Teamwork, communication reduce SSIs in heart patients
By Robert Roos,
icanNEWS staff
icanNEWS –- The use of a quality improvement team to monitor infection control practices and infection rates significantly reduced surgical site infections (SSIs) in heart bypass patients at Barnes-Jewish Hospital in St. Louis, according to a report to be presented Tuesday at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC) in Seattle.
The interdisciplinary team was set up after an increase in SSIs in coronary artery bypass graft patients in 1998. With the team in place, SSIs in these patients dropped by more than 50% from 1998 to 1999, according to the report by certified infection control specialist Diane Hopkins, RN, BSN, and associates.
The quality improvement team includes the chief of cardiothoracic surgery, a surgical assistant, the operating room (OR) manager, an OR nurse, an anesthesiologist, a perfusionist, the intensive care unit manager, a clinical specialist, a hospital epidemiologist, and an infection control specialist. The team meets quarterly to review SSI rates, perioperative procedures, glucose levels, and timing of preoperative antibiotic treatment, according to the report abstract.
The team devised an infection control checklist covering such areas as dress code, surgical scrub, drape placement, and skin preparation. Hopkins told icanNEWS that OR personnel use the list to monitor their own procedures, and she also uses it in monthly observations of the staff. "Part of our thought was to make them more aware, to look at what they're doing, she said. In addition, the surgical assistants developed a form for collecting data on risk factors for infection at patients' graft sites.
Other steps taken by the team included requiring documentation of preoperative patient showers, using a nonporous perineal drape, and encouraging decreased use of cauterization, according to Hopkins.
The overall SSI rate for heart bypass patients in 1998 was 10% (56 of 562). Rates for specific sites included deep chest, 3.6%; superficial chest, 2.3%; and graft, 4.1%. In 1999, after the intervention, the overall rate dropped to 4.9% (32 of 650, P=.0007). Deep chest infections accounted for 0.6%, superficial chest infections for 1.4%, and graft infections for 2.9%.
In 2000 the overall rate increased to 7.6%, a reversal that Hopkins attributed to heavy staff turnover in the second half of the year. "We had a lot of staff change, and a lot of those were part of the [quality improvement] team," she said. "It took a while to get everyone up to speed." She added that for the first 3 months of this year, the SSI rate dropped back to 3.6%.
Improved communication and awareness were the keys to the intervention's success, according to Hopkins. "We did a lot of communicating about what was going on with the rates," she said, adding that she continues to observe the OR staff monthly to help ensure that they maintain the infection control protocols.
Hopkins DM, Rieger Y, Gay W, et al. Decrease in coronary artery bypass graft surgical site infections through use of continuous quality improvement. Presented at the 28th annual meeting of the Assocation for Professionals in Infection Control and Epidemiology, Seattle, June 10-14, 2001; abstract 162. Abstract available at www.apic.org/apic2001/oralabs.pdf .
First published (June 11, 2001) on icanPREVENT.com. Copyright 2001, ican INC.
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