The project's goal was to reduce the cardiac NSQIP SSI rate to 2 percent, according to lead author Barbara A. Drake, RN, clinical quality and safety coordinator for Vancouver General Hospital. The team succeeded in lowering the infection rate to a NSQIP average of 1.6 percent in the nine months after fully instituting the surgical best practices bundle in July 2013, she reported.
Ms. Drake attributed their success to involving all health care disciplines that care for cardiac surgical patients. The quality improvement team included surgeons, anesthesiologists, nurse practitioner, infection control specialist, quality coordinators, pharmacists, educators, nurse leaders, and staff nurses who championed the changes with their peers. After querying frontline providers and searching published best practices, the team identified several areas needing improvement.
Specifically, the group improved guidelines for prophylactic antibiotic use so that providers routinely administered the proper, weight-based intravenous dose of antibiotic at the best time and gave the patient a second dose if needed during long surgical procedures. In addition, patients received new types of wound dressings designed to reduce the chance of infection. The nurse practitioner led the team in standardizing the postoperative wound care of the surgical sites.
Another change involved active warming of patients to normal body temperature once they were taken off the cardiac surgery bypass machine. Patients are deliberately cooled when on the cardiac bypass machine, but warming the patients as soon as possible can help reduce the chance of infection. Cold constricts blood vessels, hindering oxygen needed for healing, Ms. Drake explained.
She said many of the new improvements came from information obtained from Safer Health Care Now, a program of the Canadian Pati
|Contact: Sally Garneski|
American College of Surgeons