Archive Infection Control 2017

Get Buy-in for Bundles To Reduce Infection Risks

Q&A with Chad Buhs, MD, surgeon champion of SSI prevention.

You oversaw a program that reduced colorectal surgery infection rates by 11%. Why did you take charge of those efforts?
There was a problem with our infection rate, so we gathered as a care team and worked on improving it by implementing a standardized approach to pre-op showering, patient education, maintaining normothermia, controlling blood glucose levels, and using wound protectors and closing trays. Ultimately, it was about wanting to do better for our patients.

Chad Buhs, MD

What proved most challenging in implementing the changes?
Getting buy-in from everyone involved. That was especially true for surgeons, who often believe that the way they've always done things is best. Most surgeons won't respond if you tell them they need to use a different antibiotic. But they're more likely to get onboard if you have data showing that their infection rates are high, compared with other surgeons using the antibiotic you want them to switch to.

Why are quality improvement bundles useful?
Implementing a bundle is called "clumping." The idea is to employ a group of measures that are more effective as a whole than they would be if implemented individually. It's like tuning up your car. It still might sputter if all you do is change the oil, but if you also change the spark plugs and clean the air filter, it will run dramatically better.

What's the best way to make bundles work?
If you try to make too much change too quickly, your staff will push back and lose interest. Zero in on making 3 to 4 elements of a bundle work. Additional steps can be added later after you hardwire those initial changes into practice and build off their successes. You also have to keep staff and surgeons engaged. I meet with surgeons quarterly and the OR staff biannually to present infection data and to talk about what we're going to tackle next. Everyone must feel like they're constantly involved in the process improvement.

AORN and the American College of Surgeons recently argued about skullcaps increasing infection risks. What do you wear?
I've worn both: whatever a facility provides. It was a power grab by both sides and didn't have anything to do with hard data. What you wear on your head really doesn't make that much of a difference in infection rates, unless, of course, you have a lot of hair sticking out from under the cap and falling into the surgical wound. I'd be thrilled if I had that much hair to cover. OSM

Dr. Buhs (chad.buhs@mayo.edu) is a general surgeon affiliated with the Mayo Clinic Health System in Mankato, Minn.

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