Increasing Hand Hygiene Compliance By Changing the Culture

Abstract

Project: Despite historically low overall surgical site infection rates, in 2009, our 150-bed acute care facility experienced one of our highest surgical site infection rates of 0.39 per 100 surgical cases for both wound class I and II surgeries. To immediately address the issue, we introduced a Methicillin Resistant Staphylococcus aureus (MRSA) surveillance program and a decolonization method for patients in the preoperative period for elective surgeries. In the initial phase, we targeted high risk surgeries including total hips, knee, and spine surgeries. Patients were instructed during their preoperative testing appointment to shower with the provided 4% chlorhexidine gluconate solution the night before and the morning of their scheduled surgery. The patients were instructed to wear clean pajamas to bed and freshly laundered clothes to the hospital the day of their surgery. Patients were reminded not to shave any body part. In addition, we implemented MRSA surveillance targeting patients to have devices implanted. Our plan included screening the patients 7 days prior to surgery with a nasal swab sent for culture to check for MRSA colonization. If positive, the physician’s office would be notified and provided a decolonization protocol. The protocol, if prescribed by the physician, instructed the patient to use 1%muciprocin nasal cream in each nostril twice a day for five days prior to surgery. Also, these patients were instructed to bathe with a 4% chlorhexidine gluconate solution approximatley 5-7 days prior to surgery. Results: The overall annual rate of SSIs decreased from 0.39 per 100 surgeries in 2009 to 0.25 per 100 in 2010with rate reduction of 35%. Our wound class I surgical site infection rate reduced by 61% as it dropped dramatically from 0.39 per 100 in 2009 to 0.15 per 100 in 2010. After initiating the second phase of our project in May 2010, we continued to see a further rate reduction of 24% with a drop in the overall SSIs from 0.25 in 2010 to a current rate of 0.19. Lesson Learned: MRSA surveillance and decolonization protocol with chlorhexidine is an effective method to reduce surgical site infections. During the third phase of this project, we will include patients who require surgical intervention during their hospitalization. Additionally, wewill implement a process to use CHGwipes the day of surgery for those patients who were unable to complete the preoperative bathing protocol.