An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network Surgical Infection Prevention (SIP) Webinar Series #2: Infection Prevention Strategies in the Intra-operative Period May 22, 2019
Agenda • Welcome & FHA Mission to Care HIIN Overview – Cheryl Love, RN, BSN, BS-HCA, MBA, LHRM, CPHRM, Director of Quality and Patient Safety and Improvement Advisor, FHA • Surgical Infection Prevention Series: Taking a Deep Dive into Intra-operative Recommendations – Linda R. Greene, RN, MPS, CIC, FAPIC, Manager of Infection Prevention, UR Highland Hospital, Rochester, NY • Q&A • Upcoming HIIN Events and Opportunities • Evaluation Survey & Continuing Nursing Education
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) • Hospital-onset MRSA Bacteremia • Injuries from Falls and Immobility • Pressure Ulcers (PrU) • Sepsis • Surgical Site Infections (SSI) • Venous Thromboembolisms (VTE) • Ventilator-Associated Events (VAE/IVAC/PVAP) • Readmissions (12% reduction) • Worker Safety
SSI Resources, Trainings and Tools Mission to Care Website HRET HIIN Website SSI Change Package SSI Top 10 Checklist SSI-Colon Prevention Resource Guide SOAP UP Resources Watch Past Webinars HRET HIIN Resource Library SSI Podcast Series Case Review Templates, Guidelines and more…
UP Campaign: Spreading Cross Cutting Strategies Designed to reduce multiple forms of harm with simple, easy-to-accomplish activities that cut across several topics to decrease harm. Focused on four components: • SOAP UP: Hardwire Hand Hygiene • GET UP: Mobilize Patients • WAKE UP: Prevent Over-sedation • SCRIPT UP: Optimize Inpatient Medications 5
FHA Mission to Care Update: SSI Colon Rates 5.50 5.00 4.50 4.00 3.50 Rate per 100 3.00 2.50 2.00 1.50 1.00 0.50 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 8/18 9/18 10/18 11/18 12/18 1/19 2/19 3/19 FL Rate 4.14 4.40 3.30 4.99 3.93 4.00 3.15 2.64 2.90 2.84 3.66 3.70 3.55 3.31 2.34 4.03 3.21 3.78 4.20 3.17 3.42 3.74 3.03 4.59 4.49 3.85 3.03 3.77 3.61 2.71 2.10 HRET HIIN Rate 4.54 4.31 4.35 4.65 4.35 3.97 4.05 3.89 4.22 4.07 4.03 4.39 4.37 4.06 3.89 4.26 4.10 4.46 4.24 4.15 4.31 4.24 4.29 4.52 4.74 4.11 3.96 3.56 4.15 3.59 2.50 # FL Reporting 83 82 82 81 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80 79 80 79 73 73 70 #HRET HIIN Reporting 1,086 1,094 1,093 1,091 1,096 1,091 1,087 1,091 1,092 1,090 1,086 1,086 1,090 1,086 1,086 1,083 1,084 1,082 1,084 1,079 1,075 1,077 1,073 1,070 1,072 1,061 1,050 1,049 947 884 718 Source: HRET Comprehensive Data System, May 20, 2019
FHA Mission to Care Update: SSI Hysterectomy Rates 2.25 2.00 1.75 1.50 Rate per 100 1.25 1.00 0.75 0.50 0.25 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 8/18 9/18 10/18 11/18 12/18 1/19 2/19 3/19 FL Rate 1.36 1.27 1.92 0.60 0.72 0.91 0.76 0.84 1.18 1.38 1.46 1.03 1.11 1.07 0.94 0.99 0.44 0.68 1.20 1.00 1.26 0.57 1.23 1.85 0.67 1.50 1.15 1.01 1.30 1.29 0.78 HRET HIIN Rate 1.44 1.24 1.42 1.00 1.16 1.31 1.28 1.28 1.38 1.32 1.29 1.26 1.38 1.12 1.28 1.14 1.20 1.02 1.32 1.36 1.26 1.22 1.31 1.39 1.25 1.37 1.13 1.10 1.43 1.08 0.81 # FL Reporting 82 81 80 81 79 79 79 79 79 79 79 79 79 79 79 78 79 79 79 79 79 78 78 79 79 78 79 79 73 73 67 #HRET HIIN Reporting 1,046 1,054 1,053 1,058 1,054 1,052 1,054 1,048 1,051 1,051 1,048 1,044 1,044 1,043 1,041 1,039 1,043 1,036 1,037 1,032 1,028 1,029 1,026 1,026 1,028 1,020 1,008 1,005 897 846 675 Source: HRET Comprehensive Data System, May 20, 2019
FHA Mission to Care Update: SSI Knee Rates 1.20 1.00 0.80 Rate per 100 0.60 0.40 0.20 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 8/18 9/18 10/18 11/18 12/18 1/19 2/19 3/19 FL Rate 0.75 0.87 0.56 0.67 0.50 0.72 0.46 0.60 0.49 0.47 0.76 0.41 0.38 0.59 0.89 0.31 0.45 0.50 0.57 0.69 0.72 0.24 0.55 0.39 0.55 0.78 0.68 0.33 0.68 0.33 0.67 HRET HIIN Rate 0.69 0.59 0.61 0.76 0.48 0.56 0.74 0.63 0.83 0.67 0.83 0.66 0.87 1.16 1.03 0.46 0.58 0.52 0.67 0.78 0.75 0.62 0.63 0.63 0.66 0.75 0.63 0.47 0.51 0.37 0.38 # FL Reporting 68 65 66 65 64 64 64 63 61 60 60 61 62 61 61 61 61 60 58 61 61 61 60 55 55 51 53 53 46 46 38 #HRET HIIN Reporting 806 818 815 818 852 848 852 854 850 848 846 842 847 846 846 847 852 851 851 853 843 847 838 829 828 822 805 812 712 642 531 Source: HRET Comprehensive Data System, May 20, 2019
FHA Mission to Care Update: SSI Hip Rates 1.50 1.25 1.00 Rate per 100 0.75 0.50 0.25 0.00 BL 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 7/17 8/17 9/17 10/17 11/17 12/17 1/18 2/18 3/18 4/18 5/18 6/18 7/18 8/18 9/18 10/18 11/18 12/18 1/19 2/19 3/19 FL Rate 1.42 0.90 1.17 0.80 1.18 0.90 1.16 0.42 1.07 1.16 1.36 0.99 0.89 0.96 1.00 1.03 1.14 0.63 1.02 1.33 1.32 0.81 0.41 0.85 0.80 1.21 0.89 0.74 0.40 0.96 0.51 HRET HIIN Rate 1.23 0.96 1.21 1.04 1.13 1.20 1.16 1.11 1.19 1.03 1.30 1.06 1.39 1.32 0.98 1.18 1.25 1.13 1.13 1.23 1.13 1.36 1.06 0.98 1.15 0.98 0.98 0.98 1.01 0.84 0.61 # FL Reporting 67 64 65 65 64 64 64 63 61 60 60 61 61 61 61 61 61 60 59 61 61 61 61 55 55 52 53 53 46 46 38 #HRET HIIN Reporting 786 800 798 797 834 836 832 834 832 830 827 820 822 827 828 829 839 842 837 841 833 834 828 818 818 816 795 799 697 632 522 Source: HRET Comprehensive Data System, May 20, 2019
Infection Prevention and NHSN Virtual Series Date Topic Register Online Oct. 23, 2018 NHSN: SSI Surveillance Identification Event archive* and Analysis Nov. 20, 2018 SSI-Colon: How to Assess Root Cause Event archive* and Prevention Strategies Dec. 18, 2018 NHSN: VAE Surveillance Identification Event archive* and Analysis Event archive* Jan. 22, 2019 VAE: How to Assess Root Cause and Prevention Strategies Feb. 19, 2019 NHSN: MRSA Bacteremia Surveillance Event archive* Identification and Analysis Mar. 26, 2019 MRSA Bacteremia : How to Assess Root Event archive* Cause and Prevention Strategies Apr. 26, 2019 SIP Webinar Series #1: Pre-operative Event archive* Strategies for Prevention of SSI *Access Event Archives (Recordings | Slides) on the Mission to Care HIIN Website 10
Surgical Infection Prevention; Taking a Deep Dive into Intra-operative Recommendations Linda R. Greene, RN, MPS,CIC, FAPIC Manager, Infection Prevention UR Highland Hospital Rochester, NY linda_greene@urmc.rochester . edu
Objectives Identify specific risks during the intra-operative period Discuss recent literature linked to risk reduction Identify strategies to reduce risks
Polling Question1 What is your background? 1. Infection Prevention 2. Quality or patient safety 3. Management 4. OR nurse 5. Other
Surgical Risks Most Common Complications during surgery: Surgical site infection Postoperative sepsis Thromboembolic complications Cardiovascular Respiratory ( pneumonia)
The intra-operative period Procedural variables that affect risk of SSI: Antibiotic prophylaxis Duration of Surgical scrub Pre-op hair removal Choice of pre-op skin preparation- need both fast acting and sustained effect Wound class
Variables Sterilization of instrument and the environment Foreign material in the surgical site Surgical technique Elevated Glucose- high Glucose levels with or without diabetes Hypothermia – vasoconstriction limits blood flow and oxygen https://www.infectiousdiseaseadvisor.com/home/decision- support-in-medicine/hospital-infection-control/surgical- site-infections/
Observations All surgical wounds are contaminated by bacteria but only a few get infected Different operations have different inoculums of bacteria Similar operations performed by the same surgeon in different populations have different rates of infection SSIs have varying degrees of severity
Bacteria get into wounds
Where are the Pathogens ? Pathogen source for most SSIs is endogenous flora of the patient’s skin, mucous membranes or GI tract. 20% of the skin’s pathogens live beneath the epidermal layer in hair follicles and sebaceous glands. Any incision can carry some of the bacteria directly to the operative site.
Leading SSI Pathogens Gram Positive Bacteria Gram Negative Bacteria MRSA Enterobacter MSSA Coag. Negative Staph Pseudomonas Enterococci Ecoli Streptococci Species Other Bacteria Anaerobic Bacteria Fungi
Etiology Exogenous sources: Hands of care givers Exposure to non sterile environment Contamination of fluid, supplies or equipment Air flow
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