Teamwork at the front line can reduce SSI rate

By Sarah Guy, MedWire Reporter

Rates of surgical site infection (SSI) can be markedly reduced by the implementation of a front-line provider group that uses local wisdom and existing evidence on patient safety, report US researchers.

Indeed, the surgery-based comprehensive unit-based safety program (CUSP) set up at their institution reduced SSI rates after colectomies and proctectomies by a significant amount over a 1-year period, they report in the Journal of the American College of Surgeons.

They say that the success of the program was down to accurate outcomes measurement, support of hospital leadership, and engaged front-line personnel in the context of a strong safety culture. Furthermore, it involved practical interventions such as standardizing preoperative skin preparation.

"The CUSP program is unique because it focuses on the frontline providers - the nurses and the medical techs taking care of the patients day to day - and it gives them the power to identify and fix defects in the operating room," said co-author Elizabeth Wick (Johns Hopkins Hospital, Baltimore, Maryland), in a statement to the press.

She added that colorectal SSIs are traditionally hard to prevent, with wound infections being an important risk factor for hospital readmission, increased lengths of stay, and re-operations.

Wick and colleagues engaged a multidisciplinary CUSP team involving leaders in nursing, anesthesiology, surgery, and infection control, and surveyed their views on how SSIs develop and what can be done to prevent them. These answers, plus existing evidence, indicated that skin preparation, maintenance of normothermia, and intraoperative sterile technique should be the priorities for reducing colorectal SSI.

A total of 324 consecutive colorectal surgery patients were exposed to the CUSP team's interventions over 1 year, and the SSI rate dropped to 18.2% from 27.3% in the 12 months preceding the intervention, a significant difference.

The team also saw modest improvements in superficial SSI and organ-space infection rates, but no difference in rates of deep-vein thrombosis.

Wick and co-workers estimate that they prevented a total 28 infections during the intervention period, resulting in an approximate US$ 168,000 (€ 137,075) to $ 280,000 (€ 228,458) saving in 1 year.

"Surgery is a field at high-risk for adverse events, and when an adverse event occurs, it can lead to a cascade of other events that can result in long-term morbidity or disability for the patient, as well as increased costs for the system," they conclude.

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