Archive July 2018 XIX, No. 7

How We Lowered Our SSI Rate

When we saw a spike in infections, here's how we addressed it.

Charlene Mahoney

Charlene Mahoney, BSN, RN, CPAN

BIO

CHG x 2
CHG x 2 GYN patients use CHG wipes at home before surgery and then we prep with CHG in the OR on the day of surgery.

During routine monitoring, we noticed that our infection rates were increasing for our colorectal and gynecological procedures over an 18-month period. We knew that we had to take a deeper dive into the problem and find a solution. We were already in the process of implementing some of the ERAS (Enhanced Recovery After Surgery) protocols in a few of our other surgical service lines, so we moved our colorectal and abdominal hysterectomy procedures to the top of the list with the focus being on SSI reduction.

In the fall of 2016, we brought together a team of surgical techs, nurses, surgeons and infection control personnel and implemented new practices that have dramatically reduced our infection rates. Here are 3 of the important steps we took.

1. Pre-op CHG wipes.

Before the intervention, we had 12 surgeons performing colorectal surgery with little standardization of perioperative care. For example, some patients were prepped pre-operatively with chlorhexidine gluconate (CHG) wipes, while others used different solutions. After we gathered our multidisciplinary team, we began looking at the research and ERAS protocols that impacted surgical site infection rates. One of the measures suggested in the ERAS colorectal protocol includes using CHG on the patient's surgical site pre-operatively.

Though we always advised patients to shower the night before or the morning of surgery, we wanted to improve the process. Now, we have the colorectal surgeons hand out CHG wipes at their office when scheduling the patient for surgery. As part of that appointment, the doctor will give them the wipes and instructions on how to use them before arriving at the hospital. When the patient arrives and is in pre-op, we wipe them down again with CHG.

Getting all our surgeons to comply with the new protocol took some work. Our chief of surgery engaged the colorectal surgeons, letting them help create the perioperative care protocol. The participating surgeons then had to sign off on it. Getting cooperation was relatively easy with our employed surgeons, but the process took some work with other surgeons. We found that education was quite helpful. We were already using a similar protocol in all our joint replacement surgeries that resulted in complete elimination of SSIs in those procedures over the past year. Once the rest of the surgeons understood the value of pre-operative CHG cleaning and demonstration of similar results in other specialties, they were on board with this added step. We were also able to convince the hospital to pay for CHG wipes for many of our surgeons, which eliminated another potential objection.

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