Surgical Infection Prevention: Success Stories UTAH Success Through Redesign – St. Marks Hospital, Salt Lake City , Utah St. Mark’s Hospital in Salt Lake City, Utah was invited to participate in a nationwide collaborative project aimed at the safe delivery of day to day care of the patients undergoing surgery in their hospital. In 1999, the Hospital Infection Control Practice Advisory Committee developed a set of guidelines to reduce the risk of surgical site infection (SSI). The St. Mark’s multidisciplinary team selected the following five guidelines to target, and developed monitors to capture & track appropriate data. Prophylactic antibiotics Perioperative Normothermia Hair clipping vs. Razor for Shaving Glucose Control Supplemental Oxygenation The St. Mark’s team conducted an investigation by observing what was actually happening in their facility. Even though statistically St. Mark’s incidence of surgical site infection was lower than the national average, the team adopted a “zero tolerance” approach, stating one infection is too many. Several issues were discovered during this investigation, including the following: lack of standardized processes; a sizeable population of patients at high risk of infection due to patient factors (i.e. gastric bypass patients); variable application practices among physicians and staff. Initially, several planning issues were discovered as the team explored the underlying causes. For instance, some individuals held to their preferred practices because the surgical infection rate was low, so there was not a rush to change their practice; others were unaware of the guidelines and the potential benefit; and still others claimed there was a lack of references supporting the changes as in the case of oxygenation. St Mark’s participation with other hospitals in the collaborative process revealed some “new news” on this topic of SSI. Other hospitals in the collaborative project identified the use of additional reporting tools, which offered the opportunity to gather more information and improve tracking of surgical site infections. The information gathered from the national collaborative meetings provided additional references and ideas to promote changes within St. Mark’s Hospital. Educational interventions were specifically designed to address and overcome staff and physician resistance, and some processes required redesign. St. Mark’s adopted a plan that included strategic networking in the redesign with the OR staff and implementation of their internal process changes. Physicians were carefully chosen to champion the selected interventions and to assist in educational efforts to overcome the identified barriers. Reference packets were created that would provide clear evidence regarding the changes being adopted. The St. Mark’s team verified that they were using all of the suggested tracking tools to detect surgical site infections, such as coded data, physician mailings, and mechanisms for staff reporting of surgical infections. The team successfully implemented numerous changes intended to decrease the surgical infection rate and improve the care that their patients receive. For example, a written antibiotic prophylaxis guideline was developed to improve the appropriate timing and proper use of prophylactic antibiotics. The room temperature in OR was increased from 62 to 65 degrees, and the use of thermal head bonnets were instituted as additional measures to keep the patients warm. Prepping procedures were changed to include clipping. Anesthesiology changed their practice to include maintaining a FIO 2 of greater than 80% during the operation and the use of 3 liters of O 2 by nasal cannula in the PACU. The pharmacy and medical staff worked together to address the glucose control needs of their patients, and new standard hospital insulin sliding scale and infusion protocols were developed and approved by the medical staff. Congratulations to St Mark’s for participating in this project that resulted in learning and sharing of information and resources to accomplish a common goal. Their efforts through the extensive education provided to the surgical staff and physicians, as well as innovative process redesign activities allowed St Mark’s to demonstrate a significant drop in their overall surgical infection rate. St Mark’s worked collaboratively on this project with HealthInsight, the Medicare Quality Improvement Organization for Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. HealthInsight is continuing to work with hospitals statewide to improve quality of care and to continue to decrease their rates of surgical infection. For more information, contact: Terri Rose, HealthInsight, (801) 892-0155, trose@healthinsight.org. This material was prepared by HealthInsight, the Medicare Quality Improvement Organization for Utah , 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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