Achieving and sustaining zero: Preventing surgical site infections after isolated coronary artery bypass with saphenous vein harvest site through implementation of a staff-driven quality improvement rocess

Kles CL, Murrah CP, Smith K, Baugus-Wellmeier E, Hurry T, Morris CD

"A significant reduction in deep sternal wound infections was achieved by working at all levels of the organization through a multidisciplinary approach to create sustained change. Using real-time observations for current practices, areas for improvement were identified. By engaging frontline staff in the process, ownership of the outcomes and adherence to practice change were promoted. The result was a dramatic, rapid, and sustainable improvement in the prevention of deep sternal wound infection."

Organizational culture changes result in improvement in patient-centered outcomes: Implementation of an integrated recovery pathway for surgical patients

Wick EC, Galante DJ, Hobson DB, Benson AR, Lee KH, Berenholtz SM, Efron JE, Pronovost PJ, Wu CL

"Our trust-based accountability model, which included both senior hospital leadership and frontline providers, provided an enabling structure to rapidly implement an integrated recovery pathway and quickly improve outcomes, value, and experience of patients undergoing colorectal surgery. The study findings have significant implications for spreading surgical quality improvement work."

Performance improvement initiative: Prevention of surgical site infection (SSI)

Ng WK, Awad N

"Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care."

Prevention of surgical site infection

Harrington P

"Multidisciplinary team working, combined with audit and surveillance, early recognition of signs and symptoms of infection, and implementation of evidence-based guidance are essential for reducing the incidence of SSI. Nurses caring for patients in the pre, peri and post-operative period have an important role in advising individuals about the risks associated with SSI and how infection should be managed."

Surgical site infection prevention: A qualitative analysis of an individualized audit and feedback model

Nessim C, Bensimon CM, Hales B, Laflamme C, Fenech D, Smith A

"Provision of individualized AF data had a significant impact on promoting individual practice change. Despite this, we concluded that practice change is a shared responsibility, requiring a team leader. So, AF had little bearing on establishing a necessary multidisciplinary team approach to SSI prevention, to create more effective and sustainable practice change among an entire team."

Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections

Wick EC, Hobson DB, Bennett JL, Demski R, Maragakis L, Gearhart SL, Efron J, Berenholtz SM, Makary MA

A study evaluated the association between implementation of a surgery-based comprehensive unit-based safety program (CUSP), which consists of a multidisciplinary team of front-line providers, and one year of pre and post-CUSP intervention SSI rates using a high risk pilot model. It demonstrated a surgery-based CUSP intervention that might have markedly decreased SSI in a high-risk population.

Effect of surgical safety checklists on postoperative morbidity and mortality rates, Shiraz, Faghihy Hospital, a 1-year study

Askarian M, Kouchak F, Palenik CJ

A six-month, interventional study at a 374-bed referral educational hospital found that surgical complications decreased by 57% following the implementation of the Surgical Safety Checklist, the most common complication being surgical site infection. The study also observed high patient information detection and elevated levels of cooperation by surgical personnel.

Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3?

Meeks DW, Lally KP, Carrick MM, Lew DF, Thomas EJ, Doyle PD, Kao LS

A retrospective chart review of 517 patients undergoing laparotomies for colorectal, hysterectomy or abdominal vascular procedures and evaluation of safety climate using the Safety Attitudes Questionnaire found that good safety and teamwork climate, alone, are not sufficient to improve compliance with surgical site infection prevention guidelines. Infection prevention guidelines must be multifaceted, specific to the hospital and service, and resilient during emergencies.

Effect of a Comprehensive Surgical Safety System on Patient Outcomes

de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM, Boermeester MA; for the SURPASS Collaborative Group

A controlled, multicenter, prospective study compared patient outcomes of 3,760 patients before and 3,820 patients after the implementation of a comprehensive surgical safety checklist. The Surgical Patient Safety System (SURPASS) checklist may lead to improved patient outcomes by improving teamwork, communication and attitudes toward quality and safety, and the study found that implementation of the checklist was associated with a reduction in rates of surgical complications,such as surgical site infection, and mortality in hospitals with a high standard of care.

Chasing Zero: Our Journey to Preventing Surgical Site Infection

Roesler R, Halowell CC, Elias G, Peters J

An article reviews an investigation into the problem of surgical site infection after the discovery of an increase in methicillin-resistant Staphylococcus Aureus infections at a healthcare facility. After making important changes to the facility culture, including a focus on reminding each other when breaks in antiseptic technique are observed and critiquing each other on their practices in a non-threatening environment, only one surgical site infection was identified in the following seven months.

Identifying opportunities for quality improvement in surgical site infection prevention

Gagliardi AR, Eskicioglu C, McKenzie M, Fenech D, Nathens A, McLeod R

A collective case study involving an analysis of interviews with clinical and professional managers at seven teaching hospitals to evaluate surgical site infection prevention strategies found that organizations must encourage greater teamwork through organizational support of quality improvement.

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-H, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; for the Safe Surgery Saves Lives Study Group

A prospective study representing eight hospitals in eight cities participating in the World Health Organization's Safe Surgery Saves Lives program included data on 3,733 patients before and 3,955 patients after the implementation of the WHO Surgical Safety Checklist, designed to improve team communication and consistency of care. The study found that implementation of the Surgical Safety Checklist was associated with reductions in rates of deaths and complications, including surgical site infection, in noncardiac surgical procedures.