the providence health care experience dr ahmer karimuddin meghan macleod dr alex seal phc surgical...
TRANSCRIPT
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the Providence Health Care Experience
Dr Ahmer KarimuddinMeghan MacLeod
Dr Alex Seal
PHC Surgical ProgramUniversity of British Columbia
February 19th, 2015University of
British Columbia
Preventing Surgical Site Infection
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Disclosure
There are no conflicts of interest and nothing to disclose
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Outline
1. Why this is important
2. Our approach to thischallenging problem
3. Bundle
4. Results
5. the FUTURE
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THANK YOU
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SSI Prevention TEAM• Jock Reid• Jim Abel• Ahmer Karimuddin• Victor Leung• Chris Prabhakar• Meghan MacLeod• Lisa Toback• Elisa Lloyd-Smith• Stephen Parker• Michelle Bech• Thelma Velasco• Lona Cunningham• Sandy Grimwood• Rupinder Khotar• Alex Seal
...all of SPH and MSJ
• Randy Rae• Jin-So Pao• Alice Lee • Flavia Mandic• Sharon Bisson• Paul Smith• Howard Green• Barry Schafer• Lu Oviatt• Tamara Younger• Lia Randell
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THANK YOU SPH & MSJ Team
SSI’s
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Background
• Why do this?
• Opportunity to improve the care of patients
• Individual
• Service
• Site
• City, province, etc...
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Background
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DATA
NSQIP Risk Adjusted DataSurgical Site Infection
All Cases reviewed July 2011 – June 2012
SPH MSJ
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Goal of Working Group
Ultimately Reduction in Rates of SSI**
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Goal of Working Group
1. ID the problem
2.Explore the process
3.Build the Team
4. ID root causes/best practice
5.Select and test solutions
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EPIC Approach
• Will it be EPIC?
• E - Easy to implement
• P - Permanent
• I - Impact High
• C - Cost effective
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Best Practice Brainstorm
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Strategies for Prevention
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Brainstorm
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Looked at Other Centres• Example initiative:
• Northwestern experience: OR closing bundle (colorectal)
• New gloves
• New instruments
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PHC = FOCUS Bundle• F - Focused
• O - Opportunities of
• C - Care
• U - Utilizing
• S - Standards
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PHC SSI Prevention Bundles
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Example: Pre-op Antibiotics
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PHC approach based on best practice
1. Risk Assessment
2. Creation of key preventative strategies
3. Adherence to key strategies
4. Active surveillance
• = REDUCTION IN RATES
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PHC SSI Prevention Bundle• Areas for Education Opportunities
1. Pre-Admission Clinic
2. Pre-OP
3. SPH OR
4. MSJ OR ✓
5. PAR ✓
6. Wards ✓
✓✓
✓
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Appropriate OR Dress Attire
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PHC SSI Prevention Bundle
I pity ‘da foolwho
dresses like mein da OR
Intra Operative FOCUS
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How are we doing now?
• S
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SPH
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MSJ
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NSQIP data: Out of the pink!
Report Period SPH SSI MSJ SSI
07/11-06/12 2.02H 1.64H01/12-12/12 1.70H 1.75H04/12-03/13 1.49H 1.72H07/12-06/13 1.36H 1.56H10/12-09/13 1.30 1.46H01/13-12/13 1.18 1.1404/13-03/14 1.19 0.93
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Implementing a Bundle
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SQAN Summer Student AUDIT
• Best compliance with bundle intra-operative components
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Bundle Compliance AUDITPreoperative
Surgical Day CareIntraoperativePostoperative
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SPH
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MSJ
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FUTURE
• Opportunity for improvement
• Focus on areas from audit where lower compliance
• Pre-OP warming
• Pre-OP surgical site chlorhexidine prep by patient
• Pre-OP site shave in Daycare
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FIN