Surgical Infection Prevention: Success Stories OKLAHOMA Small Hospital Achieves Big Success in Oklahoma Collaborative At the beginning of Oklahoma Foundation for Medical Quality’s (OFMQ) Surgical Infection Prevention (SIP) Collaborative, Choctaw Nation Health Center’s team aimed to reduce surgical site infections in its pilot population by 50 percent. As the smallest hospital in the project, Choctaw Nation was initially concerned about the time and resources the collaborative requires. However, the team soon found that being a small facility has advantages.Despite a slow start, the team rallied behind the collaborative process to reach its goal and spread improvements to new areas. During the collaborative, Choctaw Nation implemented several successful changes in its pilot population, including: Adopting standing orders for antibiotic usage Replacing razors with clippers in operating rooms Recording fingerstick blood sugar readings in pre-op area Using the rapid cycle methodology learned during the first session of the SIP collaborative, the Choctaw Nation team began by implementing a change to ensure patients receive appropriate prophylactic antibiotics within one hour before incision. Using evidence-based medicine and extensive resources from OFMQ, the team held training sessions to introduce SIP to existing surgical staff and implemented a process to educate new staff about the project. Over the yearlong collaborative, the Choctaw Nation team reached its goal of reducing infection rates in its pilot population by 50 percent. For more information, contact Tracie LaGere, OFMQ communications manager, at 405.840.2891 or Tammy McGee at Choctaw Nation Health Center at 918.567-7000.  Evidence-based Processes Improve Patient Care Bone and Joint Hospital wowed colleagues at the Oklahoma Collaborative Surgical Infection Prevention Outcomes Congress with its extremely low surgical infection rates. The hospital has long supported evidence-based practices and was already following national guidelines before joining the SIP collaborative. Bone and Joint Hospital infection rates are historically low; nonetheless, the hospital was able to further reduce its infection rates. At the SIP Outcomes Congress, Bone and Joint Hospital’s latest data revealed total hip and knee infection rates of less than 1 percent, 0.61 percent for hip and 0.50 percent for knee. The hospital aspired to improve the care of surgical patients by evaluating additional practices to augment current practices to prevent surgical site infections. The goals set measured total infection rates; antibiotic timing, selection and discontinuation; patient warming; and clipping versus shaving. Bone and Joint Hospital also aimed to educate all staff on the national SIP project. In all measures, Bone and Joint Hospital showed improvement, some more significantly than others. Measures Baseline Goal Rate (as of 10/03) Total hip infection rate 1.35% 1.01% .61% Total knee infection rate .88% .66% .50% On-time antibiotics (0-1 hr Ancef / 0-2 hrs Vanco) 97.8% 100% 99.6% On-time antibiotics (Ancef 0-30 minutes) 82.9% 95% 88% Appropriate selection of prophylactic antibiotic 98.7% 100% 99.9% Antibiotic discontinued within 24 hrs 97.8% 100% 98% Clipping versus shaving 100% 100% 100% % of THA & TKA patients with normothermia maintained unknown 90% All TKA & THA patients being warmed For more information, contact Tracie LaGere, OFMQ communications manager, at 405.840.2891 or Janet Farhood, CEO of Bone and Joint Hospital , or Pat Vernon, Infection Control Coordinator at Bone and Joint Hospital at 405.552.9232. Making it Easy to Do the Right Thing Mercy Health Center signed up to participate in the Oklahoma Foundation for Medical Quality’s Surgical Infection Prevention Collaborative (SIP) in April 2002. Its overall goal was t o improve the care of patients undergoing surgery at Mercy Health Center by redesigning systems of care and testing and implementing new practices. At that time, 101 surgical procedures had been performed without incidence of infection. Participants representing several disciplines throughout Mercy Health Center formed the Ounce of Prevention team. The team’s measurable goal was to double the number of surgical procedures without incidence of infection. Ounce of Prevention indicator goals: One hundred percent of eligible surgical patients will receive antibiotic prophylaxis within zero to 60 minutes of incision, remaining consistent with approved guidelines. Surgical site infections will be reduced by 50 percent by Increasing staff knowledge of surgical infection prevention measures (100 percent) Using clippers for indicated hair removal (100 percent) Maintaining euthermia (100 percent) Optimizing Oxygen Tension One hundred percent of the prophylactic antibiotics will be discontinued within 24 hours after surgery. The Ounce of Prevention team successfully met and sustained its goals for the selected indicators and initiated spread throughout the organization and continues to be committed to the Surgical Infection Prevention initiatives. Results produced by August 2002: The goal was doubled. Mercy had performed 401 surgical procedures before incidence of infection, a four-fold increase since the team began. Initiating rapid cycle process improvement on several different indicators in the same interval built momentum for change. Indicators were targeted to different members of the OR staff, an approach that distributed “successes” to everyone from the OR technicians to the surgeons thereby enhancing buy in. All members of the surgical services were involved in and became advocates for at least one of the initiatives. The collaborative approach overcame boundaries and divisions that had limited process redesign in the past. For more information, contact Tracie LaGere, OFMQ communications manager, at 405.840.2891 or Ronda Pasley-Shaw at Mercy Health Center at 405.755.1515. This material was prepared by the Oklahoma Foundation for Medical Quality , the Medicare Quality Improvement Organization for Oklahoma , 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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