At Salem Hospital, we've successfully implemented the SCIP (Surgical Care Improvement Project) measures related to antibiotic prophylaxis. They call for administering an antibiotic within 1 hour prior to surgery (SCIP-INF 1), ensuring that the physician prescribes an antibiotic appropriate to the procedure and the patient (SCIP-INF 2) and discontinuing the antibiotic within 24 hours after surgery (SCIP-INF 3). Read on if you're interested in improving your compliance rate with these SCIP measures.

SCIP INF-1 1 hour prior to surgery
The easiest way to incorporate something new is to add it to the list of what needs be done for each case. The success of aviation-style checklists is well-documented, so if you don't use perioperative checklists, it's time to begin. Checklists ensure things are done properly, consistently and at the same time, every time.

In our hospital, the antibiotic prophylaxis process begins with the physician, who writes the order for the antibiotic to be administered within an hour of surgery (or within 2 hours if the order calls for vancomycin). The order is documented in the electronic medical record. The pre-op nurse and pharmacist ensure that the order has been written. Then, before the patient enters the operating room, a documented handoff between the pre-op nurse and anesthesia provider occurs. They start the antibiotic based on the surgery schedule and document it on the medication reconciliation record (MAR) and the anesthesia record.

Verify the administration of the appropriate prophylactic antibiotic during the physician-led time out. If the case runs longer than expected, or if you miss the 60-minute window, you might have to re-dose (be sure to consider the half-life of the antibiotic).

SCIP INF-2 Get the right antibiotic
Collaboration between pharmacy and surgery is key to success with this SCIP measure. The Centers for Medicare and Medicaid Services has developed a guideline to assist physicians in choosing the right antibiotic. Pharmacy can provide the surgeons with these recommendations, which take into consideration the type of surgery and whether the patient has any medication allergies.

SCIP INF-3 Discontinue on time
The third SCIP measure calls for discontinuing the antibiotics within 24 hours after surgery. Antibiotic administration time frames are pre-determined, and start and stop times are entered on the medication administration record (MAR) at the time the orders are written. When the antibiotic stop time arrives, the nurse gives the last dose and then the order is automatically removed from the MAR.

Working toward zero
Obtain as much feedback as possible from the people directly involved in the process. Any gaps in compliance may mean you need to revisit and make changes. Our information systems department played an integral role in developing and refining parts of the process related to our electronic medical record system.

Surveillance should be an integral part of your infection prevention program. We're fortunate to have an electronic surveillance system that lets us identify potential healthcare-acquired infections in real time, and take action accordingly.

If you identify a surgical site infection, investigate immediately. Since our infection rate is very low, we can do a "deep-dive" analysis of hospital-acquired infections within days of the event. This deep-dive is multi-disciplinary and may involve staff members from the nursing, surgery, sterilization and disinfection departments in addition to infection prevention staff. The goal of the deep-dive is to identify any compliance gaps and see if we can learn anything that will improve our processes and prevent future infections.

Whether your compliance and infection rates are excellent or have room for improvement, it's important that you report how you're doing to all stakeholders. Data is most helpful when it makes its way back to the end-users and other people who can influence change. We post performance improvement data on bulletin boards and on a hospital electronic dashboard. We also report infection rates monthly to the infection prevention committee. We comply with all external reporting requirements as well, including CMS and Oregon state requirements.

Although it's always been important, preventing hospital-acquired infections has gained much more attention among patients and healthcare providers these days. At Salem Hospital, our goal is to do everything we can to reach zero hospital-acquired infections. Successful compliance with the SCIP measures is one way we're making that happen.