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New findings Support SSI Solutions

Publish Date: 12/5/2012
  1. Patient undergoes standardized skin cleaning and skin prep before surgery
  2. Surgical team uses new gowns, gloves and instruments during the transition from the contaminated to the clean part of the surgical procedure
  3. Postop wound care is managed closely with good hand hygiene by all caregivers
These are three of the targeted solutions based on 34 unique correlating variables for colorectal SSI risk that have been developed and tested in a Colorectal Surgical Site Infection quality improvement project through Joint Commission’s Center for Transforming Healthcare (the Center).
Applying these solutions to practice has led to a significant and sustained reduction in colorectal surgical site infections at seven U.S. hospitals participating in the project, according to project results released last week.
Several of these solutions are in line with AORN recommended practices, including practice recommendations for:
  • preoperative patient skin antisepsis
  • antibiotic prophylaxis
  • warming interventions
  • hand hygiene
  • isolation technique prior to closure
Isolation technique is now incorporated in AORN’s 2012 updated Recommended Practices for Sterile Technique with step-by-step instructions for implementing isolation technique in surgeries involving the colon and metastatic tumor resection.
“Solutions must come from evidence,” stressed AORN Perioperative Nursing Specialist Sharon Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC. “Our work with The Joint Commission to understand their new data from this project has lent even further evidential support to the practice recommendations AORN advocates to prevent surgical site infections, particularly in cases that involve contaminated and clean areas.”
Ramona Conner, MSN, RN, CNOR, AORN manager of standards and recommended practices praises the speed with which these important evidence-based solutions for SSI have been made available to practitioners. “By communicating with each other as we shaped our individual projects, we have helped bring the reality of research into practice.”

New data for smart solutions  

One key finding from the Center project was “inconsistent interpretation and execution of best practices at the point of care, such as lack of a standardized protocol to prevent avoidable wound contamination,” according to Project Lead Siew Lee Grand-Clément, RN, MSN, CPHQ. 
She hopes knowledge gained from this project will provide insight into the barriers to adopting recommended practices for the complete care of surgical patients. 
Collectively, the Center project participants saw overall reduction in superficial incisional SSIs by 45% and in all types of colorectal SSIs by 32%.
Other results of the project showed:
  • cost savings of more than $3.7 million for the 135 estimated colorectal SSIs that were avoided
  • average length of stay for patients with any type of colorectal SSI decreased from an average of 15 days to 13 days
 
Project participants used Robust Process Improvement™ methods and data methodology from the American College of Surgeons American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) to identify a baseline occurrence of all colorectal SSIs at their facility and pinpoint specific risk factors in order to develop and test specific solutions and measure outcomes.
Using NSQIP data and methods that depend on the collection of very valid clinical info “strongly bolsters the validity of these outcomes” and “underscores the importance of finding unique solutions so SSI can be targeted effectively,” notes Mark Chassin, MD, FACP, MPP, MPH, president of The Joint Commission.
The Joint Commission will add these solutions for colorectal SSI to their Targeted Solutions Tool™ after the solutions are pilot tested in other health care organizations. Look for the updated tool in the first half of 2013. 

Additional Resources

Access the story board with results, risk factors and targeted solutions from The Joint Commission Center for Transforming Healthcare Colorectal Surgical Site Infection Project
Learn more about AORN’s 2012 update to the Recommended Practices for Sterile Technique in a webinar presented on Dec. 5, that’s now available online, and read these recommended practices in the 2013 edition of Perioperative Standards and Recommended Practices

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