506. A Standardized Pre-Operative Surgical Site Infection Prevention Protocol with Patient Adherence Components for Spinal Fusion Patients
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Schaffzin et al Pre op 40654.pdf (2.0 MB)
  • Background: Current SSI prevention bundles focus on peri-operative care only, and have reduced but not eliminated SSIs. Standardizing pre-operative SSI-related care has not been studied well. This study’s purpose is to test the effect of a pre-operative SSI prevention protocol on spinal procedure SSI rates.

    Methods: Based on evidence and expert consensus, we developed a set of pre-operative actions beginning at outpatient surgery scheduling and ending at day-of-surgery operating room transfer. A single tracking document was designed to document all staff and patient (self-reported) activities, which were tracked as all-or-nothing measures. Individual component failures were tabulated to identify areas in need of attention. Data was analyzed using statistical process control methods. 

    Results: Initiated in July 2012, the protocol has 15 outpatient staff (intensive patient education; screening for bleeding risk, skin colonization, nutritional status, metal allergy, and skin healing issues; bowel regimen; and skin antisepsis instruction), patient (bowel regimen, skin antisepsis, and treatment recommendation adherence) and pre-operative unit staff (patient hair in bonnet; chlorhexidine wipes applied to front and back; patient warmed; and patient belongings stored) components. Through March 2013, monthly median adherence was 88.9% (range 71.4-95.0%) among staff and 75% (range 57.9-91.7%) among patients. Since protocol implementation, a significant number of procedures was performed between infections. No SSIs occurred in patients with idiopathic scoliosis (n=48, baseline 3.8%), and the overall rate of infection has remained stable (baseline 4.4%). 

    Conclusion: We effectively implemented a pre-operative surgical site infection prevention protocol. SSI frequency was decreased, particularly in idiopathic scoliosis patients. Tracking both staff and patient adherence components is helpful to direct optimization efforts. To affect overall SSI rates, attention must expand from peri-operative to pre- and post-operative phases of care.

    Joshua Schaffzin, MD, PhD1, Jennifer Anadio, MA2, Mary Anne Lenk, BS3, Maureen Grady, RN2, Peter Sturm, MD2 and Pre-Operative Surgical Site Infection Team, (1)Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Division of Pediatric Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (3)James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH


    J. Schaffzin, None

    J. Anadio, None

    M. A. Lenk, None

    M. Grady, None

    P. Sturm, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.