Peer Sharing: Strategies for Reducing Surgical Site Infections - PowerPoint PPT Presentation

Peer Sharing: Strategies for Reducing Surgical Site Infections Related to Colon Procedures June 21, 2018

Agenda • Welcome & FHA Mission to Care HIIN Overview, Trends and Progress: Surgical Site Infections • Cheryl Love, RN, BSN, BS-HCA, MBA, LHRM, CPHRM, Director of Quality and Patient Safety and Improvement Advisor, FHA • Strategies for Reducing Surgical Site Infections Related to Colon Procedures • Dorin T. Colibaseanu, MD, FACS, FASCRS; A.C. Burke, M.A, CIC, Infection Prevention – Mayo Clinic • Diane Campbell, MSN, RN, CSSBB, AVP of Regulatory and Medical Affairs, Infection Prevention; Michelle Hunt, BSMT, ASCP, CIC, Manager, Infection Prevention; Daniel Haight, MD, FACP, FSHEA, Medical Director, Infection Prevention – Lakeland Regional Health • Upcoming HIIN Events and Opportunities

HIIN Core Topics – Aim is 20% reduction Adverse Drug Events (ADE) • • Catheter-associated Urinary Tract Infections (CAUTI) • Clostridium Difficile Infection (CDI) • Central line-associated Blood Stream Infections (CLABSI) • Injuries from Falls and Immobility Pressure Ulcers (PrU) • • Sepsis • Surgical Site Infections (SSI) • Venous Thromboembolisms (VTE) • Ventilator Associated Events (VAE ) Readmissions (12% reduction) • • Worker Safety

Raise your game: The UP Campaign Cross cutting set of practices to better engage front-line staff without creating additional burdens

HAND HYGIENE reduces harm in SEVEN focus areas CDI SSI VAE CLABSI Sepsis MDRO CAUTI S O A P - U P http://www.fha.org/soapup

PROGRESSIVE MOBILITY reduces harm in EIGHT focus areas Worker Falls PrU VAE VTE Delirium CAUTI Readmissions Safety G E T - U P http://www.fha.org/getup

SEDATION MANAGEMENT reduces harm in SEVEN focus areas Failure Airway ADE to Delirium Falls VTE VAE Safety Rescue W A K E - U P http://www.fha.org/wakeup

ONGOING EVALUATION OF MEDICATIONS reduces harm in TEN focus areas ADE Falls CDI CAUTI SSI VAE CLABSI Sepsis MDRO Readmissions S C R I P T - U P

FHA Mission to Care Update: Florida | SSI Rates 7.00 6.00 5.00 Rate per 100 4.00 3.00 2.00 1.00 0.00 M- M- M- BL O-16 N-16 D-16 J-17 F-17 A-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 17 17 18 Colon 4.29 5.30 4.00 5.79 5.35 4.79 4.23 3.42 3.73 3.83 4.63 5.31 4.92 3.64 3.69 5.24 4.22 4.85 4.88 Hysterectomy 1.47 1.29 2.07 0.61 0.73 0.92 0.77 0.99 1.20 1.40 1.47 1.05 1.13 1.08 0.95 1.13 0.32 0.73 1.25 Knee 0.77 0.87 0.56 0.67 0.45 0.72 0.46 0.60 0.49 0.47 0.81 0.41 0.46 0.59 0.85 0.25 0.53 0.53 0.32 Hip 1.44 0.90 1.15 0.80 1.18 0.90 1.16 0.42 1.07 1.25 1.51 1.13 0.87 0.97 1.00 0.95 0.99 0.60 0.77 Source: HRET Comprehensive Data System, April 18, 2018

FHA Mission to Care Update: SSI - Colon 7.00 6.00 5.00 Rate per 100 4.00 3.00 Florida Target: 3.43 2.00 1.00 0.00 M- M- M- BL O-16 N-16 D-16 J-17 F-17 A-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 17 17 18 FL Rate 4.29 5.30 4.00 5.79 5.35 4.79 4.23 3.42 3.73 3.83 4.63 5.31 4.92 3.64 3.69 5.24 4.22 4.85 4.88 HRET HIIN Rate 5.38 4.67 4.67 4.78 4.84 4.55 4.52 4.17 4.70 4.59 4.55 5.02 5.14 4.64 4.45 4.92 4.67 5.15 4.20 # FL Reporting 83 82 82 81 80 80 80 80 80 80 80 80 80 80 80 80 78 78 70 #HRET HIIN Reporting 1,1041,1221,1201,1201,1211,1181,1191,1141,1151,1091,1091,1071,1081,1061,0951,0871,000 941 833 Source: HRET Comprehensive Data System, April 18, 2018

FHA Mission to Care Update: SSI - Colon

SSI Resources, Trainings and Tools http://www.fha.org/health-care-issues/quality-and-safety/mtc-hiin.aspx http://www.hret-hiin.org  SSI Change Package  SSI Top 10 Checklist  SOAP UP Resources  Watch Past Webinars  HRET HIIN Resource Library  Guides  Case Studies

Mayo Clinic Florida - CRS Infection Prevention Initiative 21 JUNE 2018 Dorin Colibaseanu, MD, FACS, FASCRS

Source: NSQIP The Odds Ratio has been trending up over the past 5 yrs. *Note: NSQIP Data; 20% sample size of population; includes all SSI infection types

- Above the target SIR 50% of the past 12 quarters *Note: Enterprise Quality Scorecard Data; Includes deep and organ space infections identified at surgical hospitalization or readmission

Goal Prevent CRS postoperative infections from surpassing the expected rate. Proactively implement a bundle of evidence-based processes across CRS practice, intraoperatively and postoperatively.

Our Interdisciplinary Team Dorin Colibaseanu Kristin Dub Mackenzie Sutherlin CRS Surgeon 8 South RN PACU RN Ingrid Zuzarte Jacey Fazio Health Systems Engineer OR Nurse Supervisor Erin Markley Kristi Smith 8 South Nurse Supervisor General Surgury ARNP

BACKGROUND: Bundle 2011 Rochester Of Project Changes Implemented Overall CRS SSI Rate decreased from 9.8% pre- implementation to 4% post- implementation

• Mapped current state from preo-op through discharge Our • Compared our process to Project bundle of changes implemented by Rochester Process • Prioritized using Impact-Effort Grid • Gathered process-driven baseline metrics of current state

Impact – Effort Grid

OR-Based Interventions Sample Improvement Objective Relevant Metrics Target for Metrics Status Size *If room temp is not 73F upon patient entering, *If room temp is not 73F upon patient 70% of cases raise the Standardize process to raise entering, 43% of cases raised the room Complete - room temp to maintain Patient Temp in OR OR temperature so patient is temp to maintain patient temp of 36C 20 preference cards patient temp of 36C 36C *Patient temp was 36C upon closing for include change *Patient temp is 36C 77% of cases upon closing for 90% of cases * 32% of cases the team regowned AND Develop and implement best regloved 60% of abdominal cases Regown and Reglove practice to regown/reglove for * 28% of cases the team regloved the team regowns and 20 Complete abdominal cases * 40% of cases the team neither regowned regloves nor regloved Complete - Develop closing tray to be used * 58% of cases did not using separate 75% of abdominal cases Closing Tray 20 preference cards now during closing closing instruments use closing tray include closing tray

Perioperative Interventions Sample Improvement Objective Relevant Metrics Target for Metrics Status Size * 88% of cases came to floor with blue/white Complete - all floor forms 100% of nurses on floor Floor Nurse Education for floor nurses on nurses have been * 70% of nurses on floor did not use not using blue/white Education on PACU how to use blue/white forms 26 education not to use blue/white forms forms because of Forms coming up from PACU blue/white forms due * 41% of blue/white forms were inaccurate inaccuracies to inaccuracies times or missing information * 78% of patients had dressing removed on Complete - no Standardize who removes POD 1, 22% had dressing removed on POD Goal to have 100% of intervention Dressing Removal dressings from patients at Day 1 2 dressings removed by 26 necessary as target Post-Op * 56% of patients had dressing removed by POD 2 was met at baseline RN, 33% by MD/Resident, 11% by WOC Create patient packet for arrival 100% of CRS patients upon floor including: education * 0% of patients currently receive infection receive infection Create Patient Packet on hygiene, Hibiclens, Purell N/A Piloting prevention packet prevention packet upon wipes, education on infection arriving to the floor symptoms

Where Do We Go From Here? Look at SSI rate Implement process Remeasure when data is changes across process-based available providers metrics

Summary Identify an opportunity for practice improvement early Form a multidisciplinary team Map out and understand current process well Determine which interventions are practical (must be effective) Implement Measure compliance & collect data to augment process

Thank You ! Colibaseanu.Dorin@mayo.edu

SSI-Colon Webinar and Peer Sharing Opportunity June 21, 2018

Presenters are: Diane Campbell MS BB AVP , Regulatory and Medical Affairs, Infection Prevention N, RN, CS S Michelle Hunt BS Manager Infection Prevention MT , AS CP , CIC Daniel Haight MD, F Medical Director Infection Prevention ACP , FS HEA Team Members on call for Q&A: Cateria Davis-Bruno MS N, RN, CNOR Assistant Director, OR Operations and S PD Margie Voyles RN, MS AVP , Perioperative and S urgical S ervices , CNOR Pam Troxell MS Infection Preventionist N,RN, CIC Jesse Dang MHA, PMP S enior Management Consultant , LS S GB 31

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How was SSI Colon identified as a priority? • Lakeland Regional Health’s Inst it ut e f or S af et y, Discovery and S t andard Work • S S I S IRs Data 33

Team Members • Execut ives: – IP Med Dir- Infectious disease physician – President-CMO and Emergency Department physician – AVP Quality – Executive Medical Dir - CMIO and Internal Medicine physician • Ant ibiot ic S t ewardship Team • Pat ient S afet y Officer • Infect ion Prevent ion Team • Peri-operat ive: OR, P ACU, Anest hesia • Indust rial Engineers • IT , Clinical Informat ics • Nurse Pract ice/ UBC • Educat ion • Diet ary • Nurse Managers • Dat a S cient ist • S urgeons and anest hesiologist 34