Statewide Collaborative to Reduce Surgical Site Infections: Results of the Hawaii Surgical Unit-Based Safety Program

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Research
• Surgical Infection Prevention

Background:

• Surgical site infections (SSIs) following colorectal surgery pose significant risks to patients and increase healthcare costs.
• Hawaii implemented the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Surgery to address these challenges.

Purpose of the Study:

• To evaluate the effectiveness of the AHRQ Safety Program for Surgery in reducing colorectal SSIs.
• To assess the program's impact on patient safety culture within participating hospitals.

Main Methods:

• A pre-post cohort study design was employed, encompassing all 15 hospitals in Hawaii from January 2013 to June 2015.
• The intervention involved statewide implementation of the Comprehensive Unit-Based Safety Program and specific bundles to reduce SSIs.
• Colorectal SSIs were the primary outcome, with patient safety culture assessed using the AHRQ Hospital Survey on Patient Safety Culture as a secondary outcome.

Main Results:

• A significant decrease in the collaborative colorectal SSI rate was observed, falling from 12.08% to 4.63% (p < 0.01) over the 10-quarter study period.
• Patient safety culture scores improved in 10 out of 12 measured domains, including Overall Perception/Patient Safety and Teamwork Within Units (all p < 0.05).

Conclusions:

• Statewide participation in the AHRQ Safety Program for Surgery in Hawaii was associated with a substantial 61.7% reduction in colorectal SSIs.
• The program also led to a measurable improvement in the patient safety culture across participating hospitals.