Methods for improvement COACH -Dr. Poonam Gupta Ms. Catherine Marshall - Director of Nursing Dr.Lateef Wani - CT Specialist Ms. Shiny Shiju - Head Nurse Ms. Joby Cyriac - Staff Nurse Ms. Smitha Anny - Staff Nurse Ms. Sheba Christy - Staff Nurse Ms. Elsayeda Mohd - Staff Nurse Ms. Akhila Ajithkumar - Staff Nurse Ms. Sunitha - Wound care nurse Ms. Marifie - Wound care nurse Ms. Leni B. Garcia - Head of Infecon Control Ms. Cheryln Simbulan - Infecon Control Praconer Intervenons C Clean hands. Chlorhexidine 2% bath pre operave, on the day of surgery and post operave as per protocol. Chlorhexidine packs given during discharge. Nasal de colonizaon – MSSA/MRSA screening of all paents undergoing surgery and once posive, de colonizaon process starts preoperavely. Used clippers for hair removal. L Leſt the wound dressing without exposing for 48 hours postoperavely. Observed wound for any oozing which leads to infecon. E Emphasized client and staff on best pracces for postoperave wound care and prevenon of surgical site infecon as per protocol. A Appropriate anbiocs used pre operave, intra operave and post operave for 24 hours. N Normal body temperature (Normothermia) maintained from 36.1- 37.8C as per protocol. Normal blood glucose level (Normoglycemia) maintained from 6- 8.1 mmol/L as per protocol. A connuous integrated insulin infusion system is used to keep blood glucose level within the range. Monitored temperature and blood glucose hourly for the immediate postoperave day. Educated the client to have nutrious food. Explained the importance of stop smoking to a client who is smoker, if needed given referral to smoking cessaon clinic. Problem Surgical site infecon rate was zero from 2015 to first quarter of 2016. Surveillance and monitoring connued. Resurge of one surgical site infecon idenfied in the second quarter 2016. Contribung factors for developing infecons were idenfied. It was due to uncontrolled blood glucose and not maintaining the body temperature as per protocol pre operave and in the immediate post operave. 1. Followed appropriate antimicrobial prescribing practices before and after surgery. 2. Followed protocols for hair removal, preoperative skin disinfection, and control of blood glucose levels pre operatively. 3. Educated them about the symptoms which is leading to a surgical site infection and the earliest time to approach wound care department. 4. Emphasised the significance of hand hygiene to all the team members including all health care workers. 5. Completed hand hygiene competency for all the staff. 6. Surgical site infections protocols are reviewed periodically. Acknowledgement Prof. Mckenna - Chief Execuve Officer-HH Mr. Paul Mavin - Execuve Director of Nursing-HH Mr. Ian McDonald - Assistant Execuve Director of Nursing-HH MS. Fadia Ali - Assistant Execuve Director of Quality-HH Achievement Achieved Stars of Excellence Merit Award in 2015 for surgical site infecon project. Cardio Thoracic Intensive Care Unit received Stars Of Excellence Award in 2016 for Muldisciplinary Team Work-An Innovave Culture. Conclusion We hypothesized that glycemic control in postoperave cardiac paents reduced the incidence of surgical site infecon. We achieved zero infecons for Coronary Artery Bypass Graſt chest incision risk index x 1 for 304 calendar days, Coronary Artery Bypass Graſt chest incision risk index x 2 for 1447 calendar days. Next Steps 1. Audit on post discharge glucose control level for those who undergo Coronary Artery Bypass Graſt. 2. To implement a Handbook for Cardiac Surgery Paent - “A New Life For Your Heart Enhancing Your Recovery Together.” Reference: www.ihi.org A strive towards “zero surgical site infecon rate” in Cardio Thoracic Intensive Care Unit - Heart Hospital. Authors: Akhila Ajithkumar (SN), Sheba Christy (SN), Smitha Anny (SN) Introducon High rate of surgical site infections identified after the cardiac surgery since beginning of heart hospital. A diversified approach in preventing Surgical Site Infection was developed and implemented to address and mitigate the key issues behind the infections. We gained zero infections for Coronary Artery Bypass Graft Incision Index x 1 for 954 calendar days and Coronary Artery Bypass Graft Incision Index x 2 for 1143 calendar days. AIM The incident rate of surgical site infecon were Zero in 2015, though to keep a stagnancy and sustain zero rate by December 2016. To maintain normothermia and normoglycemia above 90% in CTICU aſter cardiac surgery . With strict compliance to temperature and glycemic control we set foot to zero infecon rate from 2nd quarter to 4th- quarter of 2016. This graph turn up the compliance range of temperature and glycemic level in the post cardiac surgery clients from Jan 2016 - Jan 2017. 0 10 20 30 40 50 60 70 80 90 100 % o f p a t i e n t s Surgical site infection indicator Normothermia (36.1- 37.8C) Normo glycemia(6-8.1 mmol/L)