SSIs are the most common complication for this high-risk population, occurring in 15 to 30 per cent of patients after colorectal operations, according to the study authors. "Colorectal surgical site infections have been tough to prevent. This is a first step to understanding a strategy for prevention. Wound infections are an important risk factor for hospital readmission, increased length-of-stay, and reoperations," said Doctor Elizabeth Wick of the Johns Hopkins School of Medicine.
The Johns Hopkins Hospital participates in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The program is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in private sector hospitals. While participating in a pilot program of ACS NSQIP called "Procedure Targeted Module", which monitored outcomes in all patients undergoing colorectal surgery, the colorectal operating team discovered that they had a very high colorectal wound infection rate, approximately 30 per cent.
To address the problem, researchers decided to apply the comprehensive unit-based safety program, known as CUSP, to colorectal wound infections. The five-step quality improvement strategy was designed to bring about patient safety improvements through an interdisciplinary team approach focusing on frontline providers with the goal of changing the unit's workplace culture.
"The CUSP program is unique because it focuses on the frontline providers — the nurses and the medical techs taking care of the patients day to day — and it gives them the power to identify and fix defects in the operating room. A key component of the program is a hospital executive is part of the team to help overcome barriers and reiterate the importance of the work," Wick said.
For the study, the CUSP team identified four defects in their surgical care: antibiotic selection and dosing, skin preparation, maintenance of normal body temperature, and intra-operative sterile technique. All defects surfaced from querying frontline providers.
MEDICA.de; Source: Johns Hopkins School of Medicine