A Multidisciplinary Approach with Reducing Cardiac Surgical Site Infections

Abstract

BACKGROUND/OBJECTIVES: Despite adherence to evidenced-based practice recommendations, SSIs can still occur. The Cardiac Surgical Team, Infection Control & Prevention Department, and the Performance Improvement Department collaborated to implement best practices for reducing SSI morbidity and mortality in cardiac surgical patients. We proceeded to compare the Centers for Disease Control & Prevention (CDC) and the Surgical Care Improvement Project's (SCIP) best practices to our current practice. Additionally, process of care opportunities were identified from intense analyses involving cardiac surgical patients. Time was spent observing patient care in the Operating Room and Cardiac Surgical Intensive Care Unit. Opportunities to improve the correct timing, dosing, and documentation of antibiotics during the preoperative & intraoperative periods were found. METHODS: Buy-in from the Department of Anesthesia and Surgery Chiefs was obtained. A summary of hospital preoperative antibiotic timing data compared to best practices was presented to the members of the Departments of Anesthesia and Surgery. The practice of giving antibiotics “on-call” was discontinued; instead, the medication was administered in the Operating Room Holding Area. The Anesthesia Record was revised to highlight the preoperative antibiotic. Questioning if the preoperative antibiotic has been administered became part of the surgical time out process. The Cardiac Perfusionist assisted with antibiotic documentation on the Perfusion Record. Timers were placed in every operating room suite as a reminder to ensure the re-bolusing of selected antibiotics. Cefazolin 2 Grams was given preoperatively to all patients who weigh ≥200 pounds. Preoperative antibiotic timing and postoperative antibiotic discontinuation continued to be reviewed monthly for every case. Cardiac surgical infection surveillance continued for all open heart procedures. RESULTS: Pre-op antibiotic administration compliance within one hour before surgery was at 28.6% during December 2003 and has now been sustained at or near 100%. Use of appropriate antibiotics has been consistently 100% since October 2003. Surgical Site Infection Rates for Risk 1 CABG procedures, previously slightly greater than the 50th decile during 2002, is now below the 10th decile when compared to NNIS data. CONCLUSIONS: The Cardiac Surgical Team's acceptance/buy-in of the numerous recommendations came willingly. Operational issues at times were challenging. However, our multidisciplinary team was able to improve and sustain a high rate of performance to significantly reduce infection in the cardiac surgical patient. BACKGROUND/OBJECTIVES: Despite adherence to evidenced-based practice recommendations, SSIs can still occur. The Cardiac Surgical Team, Infection Control & Prevention Department, and the Performance Improvement Department collaborated to implement best practices for reducing SSI morbidity and mortality in cardiac surgical patients. We proceeded to compare the Centers for Disease Control & Prevention (CDC) and the Surgical Care Improvement Project's (SCIP) best practices to our current practice. Additionally, process of care opportunities were identified from intense analyses involving cardiac surgical patients. Time was spent observing patient care in the Operating Room and Cardiac Surgical Intensive Care Unit. Opportunities to improve the correct timing, dosing, and documentation of antibiotics during the preoperative & intraoperative periods were found. METHODS: Buy-in from the Department of Anesthesia and Surgery Chiefs was obtained. A summary of hospital preoperative antibiotic timing data compared to best practices was presented to the members of the Departments of Anesthesia and Surgery. The practice of giving antibiotics “on-call” was discontinued; instead, the medication was administered in the Operating Room Holding Area. The Anesthesia Record was revised to highlight the preoperative antibiotic. Questioning if the preoperative antibiotic has been administered became part of the surgical time out process. The Cardiac Perfusionist assisted with antibiotic documentation on the Perfusion Record. Timers were placed in every operating room suite as a reminder to ensure the re-bolusing of selected antibiotics. Cefazolin 2 Grams was given preoperatively to all patients who weigh ≥200 pounds. Preoperative antibiotic timing and postoperative antibiotic discontinuation continued to be reviewed monthly for every case. Cardiac surgical infection surveillance continued for all open heart procedures. RESULTS: Pre-op antibiotic administration compliance within one hour before surgery was at 28.6% during December 2003 and has now been sustained at or near 100%. Use of appropriate antibiotics has been consistently 100% since October 2003. Surgical Site Infection Rates for Risk 1 CABG procedures, previously slightly greater than the 50th decile during 2002, is now below the 10th decile when compared to NNIS data. CONCLUSIONS: The Cardiac Surgical Team's acceptance/buy-in of the numerous recommendations came willingly. Operational issues at times were challenging. However, our multidisciplinary team was able to improve and sustain a high rate of performance to significantly reduce infection in the cardiac surgical patient.