the Providence Health Care Experience Dr Ahmer Karimuddin Meghan MacLeod Dr Alex Seal PHC Surgical Program University of British Columbia February 19 th , 2015 University of British Columbia Preventing Surgical Site Infection
Jul 15, 2015
the Providence Health Care Experience
Dr Ahmer Karimuddin
Meghan MacLeod
Dr Alex Seal
PHC Surgical ProgramUniversity of British Columbia
February 19th, 2015University of
British Columbia
Preventing Surgical Site Infection
Outline
1. Why this is important
2. Our approach to thischallenging problem
3. Bundle
4. Results
5. the FUTURE
SSI Prevention TEAM• Jock Reid
• Jim Abel
• Ahmer Karimuddin
• Victor Leung
• Chris Prabhakar
• Meghan MacLeod
• Lisa Toback
• Elisa Lloyd-Smith
• Stephen Parker
• Michelle Bech
• Thelma Velasco
• Lona Cunningham
• Sandy Grimwood
• Rupinder Khotar
• Alex Seal
...all of SPH and MSJ
• Randy Rae
• Jin-So Pao
• Alice Lee
• Flavia Mandic
• Sharon Bisson
• Paul Smith
• Howard Green
• Barry Schafer
• Lu Oviatt
• Tamara Younger
• Lia Randell
Background
• Why do this?
• Opportunity to improve the care of patients
• Individual
• Service
• Site
• City, province, etc...
DATA
NSQIP Risk Adjusted DataSurgical Site Infection
All Cases reviewed July 2011 – June 2012
SPH MSJ
Goal of Working Group
1. ID the problem
2. Explore the process
3. Build the Team
4. ID root causes/best practice
5.Select and test solutions
EPIC Approach
• Will it be EPIC?
• E - Easy to implement
• P - Permanent
• I - Impact High
• C - Cost effective
Looked at Other Centres
• Example initiative:
• Northwestern experience: OR closing bundle (colorectal)
• New gloves
• New instruments
PHC approach based on best practice
1. Risk Assessment
2. Creation of key preventative strategies
3. Adherence to key strategies
4. Active surveillance
• = REDUCTION IN RATES
PHC SSI Prevention Bundle
• Areas for Education Opportunities
1. Pre-Admission Clinic
2. Pre-OP
3. SPH OR
4. MSJ OR ✓
5. PAR ✓
6. Wards ✓
✓
✓
✓
NSQIP data: Out of the pink!
Report Period SPH SSI MSJ SSI
07/11-06/12 2.02H 1.64H
01/12-12/12 1.70H 1.75H
04/12-03/13 1.49H 1.72H
07/12-06/13 1.36H 1.56H
10/12-09/13 1.30 1.46H
01/13-12/13 1.18 1.14
04/13-03/14 1.19 0.93
FUTURE
• Opportunity for improvement
• Focus on areas from audit where lower compliance
• Pre-OP warming
• Pre-OP surgical sitechlorhexidine prep by patient
• Pre-OP site shave in Daycare