Immediate Pre- operative Decolonization Therapy Reduces Surgical Site Infections: A multidisciplinary quality improvement project Dr. Elizabeth Bryce Dr. Titus Wong on behalf of the VGH decolonization team Surgery and Orthopaedics Combined Grand Rounds 12 December, 2012 1
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Immediate Pre-operative Decolonization Therapy
Reduces Surgical Site Infections:
A multidisciplinary quality improvement project
Dr. Elizabeth Bryce Dr. Titus Wong on behalf of the VGH decolonization team
Surgery and Orthopaedics Combined Grand Rounds12 December, 2012
1. Connect nasal illuminator tips to laser cable port via fiber-optic connector2. Illuminate for 2 minutes with tips placed as shown above (directed into inner tip of nose for 1st cycle and posterior for 2nd cycle)
1st Illumination Cycle 2nd Illumination Cycle
1 2
3 4
Chlorhexidine Washcloths
• Alcohol-free washcloth impregnated
with CHG
• FDA and Health Canada approved
• Used below the neck day of or night
prior to surgery
• Left on the skin (not rinsed off)
• Equivalent to 4% CHG on skin http://www.sageproducts.com/lit/20778C.pdf
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Advantages of this Approach
• Horizontal infection control strategy• Eradicate antibiotic resistant bacterial strains• No generation of bacterial resistance• No/minimal effect on human tissues• Rapid action – maximally effective in minutes• Increased compliance
VGH SSI reduction decolonization QI project
Objectives:1. To determine if immediate preoperative decolonization
using nasal photodisinfection therapy + CHG wipes reduces SSI rates in elective non-general surgeries.
2. To assess the feasibility of integration of a decolonization program in the pre-operative area
Target Population: all elective surgical procedures that were normally followed for SSI as part of the Infection Prevention and Control surveillance program
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Limitations
• not a RCT
• cannot sort out incremental benefit of CHG and PDT therapy
(1) CHG/mupirocin program in place previously (2) CHG bathing program in place previously (3) CHG/mupirocin used variably* Statistics done on the four year total numbers rather than the average
Note that these groups are not necessarily comparable re risk factors
Not Treated Patients: Reasons
Reason for Not Treated Number (%)Short Staffed 32 (16%)
After Shift 20 (10%)Dr/Nurse – Not enough time 40 (20%)
Technical Reasons 18 ( 9%)No illuminators 5 (3%)
Straight to OR from unit 21 (11%)Allergic/Patient refused 10 ( 6%)
No information 38 (19%)Miscellaneous 12 ( 6%)
Total 196
*percentage of ‘not done’ cases range from 3.4% - 8.3% among surgical subspecialties** No substantive differences between surgical subspecialties
46%
Project to Program Transition
• Goals of the Transition Team1. transfer oversight to perioperative services2. streamline process to maximize efficiency3. expand coverage4. educate and disseminate information
• Transition Team– Dr. Elizabeth Bryce, Dr. Diane Roscoe, Dr. Titus Wong, Dr.
Bas Masri, Leslie Forrester, Shelagh Weatherill, Shelley Errico, Anna Marie, Steve Kabanuk, Anna-Marie MacDonald, Kelly Barr
Project to program transitionTime MON TUES WED THU FRI SAT SUN0000
0100
0200
0300
0400
0500
0600
3LPNs 3 3 3 30700
0800
0900
1LPN 11000
2LPNs 2 2 2 21100
1200
1300
1400
1500
1600
1700
1800
1900
2000
2100
2200
2300
Time MON TUES WED THU FRI SAT SUN0000
0100
0200
0300
0400
0500
0600
Shift
TWO
Shift
ONE
Shift
ONE
Shift FOUR
0700
0800
0900
Shift FIVE
1000
1100 Shift
THREE
1200
1300
1400
1500
1600
1700
1800
1900
2000
2100
2200
2300
Increased LPNs during AM rush;
Expanded Hours; Hired
Nurse Educator
*Process streamlined by elimination of project requirements: nasal cultures, data form collection, study data entry
Education and Knowledge Dissemination
• Within VCH– rounds / in-services: surgical subspecialties, peri-
operative services, PAR, infection control, medical microbiology
Society Summer Meeting (Garden City)• upcoming: AAOS 2013 (Chicago)
– Publications: pending
Conclusions• Nasal photodisinfection therapy is microbiologically
effective
• Decolonization therapy reduces surgical site infections
• Decolonization programs can be integrated into perioperative work flow
• Nasal and skin decolonization have high degree of compliance when performed (98.8%)
• Decreases patient morbidity and is cost effective
Thank you!The Patients
Surgery Perioperative Services
Infection Control Medical Microbiology
Patient SafetyOperations and Senior Leaders
Ondine Biomedical
Special Thanks: Study LPNs, data clerks, data analysts, microbiology technologists, and perioperative staffSpecial Thanks: UBC- VGH Hospital Foundation Team Awards:
AMMI 2012 Innovation Academy
Award
Discussion / Questions?
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