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Implementation of a Pediatric Orthopaedic Bundle to Reduce Surgical Site Infections
Jan Schriefer1, Suzanne Hilt, James Sanders
1Jan Schriefer, DrPH, MSN, MBA, Associate Professor of Pediatrics and Professor of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, NY. James Sanders, MD, Professor of Orthopedics, University of Rochester School of Medicine and Dentistry, Rochester, NY. Julie Michels, MS, RN-BC, Pediatric Surgery QA/PI Specialist, University of Rochester School of Medicine and Dentistry, Rochester, NY. Kori Wolcott, BSN, RN, Pediatric Surgical Clinical Reviewer, Pediatric Surgery QA Liaison, University of Rochester School of Medicine and Dentistry, Rochester, NY. Connor Ruddy, Student Intern, from Loyola University Chicago, Chicago, IL. Jenna Hanson, Student Intern, from Colorado College, Colorado Springs, CO.
Insights
Implementing a comprehensive care bundle effectively eliminated surgical site infections (SSIs) in pediatric orthopaedic surgery patients, achieving a zero infection rate. This multidisciplinary approach significantly improved patient outcomes.
Area of Science:
- Healthcare Management
- Infectious Disease Prevention
- Pediatric Surgery
Background:
- Surgical site infections (SSIs) represent a significant financial burden, costing an estimated $27,288 per case.
- Analysis of National Surgical Quality Improvement Program data indicated potential for SSIs reduction at the University of Rochester Medical Center.
- Previous data suggested that SSIs rates could be lowered compared to peer institutions and historical baseline data.
Purpose of the Study:
- To achieve a zero rate of surgical site infections (SSIs) in pediatric orthopaedic surgery patients.
- To implement a standardized "bundle" of care practices to prevent SSIs.
- To evaluate the effectiveness of a multidisciplinary care bundle in reducing SSIs.
Main Methods:
- A multidisciplinary team, including surgeons, pediatric pharmacy, infectious diseases, anesthesia, and nursing, developed a care bundle.
- Bundle elements included preoperative chlorhexidine gluconate wipes, nutrition screening, antibiotic dosing charts, MRSA screening, temperature maintenance, and intraoperative nasal swabs.
- The care bundle was implemented for all pediatric orthopaedic surgery patients.
Main Results:
- The SSI rate decreased from a baseline of 4% in 2013 and 3.2% in 2014 to 0.0% in 2015.
- The study achieved a zero SSI rate in pediatric orthopaedic surgery patients post-implementation of the care bundle.
- Compliance with the care bundle and SSI rates were monitored monthly, with feedback provided to staff.
Conclusions:
- The implementation of a comprehensive care bundle was highly effective in eliminating surgical site infections in pediatric orthopaedic surgery.
- Continuous monitoring and feedback are crucial for maintaining low SSI rates and ensuring bundle compliance.
- A root-cause analysis protocol was established for any occurrences of SSIs to facilitate continuous improvement.
Abstract:
Surgical site infections (SSIs) cost an estimated $27,288 per case. An analysis of the National Surgical Quality Improvement Program data at the University of Rochester Medical Center suggested that rates of SSIs could be lowered in comparison with both peers and baseline. The aim of this study was to reduce the number of SSIs to zero through the implementation of a "bundle" or a combination of practices. Meetings were held with the multidisciplinary care team that includes surgeons and staff from pediatric pharmacy, pediatric infectious diseases, anesthesia, and nursing to create a care bundle for all pediatric orthopaedic surgery patients. Bundle elements included use of chlorhexidine gluconate wipes the night before surgery and the day of surgery, use of preoperative nutrition screens, development and use of a prophylactic antibiotic dosing chart, use of methicillin-resistant Staphylococcus aureus screening, maintenance of normal patient temperature, and use of nasal swabs in the operating room. The SSI rate dropped from a baseline figure of 4% in 2013 (n = 154) and 3.2% in 2014 (n = 189) to 0.0% (n = 198) in 2015 after the bundles were implemented. Both compliance with the bundle and SSI rates must be monitored monthly. Staff and providers should be offered monthly feedback on SSI rates and care bundle compliance. If an SSI does occur, a root-cause analysis is performed with the multidisciplinary care team using a standardized review form.
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