Using Best Evidence to Reduce the Rate of Surgical Site Infection

Abstract

Poster Presentation Objective To create a surgical site infection prevention bundle by examining population characteristics, context of care, and prioritization of evidence‐based interventions. Design Quality improvement plan‐do‐study‐act (PDSA) methodology with a small‐scale iterative approach to three cycles of improvement was used to create a surgical site infection (SSI) prevention bundle. Sample All women with cesarean births in scheduled day surgery operating suites and labor room operating suites at an academic medical center with 5500 births annually. Methods Care improvement process consisting of a common cause analysis of our readmission cases to determine the characteristics of our population. Next, we examined the literature on SSI prevention and treatment related to these characteristics. Three areas with significant variation from evidence‐based practice were identified: antibiotic prophylaxis, skin preparation, and education. Implementation Strategies To plan cycle one, we assessed antibiotic stewardship of participants. Overall 32% of participants and 31% of readmission participants did not adhere to guidelines To act, a forcing function in our order sets yielded a 100% compliance rate, and none of the participants in the test of change cycle ( N = 20) was readmitted. In the second cycle, we assessed skin preparation and found significant variation in processes. After education and implementation of new interventions, we found 100% compliance. The last cycle focused on patient education. To plan, we called 20 participants to assess their knowledge, what they were taught, and their current wound status. We found that we were teaching patients the signs and symptoms of infection but not prevention. Participants reported variation in care, limited education on wound care, and no education on hand hygiene; 20% reported wound deviation. Interventions applied included focused nursing education on wound care and hand hygiene when caring for infants, including a care package with materials to support the education at home. Reassessment revealed increased knowledge and wound care and no reports of wound deviations. Results SSI rates decreased during 10 months from 2.41% to 0.61% to zero. Days between SSI readmissions increased from 2 days to 68 days at present. Conclusion/Implications for Nursing Practice Developing a context and population focused evidence‐based prioritized care bundle can result in improved patient outcomes. Nursing interventions based on knowing the patient can yield sustainable results.