Results from Canadian SSI Prevention Audit

2016 CANADIAN SURGICAL SITE INFECTION

PREVENTION AUDIT Dr. Claude Laflamme

March 24, 2016

Welcome! Bienvenue à nos participants francophones Hélène Riverin

Carla Williams Patient Safety Improvement Lead

Please enter any questions in the chat box Today’s slides This call will be taped

Before we get started

- AHS-Surgery Strategic Clinical Network; Stacy Kozak

- Atlantic Health Quality & Patient Safety Collaborative; Amy Howard - BC Patient Safety & Quality Council; Geoff Schierbeck - Health Quality Ontario; Mina Viscardi-Johnson - Sask. Ministry of Health- Patient Safety Unit; Jocelyn Leblond

Thank you!

Patient Safety Metrics Team: - Virginia Flintoft - Alex Titeu - Anne MacLaurin - CPSI Dr. Curt Smecher Dr. Claude Laflamme

Our Guest Speakers

Audit Participation SSI Prevention Results

SSI Scores Summary

Audit Participation

Sites 52

Patients 2082

Clean I & II 1998

Responses by Province

SSI Prevention Audit

Cardiac OnPump /

Chirurgiecardiaque avec

pompe

Cardiac OffPump /

Chirurgiecardiaque sans

pompe

C-Section /Césarienne

GeneralSurgery /Chirurgiegénérale

Gynecology /Chirurgie

gynécologique

Ophthalmology/ Chirurgie

ophtalmologi..

Orthopedics /Orthopédique

Vascular /Chirurgievasculaire

Thoracic /Chirurgie

thoracique

Other / Autre No Response /Pas de

réponse

0%

10%

20%

30%

40%

50%

Re

239

298

570

211

501

6336

2052

71

29%

SitesPatients 1,998

52

Participants by Type of Surgery


Participants by Surgical Wound Class

Sites 52 Patients 2082

Participants by Surgical Wound Class I and II


SSI Scores Summary

How to interpret the indicator slides

Sites/Patients = Total counts Green bar = Best Practice Red Bar = Incorrect Practice Grey Bar = Not Recorded or No

Response Y-Axis = % Total Records - Green

+ Red + Grey bars (e.g. % overall Best Practice = 60%)

n = 900 Sum of green and red bar counts Green Bubble = Best Practice /

(Best + Incorrect Practice) x 100 Red Bubble = Incorrect Practice /

(Best + Incorrect Practice) x 100

67%

33%

Sites 52 Patients 1000 n = 900


C. Pre-op shower or bath with soap or antiseptic agent

Not Recorded = 781

n = 1209

85%

15%

C. Pre-op shower or bath with soap or antiseptic agent

Total Patients 867

81% 88%

88%

66%

n = 354 n = 338 n = 131 n = 74


D. Solution used for intra-operative intact skin cleansing


Note: Yes includes • 2% CHD w alc, P-I with alc & Contraindicated for all • PI for Gyne and C-Section • PI Head and Neck for Ophthalmology and Other.

n = 1959

74%

26%


D. Solution used for intra-operative intact skin cleansing

68% 82% 92% 88%

Total Patients 1487

n = 558 n = 500 n = 230 n = 173

Note: Yes includes • 2% CHD w alc, P-I with alc & Contraindicated for all • PI for Gyne and C-Section.


Antibiotics not indicated / Antibiotiques non indiqués,Within 120 minutes before incision for Vancomycin orFluoroquinolones / Dans les 120 minutes précédantl’incision, dans le cas de la vancomycine ou de la

fluoroquinolone, Within 60 minutes before incision /Dans les 60 minutes précédant l’incision chirurgicale

No antibiotics given / Aucun antibiotique n’a étéadministré & None of the above / Aucun de ces choix

No Response / Pas de réponse & Not Recorded / Nonconsigné

0%

20%

40%

60%

80%

100%

Re

1,779

178

41

E. Prophylactic Abx administration


n = 1957

91%

9%

General Surgery / Chirurgiegénérale Orthopedics / Orthopédique

Gynecology / Chirurgiegynécologique C-Section / Césarienne

Antibiotics notindicated /

Antibiotiquesnon indiqués,

Within 120minutes before

incision forVancomycin orFluoroquinolo..

No antibioticsgiven / Aucunantibiotique

n’a étéadministré &None of the

above / Aucunde ces choix

No Response /Pas de

réponse & NotRecorded /

Non consigné








No Response /Pas de


Non consigné








No Response /Pas de


Non consigné








No Response /Pas de


Non consigné

0%

20%

40%

60%

80%

100%

Re

481

75

14

478

16 7

214

24

1

180

15 16

E. Prophylactic Abx administration Total Patients 1521

87% 97% 90% 92%

n = 556 n = 494 n = 238 n = 195


1g < 80kg, 2g < 80kg, 2g > 120kg, 2g 80-120 kg, 3g >=120kg & Weight based dose for paediatric patient /

Posologie en fonction du poids pour les patients enpédiatrie

< 1g for any adult patient / pour tout patient adulte, > 3g,1g >= 80kg, 3g >= 120kg,

No antibiotics given / Aucun antibiotique administré &Other antibiotic used / Autre antibiotique


0%

20%

40%

60%

80%

100%

Re 1,274

636

88

F. Dose of Cefazolin used as Prophylactic Abx


67%

33%



1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g

>= 120kg &Weight based

dose forpaediatric patient

/ Posologie enfonction du poidspour les patients

en pédiatrie

< 1g for any adultpatient / pour toutpatient adulte, >3g, 1g >= 80kg,

3g >= 120kg, No antibioticsgiven / Aucunantibiotiqueadministré &

Other antibioticused / Autreantibiotique

No Response /Pas de réponse &

Not Recorded /Non consigné

1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g




en pédiatrie






1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g




en pédiatrie






1g < 80kg, 2g <80kg, 2g > 120kg,2g 80-120 kg, 3g




en pédiatrie






0%

20%

40%

60%

80%

100%

Re 328

220

22

413

4939

145

89

5

146

54

11

F. Dose of Cefazolin used as Prophylactic Abx

Total Patients 1521

60% 89% 62% 73%

n = 548 n = 462 n = 234 n = 200


Yes / Oui & Redosing not required / Redosage nonrequis

No / Non No Response / Pas de réponse, No prophylacticantibiotic given / Aucune antibioprophylaxieadministrée, Not Recorded / Non consigné

0%

20%

40%

60%

80%

100%

Re

1,490

46 46

G. Appropriate Prophylactic Antibiotic Redosing according to guidelines


97%

3%

n = 1536

General Surgery / Chirurgie générale Orthopedics / Orthopédique Gynecology / Chirurgie gynécologique C-Section / Césarienne

Yes / Oui &Redosing not

required /Redosage no..

No / Non No Response /Pas de

réponse, Noprophylactic a..











No Response /Pas de


0%

20%

40%

60%

80%

100%

Re

376

1913

463

3 7

168

2 2

170

10

G. Appropriate Prophylactic Antibiotic Redosing according to guidelines

Total Patients 1233

97% 99% 99% 100%

n = 389 n = 466 n = 170 n = 170

G. Appropriate Prophylactic Antibiotic Redosing according to guidelines (Yes/No)

Total Patients 227

80%

20%


H. Discontinuation of Prophylactic Abx


80%

20%



ABX discontinuedwithin 24 hours ofend of surgery /

L’administration desantibiotiques a

cessé dans les 24heures suivant la fin

de la chirurgie &ABX not received

after end of surgery/ Aucun antibiotiqueadministré après la..

ABX discontinuedmore than 24 hoursafter end of surgery

/ L’administrationdes antibiotiques acessé plus de 24

heures après la finde la chirurgie & No

antibiotics given /Aucun antibiotiquen’a été administré

No Response / Pasde réponse & NotRecorded / Non

consigné











consigné











consigné











consigné

0%

20%

40%

60%

80%

100%

Re 433

88

49

417

10

74

170

13

56

202

36

H. Discontinuation of Prophylactic Abx Total Patients 1521

83% 85% 75% 97%

n = 521 n = 491 n = 226 n = 208


Clippers / Tondeuse, Depilatory / Dépilatoire, Hairremoval not required / Épilation non requise

Razor / Rasoir & Removal done at home / Épilationeffectuée à la maison


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Re

1,743

182

73

I. Hair Removal Method


96%

4%

n = 1816

Not Recorded = 15

General Surgery / Chirurgie généraleOrthopedics /Orthopédique Gynecology / Chirurgie gynécologique C-Section / Césarienne

Clippers /Tondeuse,Depilatory /

Dépilatoire, Hairremoval notrequired /

Épilation nonrequise

Razor / Rasoir& Removal

done at home /Épilation

effectuée à lamaison

No Response /Pas de réponse& Not Recorded/ Non consigné



















0%

20%

40%

60%

80%

100%

Re

517

1736

468

33

209

1812

134

13

64

I. Hair Removal Method Total Patients 1521

97% 100% 92% 91%

n = 534 n = 468 n = 227 n = 147


J. Glucose was below 11.1 mmol/L on each of POD 0, 1 and 2


Note: Not at Risk (not diabetic) excluded from this measure (n=1513)

n = 390

57%

43%

Not Recorded = 7



Yes / Oui Gluc. NotDone /

Glycémie nontestée & No /

Non

No Response /Pas de


Non consigné



Non

No Response /Pas de


Non consigné



Non

No Response /Pas de


Non consigné



Non

No Response /Pas de


Non consigné

0%

20%

40%

60%

80%

100%

Re

49

28

62

48

93

5

13

10

21

16

6

4

J. Glucose was below 11.1 mmol/L on each of POD 0, 1 and 2

Total Patients 355

56%

66%

32% 60%

Note: Not at Risk (not diabetic) excluded from this measure

n = 111 n = 141 n = 31 n = 10


Induced Hypothermia / Hypothermie induite & Yes / Oui No / Non No Response / Pas de réponse & Not Recorded / Nonconsigné

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Re

1,329

435

234

K. Temperature at end of surgery or on arrival in PACU - 36.0 - 38.0 degrees C


85%

15%

Not Recorded = 100



InducedHypothermia /Hypothermie

induite & Yes /Oui



Non consigné


induite & Yes /Oui



Non consigné


induite & Yes /Oui



Non consigné


induite & Yes /Oui



Non consigné

0%

20%

40%

60%

80%

100%

Re

394

84 92

285

180

36

158

3942

136

25

50

K. Temperature at end of surgery or on arrival in PACU - 36.0 - 38.0 degrees C

Total Patients 1521

82%

89%

79% 84%

n = 478 n = 321 n = 200 n = 161

% Not Recorded by Indicator


SSI Scores Summary

SSI Scores – % Perfect Performance Total Patients 1998

Pre-op SSI Score by Province % Perfect Performance

Total Patients 1998

Peri-op SSI Score by Province % Perfect Performance

Total Patients 1998

Post-op SSI Score by Province % Perfect Performance

Total Patients 1998

Overall SSI Score by Province % Perfect Performance

Total Patients 1998


SSI Scores Summary

Orthopedics – consistent high performers Ontario – 18 sites and 863 patients Nova Scotia – 8 sites and 477 patients

• Colchester East Hants submitting monthly since July ‘15

Yukon – 1 site & 132 patients: 1st National audit participation!

Summary

Limitations of a bundle of care Culture of Patient Safety Opportunities for Improvement

– High ‘Not Recorded’ rate – especially in Pre-op shower or bath with soap or antiseptic agent

– (F.) Dose of Cefazolin used as Prophylactic Abx – (J.) Glucose was below 11.1 mmol/L on each of POD 0, 1 & 2 – (K.) Temperature at end of surgery or on arrival in PACU -

36.0oC to 38.0oC

Summary

Continue with your improvement work (95%) Opportunities for learning

– New Centers for Disease Control (CDC) report

Topic for Next National Call Glucose Control (date tba)

Next Steps

Access your data and reports at any time in Patient Safety Metrics – Surgical Site Infection Pre-operative (Pre-op) Score (SSI 14) – Surgical Site Infection Perioperative Score (SSI 15) – Surgical Site Infection Postoperative (Post-op) Score (SSI 16) – Surgical Site Infection Score (SSI 17) – https://psmetrics.utoronto.ca/metrics/login.aspx

Overall organization results – ‘Report’ tab > ‘SSI’ sub-tab

Individual unit results – ‘Data’ tab > ‘SSI’ intervention > ‘Measurement Worksheet’

table

Your Results and Scores

https://psmetrics.utoronto.ca/metrics/login.aspx

The Surgical Safety Checklist; More Than Just a “Good Catch” April 8th- 12:00 est Guests: Stacy Kozak Leslie Deuchar

FYI…

For Audit forms and Data Questions CPSI Central Measurement Team [email protected] Virginia Flintoft (416) 946-8350 Alexandru Titeu (416) 946-3103 For SSI intervention related questions: Carla Williams [email protected] (709) 685-8254

Contacts

mailto:[email protected]

mailto:[email protected]

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Results from Canadian SSI Prevention Audit

Healthcare