Surgical Infection Prevention: Success Stories MISSISSIPPI Information and Quality Healthcare Reports Successful Surgical Infection Prevention Efforts Central Mississippi Medical Center (CMMC) in Jackson has achieved improvement through collaboration with Information and Quality Healthcare (IQH), Medicare’s Quality Improvement Organization for Mississippi. CMMC participated in the national Surgical Infection Prevention Collaborative that began in 2002.  The project team worked with surgical staff to improve knowledge of surgical infection prevention, using a series of in-service programs and giving a pre-test and a post-test. From an original 4.3 percent level of staff scoring 100 on the pre-test, the in-service sessions resulted in all the staff scoring 100 percent on the post-test. Both the coronary artery bypass graft surgery and the abdominal hysterectomy surgical site infection rates were decreased by more than 50 percent. The timing of prophylactic antibiotic administration showed improvement from 45.2 percent to 97 percent. A test indicator measuring the use of clippers rather than razors to decrease the risk of infection went from 34.2 percent to 93.1 percent. Utilizing CMMC's own "find-it-fix-it-check-it" version of the "Plan Do Study Act" process, CMMC was able to increase the percent of surgery patients who had hair removal with clippers rather than with razors. Interventions included: staff and physician education, preps by the pre-op holding nurses, revision of the pre-op check-list form, removal of razors and standardization of clippers to ensure that they all provided good prep results. Interventions were enhanced through an OR manager champion dressed as "Zorro" who removed razors from the area. As each intervention was implemented, the indicator rate showed improvement. The feedback to the staff as the rates improved reinforced the success of their efforts. Keys to success included administrative support; involvement of clinical champions; supportive senior leaders; continual education; monthly feedback of data; reference to evidenced-based medicine; and continual monitoring of performance. ***** Between January 2003 through June 2004, participating hospital teams implemented, tested, and tracked changes in prophylactic antibiotic administration for patients undergoing elective procedures including hysterectomy, laminectomy, joint replacement, colorectal and cardiac surgeries. The teams made significant progress including: Increasing the proportion of surgical patients receiving prophylactic antibiotic within one hour prior to surgical incision, from 53.9 percent to 61 percent; Increasing the proportion of surgical patients with prophylactic antibiotics discontinued within 24 hours after surgery end time, from 34.8 percent to 48.2 percent. The modified collaborative was led by IQH, the Medicare Quality Improvement Organization for Mississippi, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Mississippi hospitals are continuing to work with IQH to improve quality of care. For information, contact: C arole Kelly, IQH Communications Manager, 1-800-844-0500, ext. 209, and Marsha Watson, IQH Quality Improvement Manager, ext. 232. This material was prepared by IQH, the Medicare Quality Improvement Organization for Mississippi, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

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