1233. System dynamics modelling for analysis of pre-surgical interventions to reduce surgical infections at a South Indian tertiary care centre

Abstract

Abstract Background Surgical site infections (SSIs) warrants exploring context-based interventions to minimise their occurrence especially in resource limited settings. Pre-operative interventions are highlighted as important in reducing infections along the surgical pathways. The aim of this study is to investigate whether these interventions can reduce SSIs to inform policy making. Methods A patient centred operational perspective of the entire surgical patients’ pathways including infection management was developed by employing the System Dynamics methodology using the STELLA software. The development process was based on the principles of Group Model building involving healthcare staff, and included: pre-surgery, surgery, post surgery, emergency, re-admission, clinical management, and infection management phases. The model represented (i) categories of patients entering the pathways, (ii) states of patients on the pathways and their evolution over their states, (iii) mix of resources involved in activities, (iv) rules and processes to manage patients, and (v) patients’ exit and discharge routes from the pathways. Literature and policy documents informed also the model building process and the model was validated with the participation of clinical staff involved in the pathways. Results The model was run over a period of 1 year and results regarding the total number of SSIs (TSSIs) and the total number of deaths (TND) following treatment from infections (includes deaths from both SSIs and non-surgical clinical management infections). Three World Health Organization recommended interventions scenarios namely (i) Decolonization of nasal and extranasal sites on hospital admission, (ii) administration of prophylaxis antibiotic 45 minutes before incision, and (iii) skin preparation using Chlorhexidine based alcohol were simulated. TSSIs are reduced from 48 to 33, 36, and 16 under scenarios 1, 2, and 3 respectively (Figure 1) whereas TND are reduced from 35 to 31, 32, and 31 under the same scenarios. Conclusion Pre-operative interventions can be effective in reducing SSIs. Some of these interventions can be successfully implemented in resources limited settings such as the hospital described in this study. Disclosures All Authors: No reported disclosures.