Surgical Infection Prevention: Success Stories NEVADA St. Rose Dominican Hospital Achieves Higher Standards Through the assistance of HealthInsight, Nevada’s Medicare Quality Improvement Organization, and the application of human factors science, St. Rose Dominican Hospital-Siena Campus, in Henderson, Nevada, has been able to dramatically boost their performance on two out of three of the Surgical Infection Prevention (SIP) quality indicators. The SIP Committee, hard at work since December of 2003, began discussions with front line workers and various surgeons to diagnose reasons why their various performance gaps existed. Based on their diagnosis and discoveries, the committee identified solutions most appropriate for each type of gap or error, and has seen some significant results. Baseline Rates & Rates at Remeasurement for all Knee Surgeries (period beginning 7/04 and ending 11/04) Prophylactic Antibiotic Received Within 1 Hour Prior to Surgical Incision: Baseline: 36% Remeasurement: 67% Prophylactic Antibiotic Selection for Surgical Patients: Baseline: 95% Remeasurement: 97% As best practice guidelines have recently suggested, the team’s first task was to replace their entire stock of razor blades with clippers so that razors could no longer be used for skin preps beforesurgical procedures. Through team discussion and the utilization of human factors principles, the team was able to identify what they felt were the most relevant contributing factors for their outcomes. This meant asking those underlying questions such as, “Does everybody even define the ‘1 st dose of antibiotic’ in the same manner?” and “Is anybody even aware that guidelines exist and should be followed?” or “How long is our average surgical patient on antibiotics after surgery end time?” Interviews with surgeons took place so that the team could better understand why certain antibiotics were chosen and education could be offered regarding the high antibiotic resistance rate our country is currently experiencing. A lot of work is still to be done, although the St. Rose Dominican Hospital staff is determined to stay on the road of success! For information, contact: Kristen Boucher, Communications/Review Coordinator at HealthInsight, kboucher@nvqio.sdps.org or 702-933-7314. This material was prepared by HealthInsight, the Medicare Quality Improvement Organization for Nevada , under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.

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