Leading Practice: Reduction or Elimination of Surgical Site Infections

By AHRMM

AHRMM is building a repository for leading and proven supply chain practices, case studies, and toolkits that are developed from a Cost, Quality, and Outcomes (CQO) perspective. The following leading practice was submitted by:

Ochsner Health System

PROBLEM SUMMARY: Surgical Site Infections (SSIs) are a significant issue to both patients and hospitals. A SSI is an infection that is related to the operative procedure that occurs at or near the surgical incision/organ within 30 days of the operative procedure. A patient who acquires a SSI has a higher probability of morbidity and mortality, longer length of hospital stay of 10 to 14 days, higher readmission rate, and increased cost of care (approximately $20K). (www.cdc.gov/HAI/ssi)

Ochsner Health System (OHS) is a non-profit health system comprised of nine hospitals (an academic teaching hospital, several community hospitals, and a critical access hospital) both with employed MDs (staff and residents) and community based MDs.

OHS identified variation in their surgical skin prep solutions/supplies and practices/techniques within a hospital and across the system. This variation was identified as a contributing factor to SSIs.

METHOD: OHS Supply Chain team facilitated a project utilizing LEAN Six Sigma methodology with the goal to prevent/reduce SSIs. Each hospital from across the system participated in the project.

Methodology included: received approval and support from Executive and Surgeon leadership; identified key stakeholders, representation included: MDs, Nursing, Infection Control, Supply Chain, and CareFusion, the surgical prep solutions supplier; conducted observations to identify current practices and gap analysis; performed literature review for evidence based practices, processes, products; developed skin prep chart by body system; identified key variables to measure outcomes; and created an educational and implementation plan specific to each hospital.

MEANS: Created a collaborative environment among team members representing Physicians, Nursing, Infection Control Supply Chain, Operations, and CareFusion to achieve the stated goal: to reduce SSIs by eliminating the variation in practice; creating a standardized skin prep process including: a skin prep chart with identified solutions to be used for each body part (head, neck, chest, abdomen, knee, etc.), application and dry time techniques; and creating a formalized education plan for anyone who performs skin prep (MD and/or Nursing).

DATE IMPLEMENTED: 1st quarter 2015

OUTCOMES: Measured SSI rates from 1st quarter 2015 (implementation of new process) to 4th quarter 2015 for the following SSIs:

Class 1 SSI rate: 40% improvement
Class 2 SSI rate: 40% improvement
Abdominal Hysterectomy SSI rate: 82% improvement
Colorectal Surgery SSI rate: 67% improvement
C-Section SSI rate: 59% improvement
Potential cost avoidance of over $20K/SSI across the system

TOOLS:

Skin prep chart
Education and observation
Tracking spreadsheet

HOW DOES YOUR EXAMPLE ADDRESS THE ISSUE FROM A CQO PERSPECTIVE?
This project demonstrated collaboration between clinicians, supply chain, and CareFusion that supports IHI's Triple Aim of optimizing health system performance and CQO Movement’s focus on cost, quality, and outcomes.

The five components were addressed as follows:

Healthcare Information to Individuals and Families: Supply Chain facilitated the project, provided data, and collaborated with clinicians on a quality focused project.
Redesign of Primary Care Services and Structures: Project’s goal was to standardize the surgical skin prep process, with products, practice, and utilization to improve patient outcomes.
Prevention and Health Promotion: Reduction or elimination of SSIs is a key focus of CMS because SSIs negative impact a patient’s health.
Cost Control Platform: Prevention of SSIs impacts cost in several ways; cost avoidance of the expense from the complication, the increase length of stay (LOS), and/or readmission; loss revenue due to the increase LOS (i.e. the bed is occupied with the patient with SSI for the additional days, so the bed is unavailable for the new admit); and improved supply cost and utilization through standardization.
System Integration: The prevention of SSI is a system quality goal for all hospitals; Supply Chain aligned with the clinicians to achieve the quality goal.