A Safety Program to Decrease SSIs

Surgical site infections (SSIs) are the most common complication facing colorectal surgery patients, occurring in 15% to 30% of cases. SSIs prolong hospitalization, increase readmissions, require subsequent treatment, affect quality of life, and increase healthcare costs to the tune of $1 billion annually. Research has not shown an association between adherence to well-known infection control process measures and substantial SSI reduction. While the occurrence of SSIs can never be fully eliminated in any feasible scheme, many can be prevented. Addressing SSIs as a Team In a study published in the August 2012 Journal of the American College of Surgeons, my colleagues and I found that physicians and nurses often feel as though they know what needs to be done to improve safety for colorectal surgery patients, but they feel disempowered. Using these perceptions as the basis for our study, we tested the implementation of a surgery-based comprehensive unit-based safety program (CUSP) designed to address SSIs. Participants in CUSP met monthly for as little as 1 hour in small groups of surgeons, nurses, operating room technicians, and anesthesiologists, along with a senior hospital executive who ensured access to necessary resources. CUSP team members identified six key interventions that were believed to help reduce SSIs: 1. Standardization of skin preparation. 2. Prescription of preoperative chlorhexidine showers. 3. Restricted use of by-mouth bowel cleansing solution before procedures. 4. Warming of patients in the pre-anesthesia area. 5. Adoption of enhanced sterile techniques for bowel and skin portions of the case. 6. Addressing lapses in prophylactic antibiotics. With a focus on these areas, simple safety checklists were created, and caregivers were urged to speak...