A Quality Improvement Initiative to Reduce Surgical Site Infections in Pediatric Patients Undergoing Cardiothoracic
Cassidy Golden1, Kathy Murphy2, Joshua M Rosenblum3
1From the Emory University School of Medicine, Atlanta, Ga.
Insights
Surgical site infection rates in pediatric cardiothoracic surgery decreased significantly after implementing a quality improvement bundle. This initiative successfully reduced infections below the target of 1 per 100 cases.
Area of Science:
- Pediatric Surgery
- Infection Prevention
- Quality Improvement
Background:
- Surgical site infections (SSIs) pose a significant risk to pediatric patients undergoing cardiothoracic surgery.
- Reducing SSIs is crucial for improving patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To decrease surgical site infections (SSIs) to less than 1 per 100 cases in pediatric patients after cardiothoracic surgery.
- To identify perioperative risk factors and educational gaps contributing to SSIs.
Main Methods:
- A multidisciplinary workgroup developed a quality improvement (QI) bundle, including enhanced hygiene, standardized wound care, and postdischarge follow-up.
- Data from January 2014 to December 2022 were collected to assess SSI rates and patient outcomes.
- Infection preventionists adjudicated SSIs using Centers for Disease Control National Healthcare Safety Network guidelines.
Main Results:
- SSI rates decreased from 2.82 per 100 cases preintervention to 0.55 per 100 cases postintervention.
- The study included 5,610 surgical cases evaluated in SSI-QI rounds.
- No increase in reoperations, major complications, or mortality was observed.
Conclusions:
- The QI bundle effectively reduced SSI rates below the target of 1 per 100 cases.
- Key factors for success included standardized wound dressings, improved hygiene compliance (80% to 96.1%), multidisciplinary collaboration, and bedside rounds.
- The implemented strategies sustained low SSI rates, enhancing patient safety.
Introduction:
This project aimed to decrease surgical site wound infections (SSIs) to less than 1 per 100 cases in pediatric patients after cardiothoracic surgery.
Methods:
A multidisciplinary workgroup was established to identify perioperative risk factors, and educational gaps and create a bedside quality improvement (QI) rounding group to monitor wounds. SSIs were defined according to the Centers for Disease Control National Healthcare Safety Network guidelines. Infection preventionists adjudicated infections as SSIs after an SSI huddle evaluated the case. A QI bundle was developed more than 2 eras: 2015 criteria included an enhanced hygiene bundle, scripted discharge telephone calls about wound care, and 2019 criteria identified SSI risk factors, developed an SSI-QI rounding team, created additional wound care education, and standardized wound care. Data were collected from January 2014 to December 2022 to assess SSI rates per 100 surgical cases, as well as clinically relevant short- and long-term outcomes.
Results:
From December 2014 to December 2022, there were 5,610 surgical cases evaluated in SSI-QI rounds. Compared with the preintervention cohort, SSI rates decreased significantly during the intervention (SSI per 100 cases 2.82; 95% confidence interval, 1.94-4.09) and postintervention (SSI per 100 cases 0.55; 95% confidence interval, 0.24-1.26). There were no increases in reoperations, postoperative major complications, or discharge mortality throughout the study.
Conclusions:
SSI rates decreased below the goal of 1 per 100 surgical cases. Standardized wound dressings, improving hygiene compliance including bath compliance from 80% to 96.1%, multidisciplinary collaboration, bedside rounds, and postdischarge procedures contributed to lowering and sustaining low SSI rates.
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