University of Iowa Hospitals and Clinics

Iowa City, IA

Citation

Cromwell JW, Belding-Schmitt M, Brooks MK. The CUSP of improving colorectal surgery outcomes. Poster presented at: 2014 Integrating Quality Meeting: Improving Value through Clinical Transformation, Education and Science; June 11-13, 2014; Rosemont, IL.

Results

Non-SUSP Pilot Surgeons SUSP Pilot Surgeons
SSI Rate: 35.48% SSI Rate: 12.76%

SSI Reduction for SUSP Pilot Surgeons: 8% absolute reduction

SSI Prevention Bundle for Colorectal Surgery – SUSP Pilot Surgeons

Preoperative
Hibiclens (CHG) Shower

Inpatients/outpatients will shower with CHG two times preop

Oral decontamination and mechanical bowel prep Prophylactic IV Antibiotics

Use Ertapenem 1gm IV once
OR
Cefotetan 2gm IV once
If pt >120Kg, use 3gm

If allergic to bea-lactam and carbapenem:
Ciprofloxacin 400mg IV + metronidazole 500mg IV


If patient is receiving IV antibiotics for treatment give a pre-incision dose of the treatment antibiotic if the last dose was administered more than 1 hour prior (e.g. pip/tazo)

Active Warming Process

If temp in DOSA is < 36.0 a Bair Hugger is placed

OR Room temperature is > 72 degrees

Turn Bair Hugger on before induction of anesthesia

Clipping Hair in DOSA Obtain Baseline Na, K, Cl, glucose and T&S
Intraoperative
Complete Surgical Safety Checklist Antibiotics

Redose cefotetan or treatment antibiotics if surgery is longer than 6 hours

CHG Skin Prep

Always use Chloraprep or Duraprep

Wound Protector Preferred

Proven to decrease risk of wound infection and maintain moisture at the incision site

Hand Hygiene Compliance

Wash hands with soap and water after de-gowning/degloving

Use separated closing tray and change gown and gloves

Re-check glucose for pts. If preop glucose > 200 or diabetic protocol Circulator RN and Surgeon collaborate and call for count just before skin closure Limit OR Door Openings to < 10/hr
Postoperative
Sterile Wound Care

a. if soiled within 48 hrs
b. after 48 hours - Chloraprep every day and probe areas that are draining

Continue glucose monitoring for patients if preop glucose > 200 or diabetic protocol Pt. education on early identification of wound complications