare now our normothermia surgical site infection experience

Safer Healthcare NowOur Normothermia Surgical Site Infection Experience

Eating the SSI Elephant: A workshop to help Ontario Hospitals reduce SSI while meeting provincial reporting requirements

March 12, 2009

Julie McBrien – Patient Care Manager PAC, SDC & PACU

  • Background – HHS and SSI
  • Our Goal for Normothermia
  • Measures & the Data
  • Change Initiatives
  • Our Results
  • Lessons Learned/Challenges
  • Next Steps
our hospitals
Our Hospitals
  • Halton Healthcare Services is comprised of three acute care community hospitals - Oakville-Trafalgar Memorial, Milton District and Georgetown Hospital.
  • Our mission - to provide quality compassionate care and services to meet the needs of our population in a timely and effective manner - grows out of a culture of care and is shared by our staff, physicians and volunteers.
  • HHS is committed to being an innovative centre of excellence in community hospital care.
facts and figures
Facts and Figures
  • 294 Acute Inpatient beds
  • 61 Complex Continuing Care
  • 39 Rehab beds
  • 77,600 surgical procedures
  • 17,519 admissions
  • 132,470 Ambulatory visits
  • 97,700 ER visits
  • 2,346 staff
our ssi team
Our SSI Team
  • Oakville Site: Cindy MacFarlane, Cathy Goacher, Lynn Singh, Julie McBrien
  • Milton Site: Dr. Kolbasnik, Dr. Chow, Barb Roelofson, Jan Dziapak, Susan Barrett
  • Georgetown Site: Deb Hill
  • Infection Control & Prevention: Dr. Szakacs, Cynthia Shorrock
  • Patient Safety: Lynn Budgell
  • Pharmacy: Jill White
in the beginning with ssi
In the beginning with SSI ….
  • Oakville site initiated first (Nov 2005)
  • Our program sponsors - Surgical Care Committee
  • Established a small working group of key stakeholders
  • Use ‘Model for Improvement” and Plan-Do-Study-Act (PDSA) cycle to conduct small tests of change
  • Milton and Georgetown sites incorporated later
in the beginning with ssi cont d
In the beginning with SSI… Cont’d……
  • Selected & prioritized 3 of 4 components of care:
    • #1 appropriate hair removal
    • #2 antibiotic timing;
      • pre-incision & post-close discontinuation
    • #3 post-op normothermia (colorectal surgeries)



Most Recent Challenge

Aim: Through prevention, monitoring and action achieve Normothermia to Prevent Surgical Site Infections (SSI)

For identified at risk populations, maintain the patient’s core body temperature at a minimum of 36 degrees Celsius, throughout the entire surgical experience; admission through discharge from PACU

targeting the right surgical patients
Targeting the ‘Right’ Surgical Patients
  • Identified our surgical populations based on; risk, volumes, evidence of inconsistent practice & degree of support anticipated from the service;
    • Total Knee Arthroplasties
    • Total Hip Arthroplasties
    • Colo-Rectal Surgeries (elective only)
goal t o achieve 95 or higher in maintaining patients core temperature at 36 c
Improvement Objectives

Maintain normothermia ( 36C) peri-operatively for selected surgical populations


Temperature documented at each phase of the surgical process (SDC, OR, PACU)

Report % open-body cavity surgical patients with Temps  360C post-op in PACU

Goal: To achieve 95% or higher in maintaining patients core temperature at 36 C
  • Key Changes
  • Use of pre-op, intra-op and post-op warming devices on populations at risk
  • Education
  • Efforts to improve temperature monitoring methods
normothermia change initiatives highlights
Normothermia Change Initiatives & Highlights
  • Patient gowns improved – Aug 2008
  • Change of warming blanket supplier – Sept 2008
    • Ease of IV and arterial line access
    • Fixed plastic head drape
    • Heat sensor at point of patient delivery heating
  • Warming units available in all ORs
  • Inventory increased in PACU and a unit dedicated to SDC - Sept 2008
  • Warming blankets are stocked, added to the picklist & picked in CSR for the case – Sept 2008
normothermia change initiatives highlights cont d
Normothermia Change Initiatives & Highlights Cont’d…
  • Hot lines used regularly in cases over 1hour
  • Patient recliners in SDC with warming feature – Trial Jan 2009
  • Skin temperature probe trial & consistent placement of probe - Jan 2009
  • OR bed warmed with warm flannels or heating unit - more consistent practice
  • Normothermia Education: Dr. Szakacspresented to;
    • Surgeons – April 2008
    • Anesthesia – May 2008
    • Nursing - SDC, OR, PACU, and surgical floor – May 2008
lessons learned
Lessons Learned…
  • Smaller sites able to get buy in and spur change forward quickly – i.e. DS patients bringing housecoats and slippers from home
  • Integration, collaboration and standardization across HHS sites
  • Don’t under-estimate the need/value of a physician champion and the importance of education and physician/staff support
  • Dedication and effective use ‘rapid cycle change’
lessons learned17
Lessons Learned…
  • Achieved a number of improvement changes – share with stakeholders
  • Tremendous sharing and support available
    • collaboration within HHS, LHIN and SHN community
  • Understand and analyze cost implications upfront
  • Be creative about keeping team engaged and moving forward in spite of competing projects and chaos
  • Data management is an enormous barrier without electronic solutions (in long-term)
Challenges …
  • Physician culture/attitude/practice changes
  • Literature was challenged -- education needed
  • Ongoing data management
    • More paperwork!!
    • Resource intensive
    • Manual collection/collation
  • Cost implications of improvement changes
next steps
Next Steps …
  • Continue to develop automation capacity in our data management process
    • Documentation
    • Reporting & analysis
  • Initiate new cycles of change for;
    • Check success of normothermia changes
  • Monitor and report results consistently
  • Ensure we have a plan to sustain ….
  • Celebrate well and often!
still smiling and moving safety forward
Still Smiling and Moving Safety Forward


Thank You…

Julie McBrien

Halton Healthcare Services

327 Reynolds St.

Oakville, ON

(905) 845-2571 x6420