Surgical Site Infection Prevention: Interventional Epidemiology

Abstract

ISSUE: Advocate Christ Medical Center, Department of Epidemiology. noted an increase of Class I surgical site infections (SSIs) in January 2002, returned to baseline rates for 2 months, and then experienced an increase in rates again in April 2002. Neither outbreak investigation revealed a common source; however, many quality improvement initiatives were identified. PROJECT: In a effort to improve quality of care for patients and to decrease SSI rates to baseline or below, a 0.6 Infection Control Coordinator was reassigned from patient units to the surgical units and sterile processing. Included in her responsibilities were observations of surgical cases and cleaning processes, education, organization of a multidisciplinary surgical site task force, and review of policy and procedures. Utilizing the P.D.S.A. model of quality improvement, numerous initiatives were identified, and actions and measurements for improvement were put into place. The following are just a few examples of successful initiatives that were put into place: decrease in flash sterilization, purchase of new surgical instruments, strict use of clipping not shaving, appropriate timing of antibiotic usage, decrease of wet loads in sterile processing, improving traffic patterns in sterile processing, and decreasing weight of instrument trays. RESULTS: In July 2002, a marked reduction in SSI rates was noted, to below baseline rates with a continuation of the downward trend through the fourth quarter of 2003. The current rate of Class I SSIs remains below 1%. LESSONS LEARNED: Oftentimes conventional infection control programs focus on inpatient units, and problem-solving issues are identified in departments. This initiative demonstrates that assigning to a given department an interventional coordinator who is highly visible, accessible, and valued by the surgical team, can result in improved patient safety and reduce costs associated with infection levels above baseline. We could more than justify a 0.6 salary in epidemiology by initiating interventional programs.