What is a surgical infection? Our bodies are designed to protect us from getting sick. Our skin, white blood cells, and antibodies protect us from “germs” which cause sickness. However, there are always some germs that find a way around our defenses. When these germs enter our bodies, they multiply and can cause damage to parts of the body. This is called an infection. When an infection occurs after surgery, it is called a surgical infection.
Various interventions and practices influence the ability to prevent surgical infections from occurring and are the framework of the national Surgical Care Improvement Project (SCIP). The interventions include reliable delivery of appropriate peri-operative antibiotic prophylaxis (timing-60 minutes prior to incision, selection, and duration—discontinued within 24 hours of surgery end time), appropriate hair removal, keeping patients warm and oxygenated, and controlling blood glucose levels. A new measure related to urinary catheter management has been adopted, which resulted in a system-wide communication campaign to ensure providers understand the rationale behind the measure and how best to meet it. The interventions have been shown to decrease rates of surgical infections if they are applied correctly every time. Surgical team compliance with best practices in sterilization, aseptic technique, attire, and peri-operative preparation/optimization of patient risk factors are additional factors Baystate Health Surgical Services staff have focused on to prevent surgical infections.
Baystate Medical Center
- BMC was a leader in the initial 2002 Center for Disease Control/Centers for Medicare and Medicaid Services-sponsored national project to reduce surgical infections; the project has now migrated to the Surgical Care Improvement Project (SCIP) which includes not only infections but prevention of other post-operative complications (DVT/PE and post-op cardiac occurrences).
- BMC’s reliability in providing prevention processes is high as a result of using reliability principles, such as “Opt-Out,” to redesign our processes. Using this model promotes the desired action (the default) to be applied more consistently to a greater number of eligible patients.
- Surgical Services continues to demonstrate its commitment to reducing complications and improving care. Interventions implemented this past year include focusing on surgical team hand hygiene and scrub technique; decreasing immediate steam sterilization (formerly known as flash sterilization); acquiring additional instrumentation; surgical team attire; managing traffic patterns in the OR; reviewing and updating techniques and procedures to reflect best practices; and adopting new technology to limit invasive surgical procedures.
- Our surgical site infection (SSI) rate has continued to decrease every year and compares favorably as one of the best in the nation for academic training centers.
- We expanded our surveillance in 2012 to include all wound classes to better reflect our population served in order to identify additional areas for improvement in the 23 categories of surgeries we track.
- Each case of SSI prompts a potentially preventable case review (“mini” root cause analysis) to identify “misses” in order to learn and provide feedback to the patient care team about how to prevent future SSIs.
- In 2010, as part of the HQI project, BMC was designated as a top performer SCIP hospital. We have also actively participated as a mentor hospital for IHI.
Baystate Mary Lane Hospital
- BMLH Surgical Services is focusing on SI elimination and prevention of other post-operative complications and is participating in the system-wide Surgical Care Improvement Project (SCIP).
- Efforts are ongoing to minimize immediate use steam sterilization (IUSS).
Baystate Franklin Medical Center
- Multidisciplinary peri-operative services team completed a review of evidence-based practice, defining our current practice, and determining how we might implement or test changes in practice or process to decrease surgical site infections.
- The team used the model of Patient, Staff, Equipment, and Environment to focus our work. Staff researched their area of expertise and reported their findings, suggestions, or ideas to the team. This method led to high involvement and collaboration by team members.
- The team is making evidence-based practice changes in the areas of: patient skin preparation, hand hygiene, and re-education of the door opening policy once a surgical case has started.
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