the Providence Health Care Experience

Dr Ahmer Karimuddin

Meghan MacLeod

Dr Alex Seal

PHC Surgical ProgramUniversity of British Columbia

February 19th, 2015University of

British Columbia

Preventing Surgical Site Infection

Disclosure

There are no conflicts of interest and nothing to disclose

Outline

1. Why this is important

2. Our approach to thischallenging problem

3. Bundle

4. Results

5. the FUTURE

THANK YOU

SSI Prevention TEAM• Jock Reid

• Jim Abel

• Ahmer Karimuddin

• Victor Leung

• Chris Prabhakar

• Meghan MacLeod

• Lisa Toback

• Elisa Lloyd-Smith

• Stephen Parker

• Michelle Bech

• Thelma Velasco

• Lona Cunningham

• Sandy Grimwood

• Rupinder Khotar

• Alex Seal

...all of SPH and MSJ

• Randy Rae

• Jin-So Pao

• Alice Lee

• Flavia Mandic

• Sharon Bisson

• Paul Smith

• Howard Green

• Barry Schafer

• Lu Oviatt

• Tamara Younger

• Lia Randell

THANK YOU SPH & MSJ Team

SSI’s

Background

• Why do this?

• Opportunity to improve the care of patients

• Individual

• Service

• Site

• City, province, etc...

Background

DATA

NSQIP Risk Adjusted DataSurgical Site Infection

All Cases reviewed July 2011 – June 2012

SPH MSJ

Goal of Working Group

Ultimately Reduction in Rates of SSI**

Goal of Working Group

1. ID the problem

2. Explore the process

3. Build the Team

4. ID root causes/best practice

5.Select and test solutions

EPIC Approach

• Will it be EPIC?

• E - Easy to implement

• P - Permanent

• I - Impact High

• C - Cost effective

Best Practice Brainstorm

Strategies for Prevention

Brainstorm

Looked at Other Centres

• Example initiative:

• Northwestern experience: OR closing bundle (colorectal)

• New gloves

• New instruments

PHC = FOCUS Bundle

• F - Focused

• O - Opportunities of

• C - Care

• U - Utilizing

• S - Standards

PHC SSI Prevention Bundles

Example: Pre-op Antibiotics

PHC approach based on best practice

1. Risk Assessment

2. Creation of key preventative strategies

3. Adherence to key strategies

4. Active surveillance

• = REDUCTION IN RATES

PHC SSI Prevention Bundle

• Areas for Education Opportunities

1. Pre-Admission Clinic

2. Pre-OP

3. SPH OR

4. MSJ OR ✓

5. PAR ✓

6. Wards ✓

✓

✓

✓

Appropriate OR Dress Attire

PHC SSI Prevention Bundle

I pity ‘da foolwho

dresses like mein da OR

Intra Operative FOCUS

How are we doing now?

• S

SPH

MSJ

NSQIP data: Out of the pink!

Report Period SPH SSI MSJ SSI

07/11-06/12 2.02H 1.64H

01/12-12/12 1.70H 1.75H

04/12-03/13 1.49H 1.72H

07/12-06/13 1.36H 1.56H

10/12-09/13 1.30 1.46H

01/13-12/13 1.18 1.14

04/13-03/14 1.19 0.93

Implementing a Bundle

SQAN Summer Student AUDIT

• Best compliance with bundle intra-operative components

Bundle Compliance AUDITPreoperative

Surgical Day Care

Intraoperative

Postoperative

SPH

MSJ

FUTURE

• Opportunity for improvement

• Focus on areas from audit where lower compliance

• Pre-OP warming

• Pre-OP surgical sitechlorhexidine prep by patient

• Pre-OP site shave in Daycare

FIN