Surgical Infection Prevention: Success Stories TEXAS Texas Surgical Infection Prevention Collaborative Achieves Success The Texas Surgical Infection Prevention (SIP) Collaborative concluded with an Outcomes Congress held in Austin on July 19, 2004. Four hospitals presented their improvement methods and guest speakers described the evidence supporting SIP performance measures, a new guideline on surgical prophylactic antibiotics, and the role of glucose control in preventing surgical infections. Fifty hospitals began the project in August 2003 and 42 completed it. The project’s results are listed below: Required measures Baseline Final % Change Timely antibiotic administration 61.6% 84.7% 23.1% Use of recommended antibiotics 81.5% 85.0% 3.5% Discontinue antibiotics within 24 hours 38.0% 62.9% 24.9% Optional measures Baseline Final % Change Normothermia 50.0% 71.0% 21.0% Supplemental oxygen 22.5% 72.9% 50.4% Avoid shaving 64.2% 81.0% 16.8% Methodist Dallas Medical Center Achieves Better Than 95% Compliance in 5 of 6 SIP Indicators in Nine Months Working with TMF Health Quality Institute(TMF), the Medicare Quality Improvement Organization for Texas, Methodist Dallas Medical Center Neurosurgery and Orthopedic Surgery departments were able to dramatically boost performance on five of six Surgical Infection Prevention (SIP) quality indicators and to achieve 95% compliance in five out of six SIP indicators. Baseline rates and rates at remeasurement (for period beginning 9/03 and ending 5/04): Appropriate prophylactic antibiotics: from 68.3% to 98.1% Discontinuation of antibiotics: from 48.8% to 75.0% Normothermia (keeping patient body temperature at normal levels): from 78.6% to 96.2% Not shaving: from 73.8% to 100.0% Re-dosing for prolonged surgeries: from 25.0% to 100.0% On time antibiotics: from 97.6% to 96.2% At the start of the project, the hospital shared surgical site infection rates with each surgical department, identified barriers and addressed issues with evidence from the literature and through discussion. After the nine-month effort, not only were the measures improved, but there was increased awareness of measures with the anesthesia group, surgery and staff. Small Hospital Achieves Big Results in Bryan, Texas The Physicians Centre, a 16 bed hospital in Bryan, Texas, has been participating in TMF’s Surgical Infection Prevention (SIP) Collaborative since August 2003. The objective of the SIP Collaborative is to reduce surgical infections by improving preventive care. Performance measures include improving selection and timing of prophylactic antibiotics, maintaining normothermia, providing supplemental oxygen, and not shaving the surgical site. For the SIP Collaborative, The Physicians Centre is working to improve care for patients having total joint replacements or hysterectomies. An orthopedic surgeon and a gynecologist serve as clinical champions and work with a multidisciplinary team to improve care processes. The team used rapid plan-do-study-act (PDSA) cycles to develop and implement a new pre-printed order set that addressed all of the performance measures. PDSA cycles were also used to standardize IV antibiotic administration as the patient enters the operating room. To maintain perioperative patient normothermia, protocols for using patient warming devices are currently being tested. The following table documents results through November 2003: Performance Measure Baseline November 2003 Antibiotics administered within one hour prior to surgery 66.0% 95.0% Use of recommended antibiotics 76.6% 100.0% Antibiotics discontinued within 24 hour of surgery 62.8% 85.0% Perioperative normothermia 39.4% 90.0% Patients receiving 80% supplemental oxygen (FIO 2) 0.0% 90.0% Surgical site not shaved 52.1% 100.0% The hospital’s SIP team has overcome barriers such as difficulty in finding a time to meet with surgeons, documentation problems, and one surgeon’s reluctance to discontinue antibiotics within 24 hour of surgery. Team leader Chris Allen, RN, CIC, reports that “the surgeons are enthusiastic about the project and the team is motivated and works well together.” The team will be monitoring their performance measures monthly to ensure their gains are maintained. Memorial Herman The Woodlands Achieves 100% Compliance on Two SIP Measures   Memorial Hermann The Woodlands (MHTW) Hospital is participating in TMF’s Surgical Infection Prevention (SIP) Collaborative. They began piloting improvement methods with one orthopedic surgeon on his hip and knee arthroplasty cases. The goal of their project was to improve the selection and timing of prophylactic antibiotics, then involve other orthopedic surgeons. To accomplish their goal, communication about the project to physicians and hospital staff was essential. Communication methods implemented include: Use storyboards in the OR and nursing areas. Rotate them to keep interest alive. Do inservices at department meetings and at varied times in hospital classrooms. Make SIP part of Nursing Skill’s Day. Use Hospital Week, Nurses Week, any excuse to promote SIP guidelines. Present data at every Medical Staff meeting. Mail out scientific information supporting SIP guidelines to surgeons. Encourage nurses to dialogue with physicians on their antibiotic orders. Get feedback from the CEO, use his name often. Use external media to stimulate interest – MHTW’s project was covered by News-24 in Houston. According to Diane Maxwell, “The TV news coverage made people recognize that this was a real, tangible process for improved patient outcomes.” As MHTW plans to spread improvement to additional specialties later this year, they are recruiting additional physician champions and are conducting inservices to hospital staff who will become involved in the project. For arthroplasties, MHTW has reached 100% compliance on appropriate selection of an antibiotic and on administering the antibiotic within one hour prior to surgery. Discontinuation of antibiotics within 24 hours after surgery continues to be a challenge and the physician champion is talking to other surgeons about this issue. For more information on SIP resources provided by TMF, contact Robert Vaughn, MPH, at sip@tmf.org or 800-725-9216. This material was prepared by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas, 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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