Carroll Hospital Center

Hospital Team Sharing Call

Medical Center of Central GeorgiaCarroll Hospital in MarylandSUSPCohort 3June 10, 2014The Medical Center of Central GeorgiaBetty Casey, RN, MSN, CNOR, AVP Surgical Services, Felicia Simmons, RN, BSN, Nurse Director, Perianesthesia Services, Robin Mole, RN, BSN, Specialty Services Manager, Leslie Reynolds, RN, BSN, Infection Prevention SUSP Team and hospital environmentMCCG - licensed capacity 637 beds - Level 1 Trauma/Teaching Hospital Primary and secondary service area of twenty-eight counties of central andsouth Georgia with a population of approximately 796,000 residents.SUSP team: Betty Casey, RN, MSN, CNOR, AVP Surgical Services, Rhonda Beeland, RN, BSN, CNOR Nurse Director Surgery Center, Felicia Simmons, RN, BSN, Nurse Director, Perianesthesia Services, Robin Mole, RN, BSN, Specialty Services Manager, Perianesthesia Services, Beverly Brantley, RN, BSN, CNOR, Nurse Manager, Main OR Surgery Center, Leslie Reynolds, RN, BSN Infection Prevention, Anesthesia services representative, Neuro-surgical services representative, and front-line staff representation.

The Medical Center of Central GeorgiaDevelopment and Implementation of the SUSP projectSUSP Team Formation: The data showed we had opportunities for improvement in the Neurosurgical services line.

Development of Plan: Root Cause Analysis was done on each SSI. Data was placed on an Excel spreadsheet. Items that placed patient at an increased risk for infection were shaded. Trends were noted in: glucose management intra-operative temps (starting temps below 36 degrees C) Infecting pathogens column showed MRSA/MSSA as major players.

The Medical Center of Central Georgia How and Why: Chart review (random sampling of 10 charts) indicated starting temps below 36 degrees Celsius 40-50% of the time. We also had no consistent testing/treatment to establish nasal colonization status for MRSA or MSSA. Based on these facts, we decided we needed to actively pre-warm the patients and provide some type of treatment for nasal reservoir. Challenges: Supply issues Documentation (electronic vs. paper)Staff education Hospital Survey on Patient Safety (HSOPS): Fifty percent of our staff either disagreed or were neutral to the survey statement: After we make changes to improve patient safety, we evaluate their effectiveness. We knew it was important to keep them informed!S aureus x 3MRSA x 1S aureusS. aureusMRSA/ Coag Staph S. aureusInitial Intra-Operative Temperature for Spinal Cases

What we are working on now:Digging into the data on glucose management in the Neurosurgical Services population. Diabetes Healthways is attending service line meeting to fine tune our process/make recommendations. Anesthesia attends our meetings and is providing input on glucose management intra-operatively. The Medical Center of Central Georgia Whats next for your team?

Concurrent (real time) feedback to staffIncreased awareness of the impact of hypothermia and its impact has led to discussions in other surgical service lines. Dr. Ken McDonald, MD/Anesthesia is presenting a comprehensive overview of the importance of normothermia peri-operatively to all divisions within Surgical Services.

The Medical Center of Central GeorgiaQuestions we have for the SUSP teams:

Do you have a hard stop on Hgb A1C levels for elective surgical cases? How are you addressing physicians who do not optimize their patients preoperatively?

The Medical Center of Central GeorgiaCarroll Hospital CenterGap AnalysisApril 26, 2014

Effective Strategies for Implementing NPSG 07.05.01: Surgical Site InfectionsApril 23, 2014Private, nonprofit 193-bed. community hospital Full array of surgical services including minimally invasive and robotic options8,034 Inpatient & Outpatient Surgeries 176 colon surgeries

The Journey

Deep SSIs added to hospital quality dashboard in FY 2012Target met in FY 2012 and 201320% reduction in FY 2013

Point out that these Deep SSIs in our target are for all surgical cases, not just colon. 13Something changed

Deep SSI target for the entire fiscal year nearly exceeded in one single quarter!

Investigation of the usual suspectsPersonnelImplant #sPreventative measures followedEnvironmental factorsSterilization process

Actions TakenOR cleaning revamped using Virex spray and cloths rather than antimicrobial wipesAir vent cleaning back on scheduleHigher grade air filtersFlash sterilization monitoring improvedPolicy enforced to assure appropriate sterilization of instruments brought in by reps

Actions TakenRandom OR observations resumedUse of antimicrobial sutures considered but later declinedVascular SSIs presented at Vascular M&MReferred some to physician peer reviewSCIT (Surgical Care Improvement Team)/ Eliminate SSI re-formed

Gap AnalysisThe Joint Commissions Implementation Guide for NPSG 07.05.01 on Surgical Site InfectionsProvides accredited hospitals with 23 effective implementation practicesLeadership (3)Practitioner-Focused (3)Process-Focused (17)

Identified weaknesses:Practitioners accept and/or take responsibility Aligned and coordinated education for staff and LIPsActing on identified SSI issuesSupport of migration of SSI evidence-based practices from one medical service to anotherWhats next?Consideration of expanding use of PICO dressingsReview Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site InfectionsConsidering a sub-committee to evaluate preoperative patient education and review resources posted on the SUSP web siteQUESTIONS?