371. Sustained Reduction of Surgical Site Infections after Colorectal Surgery
Session: Poster Abstract Session: HAI: Surgical Site Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • 371_IDWPOSTER_Upload.pdf (738.1 kB)
  • Background:  Public Health Law 2819 mandates reporting of surgical site infections (SSIs) since 2007 for certain types of surgeries, including colorectal procedures.  In 2012 and 2013, Memorial Sloan Kettering (MSK) reported significantly higher rates of SSIs following colorectal procedures when compared to the New York State (NYS) benchmark.  The goal of this project was to reduce SSIs following colorectal surgery.    

    Methods:  A multidisciplinary project team piloted targeted interventions in the pre, intra, and post, -operative areas.  Additionally, a predictive model for identifying patients at high risk for SSI was developed and applied.

    Interventions

    Pre-Op Interventions

    Intra-Op Interventions

    Post-Op Interventions

    Data

    ·      Glycemic control

    ·      Oral decontamination for bowel preparation

    ·      Skin cleansing with Chlorhexidine

    ·      Updated patient education surgical guides

    ·      Intra-op Antibiotics:

    o  Choice

    o  Timing of first dose and re-dosing guidelines

    ·   Glycemic Control

    ·   Surgical closing Trays

    ·   New wound materials/devices

    ·      Glycemic control

    ·      Shower all CRS patients on POD 2

    ·      Improve compliance with hand hygiene

    ·      Electronically implemented wound assessment order at discharge

    ·   SSI Risk Model and Calculator

    ·   Notification System

    ·   Quarterly Feedback to Surgeons via Email

    ·   Monthly meetings to assess:

    o implementation

    o compliance for certain interventions

    o outcome data

     

    Results:  For Q1-Q3 of 2013 (pre-intervention period) the baseline SSI rate for Colon procedures was 12% (44 infections/378 procedures).  An immediate decrease in SSI rates was seen after implementation in mid-Q4 and sustained through the following year with an average post intervention SSI rate of 4% (21 infections/525 procedures).  This was a statistically significant difference (p<0.001, CI: 1.86 - 5.37).   

    Conclusion:  We demonstrated a successful and sustained reduction in SSI rates following colorectal surgery for cancer related indications with a multi-intervention approach.  Since multiple interventions were applied at the same time we are unable to assess the individual impact of each.

    Shauna C. Usiak, MPH, CIC1, Janet Eagan, RN, MPH, CIC1, Julio Garcia-Aguilar, MD2, Martin R. Weiser, MD2, Tess Pottinger, MS3, Chris Cheavers, BA3 and Kent Sepkowitz, MD, FIDSA, FSHEA3, (1)Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, (2)Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, (3)Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY

    Disclosures:

    S. C. Usiak, None

    J. Eagan, None

    J. Garcia-Aguilar, None

    M. R. Weiser, None

    T. Pottinger, None

    C. Cheavers, None

    K. Sepkowitz, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.