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Whats New in the
Patient Safety World
October 2024
Successful SSI
Bundle
Banner Health
recently reported outcomes from its implementation of an SSI (Surgical Site
Infection) bundle on over 57,000 cases at its hospitals in Arizona, California,
Colorado, Nebraska, Nevada and Wyoming between January 2019 and December 2023.
The study was presented at the APIC 24 Annual Conference and Exposition (APIC 2024, DSouza 2024). The bundle emphasized surgical
antimicrobial prophylaxis (SAP) but contained elements common to most SSI
bundles. They monitored adherence to the appropriate selection of preoperative
antibiotics, dose, administration times, and redosing. Starting from a baseline
of 67.1% in 2019, adherence to this process measure increased to 82.2% by 2023.
Hip arthroplasty
procedures saw a 32.8% decrease in SSI rates and 48.3% drop in SIR
(Standardized Infection Ratios), while knee arthroplasty procedures resulted in
a 15.2% reduction in SSI rates and 33.1% decrease in SIR. Additionally,
adherence to the SAP bundle in colorectal surgeries and abdominal hysterectomy
procedures decreased SSI rates by 17.4% and SIR by 8.11%, respectively.
Moreover, compliance
with the bundle produced the beneficial effect of shortening length of stay
(LOS) by 4 days, decreasing overall mortality rates by 4.4%, and lowering the
average 30-day readmission rates by 3.9%. Similarly, compliance with the SAP bundle
in hip arthroplasty procedures evidenced a statistically significant
(p<0.0001) reduction in average 30-day readmission rates from 11% to 7%.
Lead author Aarikha DSouza also pointed out that reducing length of
stay likely also leads to other important benefits, such as decreasing the
chances of patients developing deep vein thrombosis, pneumonia, pressure
injuries, or having a fall.
Core elements of the SSI bundle (Tsioulias
2024) included chlorhexidine
gluconate preoperative body wipes, chlorhexidine and alcohol-based skin
preparation; hair removal method standardization (clippers, hair removed in
preoperative department); preoperative antimicrobial prophylaxis guidelines
(appropriate dose, choice, timing and redosing of antibiotic); maintaining
normothermia with active warming methods (warmed IV fluids, warm forced air to
keep body temperatures >3° C); perioperative glycemic control and
postoperative oxygenation. There were also some supplemental elements specific
to procedure types:
·
Colorectal
surgery: Use of silver dressings, new sterile closing instruments/tray, gown
and glove changes, combined oral and mechanical bowel prep for elective
procedures and wound protectors.
·
Abdominal
hysterectomy: Vaginal preparation with povidone-iodine or CHG; use of new
sterile closing instruments/tray; gown and glove changes.
·
Orthopedic:
Use of silver dressings; nasal decolonization; povidone-iodine irrigation of
the surgical wound prior to closure; traffic restriction and control during the
procedure.
Pretty impressive
results!
Some of our prior columns on HAIs (hospital-acquired infections):
December 28, 2010 HAIs: Looking In All The Wrong Places
October 2013 HAIs: Costs, WHO Hand Hygiene, etc.
February 2015 17% Fewer HACs: Progress or Propaganda?
April 2016 HAIs:
Gaming the System?
September 2016 More
on Preventing HAIs
November 2018 Privacy
Curtains Shared Rooms and HAIs
December 2018 HAI
Rates Drop
January 2019 Oral
Decontamination Strategy Fails
February 2019 Infection
Prevention for Anesthesiologists
March 2019 Does
Surgical Gowning Technique Matter?
May 2019 Focus
on Prophylactic Antibiotic Duration
July 2019 HAIs and Nurse Staffing
February 2020 NICU: Decolonize the Parents
June 16, 2020 Tracking Technologies
August 2020 Surgical Site Infections and Laparoscopy
December 2020 Do You Have These Infection Control Vulnerabilities?
May 2021 CLABSIs Up in the COVID-19 Era
August 2021 Updated Guidelines on C. diff
October 2021 HAIs Increase During COVID-19 Pandemic
June 2022 Guideline Update: Preventing Hospital-Acquired Pneumonia
June 21, 2022 Preventing Post-op Pneumonia
June 28, 2022 Pneumonia in Nervous System Injuries
August 2022 Resistant Infections Up During COVID-19 Pandemic
November 15, 2020 Which Antiseptic?
December 2022 Game Changer to Prevent SSIs in Abdominal Surgery?
May 30, 2023 Non-Ventilator-Hospital-Acquired Pneumonia Finally Gets Attention
August 2023 New MRSA Guidelines
September 12, 2023 Radiology and Hospital-Acquired Infections
January 2024 HAIs Drop Sharply Post-Pandemic
February 2024 Remember the Toothbrush!
March 2024 Battle of the Antiseptics
April 2024 Hospital Beds and C. diff Infection
References:
APIC. Surgical Site
Infection Rates and other Secondary Outcomes Decrease Dramatically at
Multi-state Hospital System Through Standardized, Preoperative, Surgical,
Antibiotic Practices. APIC press release June 4, 2024
DSouza A, Dizon ME,
Leimkuehler RE, et al. Effect of a Standardized Preoperative Prophylactic
Antimicrobial Guideline on Improved Postoperative Surgical Site Infection (SSI)
Outcomes. APIC 24 Annual Conference and Exposition. Oral Abstract ISR 11; June 4,
2024
Tsioulias A. Surgical Site Infection Bundle Improves Patient Outcomes. Anesthesiology News 2024; September 11, 2024
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