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Instituting a Bundled Approach to Reduce Colon Surgical Site Infections
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Poster Abstracts / American Journal of Infection Control 44 (2016) S28-S82
Hospital; Heather Eherenman, BSN, RN, CPHQ, Clinical Process Coordinator, HSHS St. Elizabeth’s Hospital; Carol Vance, BSN, RN, CIC, Infection Prevention and Occupational Health Manager, HSHS St Elizabeth’s Hospital BACKGROUND: Catheter associated blood stream infections (CLABSI) are associated with increased morbidity, mortality, cost and length of stay. Infection Prevention departments with finite resources find it challenging to locate resources to ensure central line catheters are adequately maintained. The objective of this study was to determine if utilizing resources from other departments to preform central line management observations would decrease CLABSI rates. METHODS: A before-after study design was used at a 285-bed community hospital. In November of 2014 a central line maintenance tool utilized by Infection Prevention was instituted on medicalsurgical and intensive care units (ICU). Quality coordinators were asked to preform central line audits. The audits included rounding on every central line and reviewing the criteria for the central line, dressing and tubing maintenance and discussions with nursing staff regarding the need to switch to peripheral access. The interventions were standardized using a device abstraction worksheet as the guide. CLABSI rates were compared from November 2013 to October 2014 (pre-intervention) to November 2014 to October 2015 (postintervention). The variables used to compare the pre and post time frames included the medical-surgical and ICU CLABSI infection rate. CLABSIs were identified using National Healthcare Safety Network (NHSN) definitions. Rates of CLABSI were compared using a Chisquare analysis. RESULTS: CLABSI rates decreased after the audit tool was implemented. CLABSI rates decreased from 1.50 per 1000 patient lines pre-intervention to 0.46 per 1000 patient lines post-intervention (P = .06) (EpiInfo, CDC). CONCLUSIONS: The utilization of other departments to assist with the central line surveillance did positively impact the infection rates. This information can be used by Infection Prevention Departments to seek out assistance from other departments that are underutilized. The upfront time for education and follow up will need to be factored in to this workflow change.
9-204 Instituting a Bundled Approach to Reduce Colon Surgical Site Infections Lisa M. Sanders, BSN, RN, CIC, Infection Preventionist, Northwestern Lake Forest Hospital; Sheila Neiner, BSN, RN, CIC, Clinical Quality Leader, Northwestern Lake Forest Hospital; Grace Barajas, M(ASCP), MS, Infection Preventionist, Northwestern Medicine Lake Forest Hospital; Judith A. Horvat, BSN, RN, CAPA, CNML, Nurse Manager, Northwestern Medicine, Ambulatory Services Lake Forest Hospital; John R. Andrews, MD, Chief of Surgery, Northwestern Medicine Lake Forest Hospital; Dave Chilicki, BSN, RN, ONC, Nurse Clinician, Northwestern Medicine Lake Forest Hospital; Amy Barnard, MS, APN, CCNS, CEN, Clinical Nurse Specialist, Northwestern Lake Forest Hospital; Gaurav Chaturvedi, MD, Assistant Professor, Northwestern Medicine, Feinberg School of Medicine A community hospital in Illinois identified an increase in colon surgical site infections (SSI) in June 2013. Over a year time period, the hospital’s rate was consistently above the National Healthcare Safety
Network (NHSN) benchmark of 7.28% (pooled mean) for colon SSIs. A multi-disciplinary group was formed to address the SSI rate. METHODS: After a chart review of SSIs from July 1, 2013-July 31, 2014 and a literature review, a multidisciplinary team was formed. This team included a surgeon, hospitalist, operating room nurse, infection preventionists, and various ancillary departments to review all data. A survey was then sent to all general surgeons to assess their pre, intra and post-operative practices for colon surgery. The responses were collated and used to determine appropriate interventions and standardize care. RESULTS: Our survey of surgeons revealed that each practiced differently. Our interventions were standardized across surgeons to provide the best outcomes for patients, resulting in a 100% decrease in colon surgical site infections. Interventions included: written pre-operative (pre-op) instructions for chlorhexidine gluconate (CHG) bathing prior to surgery, pre-op patient education on nutritional supplements to take 6 days prior to surgery, documented operating room cleaning prior to start of first surgery of the day, use of a pre-moistened CHG wipe of the surgical site within 6 hours prior to surgery and glove change prior to closure of abdominal wound by both the surgeon and scrub tech. Patient education folders with the above information were placed in the general surgeons’ offices as well as the Pre-Anesthesia Center to engage our patients in their care. CONCLUSION: Multiple interventions were initiated to reduce colon surgical site infections with promising results. Our standardized bundled approach in treating patients undergoing colon surgery has shown the potential for sustained improvement in the reduction of surgical site infections in this patient population.
9-205 Implementing a Colon Bundle in 2 Hospitals: A Multidisciplinary Approach to a Quality Improvement Initiative Angela C. Gabasan, RN, BSN, MSN, CIC, Infection Preventionist, Mount Sinai St. Luke’s and Mount Sinai West; Melissa M. Alvarez-Downing, MD, Assistant Professor of Surgery, Icahn School of Medicine at Mount Sinai New York; Barbara A. Smith, RN, BSN, MPA, CIC, Infection Preventionist, Mount Sinai St. Luke’s; Eloisa Santos, RN, BSN, MA, MEd, Infection Preventionist, Mount Sinai West; Emilia Mia Sordillo, MD, PhD, Interim Director of Infection Prevention and Control, Mount Sinai St. Luke’s and Mount Sinai West BACKGROUND: Colon surgical site infection (SSI) prevention aligns with our Health System goal to reduce hospital-associated conditions to zero within the next 4 years. Our hospitals participated in the 2014 New York State Partnership for Patients Advanced Colon Bundle Program initiative to decrease colon SSIs utilizing a 7-element bundle. METHODS: Gap Analysis was performed to identify which bundle elements were already in place at our sites and to assess compliance. Bundle Implementation: We assembled a multidisciplinary team including colorectal surgeons, anesthesiologists, infectious diseases specialists, perioperative staff, and infection preventionists, with a lead surgeon and an infection preventionist as process coowners. The team consensus was to maximize compliance with the measures already in place, and to phase in the additional bundle elements. The plan included a time frame for implementation, ed-
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016
Poster Abstracts / American Journal of Infection Control 44 (2016) S28-S82
Hospital; Heather Eherenman, BSN, RN, CPHQ, Clinical Process Coordinator, HSHS St. Elizabeth’s Hospital; Carol Vance, BSN, RN, CIC, Infection Prevention and Occupational Health Manager, HSHS St Elizabeth’s Hospital BACKGROUND: Catheter associated blood stream infections (CLABSI) are associated with increased morbidity, mortality, cost and length of stay. Infection Prevention departments with finite resources find it challenging to locate resources to ensure central line catheters are adequately maintained. The objective of this study was to determine if utilizing resources from other departments to preform central line management observations would decrease CLABSI rates. METHODS: A before-after study design was used at a 285-bed community hospital. In November of 2014 a central line maintenance tool utilized by Infection Prevention was instituted on medicalsurgical and intensive care units (ICU). Quality coordinators were asked to preform central line audits. The audits included rounding on every central line and reviewing the criteria for the central line, dressing and tubing maintenance and discussions with nursing staff regarding the need to switch to peripheral access. The interventions were standardized using a device abstraction worksheet as the guide. CLABSI rates were compared from November 2013 to October 2014 (pre-intervention) to November 2014 to October 2015 (postintervention). The variables used to compare the pre and post time frames included the medical-surgical and ICU CLABSI infection rate. CLABSIs were identified using National Healthcare Safety Network (NHSN) definitions. Rates of CLABSI were compared using a Chisquare analysis. RESULTS: CLABSI rates decreased after the audit tool was implemented. CLABSI rates decreased from 1.50 per 1000 patient lines pre-intervention to 0.46 per 1000 patient lines post-intervention (P = .06) (EpiInfo, CDC). CONCLUSIONS: The utilization of other departments to assist with the central line surveillance did positively impact the infection rates. This information can be used by Infection Prevention Departments to seek out assistance from other departments that are underutilized. The upfront time for education and follow up will need to be factored in to this workflow change.
9-204 Instituting a Bundled Approach to Reduce Colon Surgical Site Infections Lisa M. Sanders, BSN, RN, CIC, Infection Preventionist, Northwestern Lake Forest Hospital; Sheila Neiner, BSN, RN, CIC, Clinical Quality Leader, Northwestern Lake Forest Hospital; Grace Barajas, M(ASCP), MS, Infection Preventionist, Northwestern Medicine Lake Forest Hospital; Judith A. Horvat, BSN, RN, CAPA, CNML, Nurse Manager, Northwestern Medicine, Ambulatory Services Lake Forest Hospital; John R. Andrews, MD, Chief of Surgery, Northwestern Medicine Lake Forest Hospital; Dave Chilicki, BSN, RN, ONC, Nurse Clinician, Northwestern Medicine Lake Forest Hospital; Amy Barnard, MS, APN, CCNS, CEN, Clinical Nurse Specialist, Northwestern Lake Forest Hospital; Gaurav Chaturvedi, MD, Assistant Professor, Northwestern Medicine, Feinberg School of Medicine A community hospital in Illinois identified an increase in colon surgical site infections (SSI) in June 2013. Over a year time period, the hospital’s rate was consistently above the National Healthcare Safety
Network (NHSN) benchmark of 7.28% (pooled mean) for colon SSIs. A multi-disciplinary group was formed to address the SSI rate. METHODS: After a chart review of SSIs from July 1, 2013-July 31, 2014 and a literature review, a multidisciplinary team was formed. This team included a surgeon, hospitalist, operating room nurse, infection preventionists, and various ancillary departments to review all data. A survey was then sent to all general surgeons to assess their pre, intra and post-operative practices for colon surgery. The responses were collated and used to determine appropriate interventions and standardize care. RESULTS: Our survey of surgeons revealed that each practiced differently. Our interventions were standardized across surgeons to provide the best outcomes for patients, resulting in a 100% decrease in colon surgical site infections. Interventions included: written pre-operative (pre-op) instructions for chlorhexidine gluconate (CHG) bathing prior to surgery, pre-op patient education on nutritional supplements to take 6 days prior to surgery, documented operating room cleaning prior to start of first surgery of the day, use of a pre-moistened CHG wipe of the surgical site within 6 hours prior to surgery and glove change prior to closure of abdominal wound by both the surgeon and scrub tech. Patient education folders with the above information were placed in the general surgeons’ offices as well as the Pre-Anesthesia Center to engage our patients in their care. CONCLUSION: Multiple interventions were initiated to reduce colon surgical site infections with promising results. Our standardized bundled approach in treating patients undergoing colon surgery has shown the potential for sustained improvement in the reduction of surgical site infections in this patient population.
9-205 Implementing a Colon Bundle in 2 Hospitals: A Multidisciplinary Approach to a Quality Improvement Initiative Angela C. Gabasan, RN, BSN, MSN, CIC, Infection Preventionist, Mount Sinai St. Luke’s and Mount Sinai West; Melissa M. Alvarez-Downing, MD, Assistant Professor of Surgery, Icahn School of Medicine at Mount Sinai New York; Barbara A. Smith, RN, BSN, MPA, CIC, Infection Preventionist, Mount Sinai St. Luke’s; Eloisa Santos, RN, BSN, MA, MEd, Infection Preventionist, Mount Sinai West; Emilia Mia Sordillo, MD, PhD, Interim Director of Infection Prevention and Control, Mount Sinai St. Luke’s and Mount Sinai West BACKGROUND: Colon surgical site infection (SSI) prevention aligns with our Health System goal to reduce hospital-associated conditions to zero within the next 4 years. Our hospitals participated in the 2014 New York State Partnership for Patients Advanced Colon Bundle Program initiative to decrease colon SSIs utilizing a 7-element bundle. METHODS: Gap Analysis was performed to identify which bundle elements were already in place at our sites and to assess compliance. Bundle Implementation: We assembled a multidisciplinary team including colorectal surgeons, anesthesiologists, infectious diseases specialists, perioperative staff, and infection preventionists, with a lead surgeon and an infection preventionist as process coowners. The team consensus was to maximize compliance with the measures already in place, and to phase in the additional bundle elements. The plan included a time frame for implementation, ed-
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016