Success of an infection control (IC)–led multidisciplinary team to encourage judicious use of surgical antimicrobial prophylaxis (SAP) to prevent surgical site infections (SSIs) and antimicrobial resistance

Success of an infection control (IC)–led multidisciplinary team to encourage judicious use of surgical antimicrobial prophylaxis (SAP) to prevent surgical site infections (SSIs) and antimicrobial resistance

June 2005 E27 2:55-3:10 PM Abstract ID 51469 Blue Ribbon Abstract Award Standardization of the central venous catheter insertion process reduces ca...

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June 2005

E27

2:55-3:10 PM Abstract ID 51469

Blue Ribbon Abstract Award Standardization of the central venous catheter insertion process reduces catheter-associated bloodstream infections in a university hospital medical intensive care unit K Wilkerson1 T Talbot1 J Foss1 M Newton1 R Wall 2 W Schaffner1 1 2

Vanderbilt University Medical Center, Nashville, Tennessee University of Washington, Seattle, Washington

ISSUE: Use of central venous catheters (CVC) has been associated with increased incidence of bloodstream infections (BSIs). We set out to decrease the rate of CVC-associated BSI (CVC-BSI) by implementing a multifaceted intervention that included provider education, a standardized insertion checklist, and real-time performance feedback. PROJECT: Our institution defines CVC-BSI using National Nosocomial Infections Surveillance (NNIS) system criteria. During the year prior to the intervention (October 2001 to September 2002), our 14-bed medical intensive care unit (MICU) had a CVC-BSI rate of 7.6/1000 central line days. Based upon published guidelines, a multidisciplinary team developed a mandatory online tutorial and examination for medical and nursing staff. At each CVC insertion or guidewire exchange, the bedside nurse completed a standardized checklist that identified evidence-based insertion behaviors. The checklists were scanned into a computerized database, allowing rapid data entry. Real-time performance feedback reports were generated, and the MICU staff and physicians were provided unit specific data at the start of each month and 3 weeks later to allow resident physicians, who rotate monthly, to review their data and adjust their practice as needed. This collaborative intervention was designed to be educational and not punitive in nature. RESULTS: Following implementation in October 2002, the intervention has been used for 701 CVC insertions. The CVC-BSI rate for lines impacted by this study decreased to a 2004 rate of 1.9/1000 central line days. There have been two periods of greater than 200 days each between CVC-BSI. Positive feedback from this intervention has led to its acceptance and continued use for more than 2 years. MICU is proud of the low BSI rate and works to maintain it. LESSONS LEARNED: Using a standardized intervention aimed at CVC insertion reduces CVC-BSI rates. Development of a successful program requires cooperation and buy-in from physicians as well as nursing staff to effect change. Use of a standardized form provides data for process improvement as well as documentation for the medical record. The observation checklist is available in the electronic medical record. Due to the continued success in the MICU, we started implementing the intervention in all critical care areas in 2004. 3:10-3:25 PM Abstract ID 54559

Success of an infection control (IC)–led multidisciplinary team to encourage judicious use of surgical antimicrobial prophylaxis (SAP) to prevent surgical site infections (SSIs) and antimicrobial resistance M Moinuddin ZH Shaikh

E28

Vol. 33 No. 5

K Bamburg K Strelczyk Methodist Health System, Dallas, Texas BACKGROUND: SSIs develop in up to 5% of surgical patients in the United States, with half of these being preventable if SAP is used judiciously. Overuse and misuse of SAP has a potential to contribute significantly to the emerging problem of antimicrobial resistance. To increase compliance with evidence-based guidelines, the Centers for Disease Control and Prevention (CDC) has launched a campaign to Prevent Antimicrobial Resistance in Surgical Patients, emphasizing wise use of antimicrobials as one of the key strategies. OBJECTIVES: To participate in Texas Medical Foundation Surgical Infection Prevention (SIP) Medicare Quality Improvement Project, with a goal of achieving .90% compliance with three core measures: 1) administration of antibiotic within 1 hour preceding surgical incision, 2) use of appropriate antibiotic and dosing, and 3) discontinuation of prophylactic antibiotic within 24 hours of surgery. METHODS: A multidisciplinary team consisting of the following departments: infection control (IC), clinical outcomes, nursing, operating room (OR) nurse educator, pharmacy, and physicians (infectious diseases, anesthesia, and surgery) was formed to develop practical ways to implement the SIP measures in the orthopedic and neurosurgical populations. Recommendations for appropriate SAP based on national guidelines were discussed with the surgeons and anesthesiologists. A laminated page with the protocol was made available on each anesthesia cart. IC and OR participated in ongoing education campaigns to the nursing staff. A data collection tool to be completed by the peri-operative team was formulated, and OR nurse educator followed-up daily to ensure accurate documentation. Rates were analyzed by IC, discussed in monthly SIP meetings, and posted on a showcase in a conspicuous OR location. Reasons for fall-out were scrutinized, and individual feedback on outliers provided to the physicians. RESULTS: Compliance rates from November 2003 (baseline) to November 2004, improved for all three indicators: 1) timely administration of prophylactic antibiotic, 84.6% to 91.1% (p=0.5); 2) appropriate antibiotic and dosage, 69.2% to 97.8% (p , 0.01); and 3) discontinuation of antibiotic within 24 hours of surgery, 67.3% to 91.1% (p , 0.01). CONCLUSIONS: A multidisciplinary approach focusing on practical strategies for implementation of evidencebased practices for SAP led to our programs success and recognition in 2004 by Texas Medical Foundation for achieving .90% compliance for all three SIP measures.

Poster Abstracts Exhibit Hall Monday, June 20 11:30 AM–2:30 PM Tuesday, June 21 10:30 AM–1:30 PM All posters will be available for viewing Monday and Tuesday. The authors will be attending their posters on the days indicated. The posters are arranged by topic (see below) and then numerically by Abstract ID number within each category.

Poster Topics Antimicrobial Resistance Antiseptics, Disinfection, Sterilization