1461. Use of an Intraoperative Checklist to Achieve High Reliability in the Reduction of Neurosurgical Shunt Infections
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • ID Week Poster2016.pdf (322.6 kB)
  • Background:  Surgical site infection (SSI) is a frequent complication of neurosurgical (NS) shunt procedures in children and can lead to increased morbidity, mortality, and healthcare costs. We sought to determine the impact of a quality improvement (QI) initiative on SSI rate following initial NS shunt procedures at a tertiary care children’s hospital.

    Methods: SSI surveillance following NS shunt procedures is performed using National Healthcare Safety Network definitions and infection rates displayed using control charts. A multidisciplinary QI team formed after the NS shunt SSI rate reached special cause variation in November 2014. An intraoperative checklist was developed using best practices from the Hydrocephalus Clinical Research Network Initiative and was adapted through a series of PDSA (plan-do-study-act) cycles beginning January 2015. The checklist was refined during each cycle. Checklist elements included: skin antisepsis, preparation/equipment set-up, antibiotic timing/re-dosing, operating room (OR) attire and traffic, and hair removal. The checklist was finalized in July 2015.  Intraoperative observations were performed by Infection Prevention and Control to monitor staff compliance and to identify additional improvement opportunities in the OR environment. Compliance with use of the checklist and NS shunt SSI rates were reviewed regularly with the QI team and shared with OR staff. A retrospective observational study compared the SSI rate before and after implementation of the QI initiative.

    Results: Checklist implementation resulted in a sustained decrease in the rate of NS shunt SSI from pre-checklist to post-checklist implementation (Table 1, Figure 1).

    Conclusion: Implementation of an intraoperative checklist using a structured improvement framework resulted in a decrease in SSI following NS shunt procedures. Support from OR leadership and a multidisciplinary, collaborative approach with regular data sharing are vital to creating local ownership and accountability and sustaining improvement.

    Table 1: SSI Rates per 100 procedures

    Date

    Numerator

    Denominator

    Rate

    Pre-checklist

    (Jan 2014-Dec 2014)

    5

    167

    2.99

    Plan-Do-Study-Act Phase

    (Jan 2015-July 2015)

    3

    122

    2.46

    Post-checklist

    (Aug 2015-Apr 2016)

    0

    190

    0.00

                                                                                  

    Lauren Farrell, MS, MLS(ASCP), CIC1, Cindy Hoegg, BSN, RN, CIC2, Mary Ann Gibbons, RN, MSN3, Lauren Satchell, BA2, Roseann Osadchuk, RN4, Talene A. Metjian, PharmD5, Sonja Joiner Jones, RN, MS4, Gregory Heuer, MD, PhD6 and Julia Shaklee Sammons, MD, MSCE7, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (3)Department of Safety and Medical Operations, The Children's Hospital of Philadelphia, Philadelphia, PA, Philadelphia, PA, (4)Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Antimicrobial Stewardship Program, The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, Perelman School of Medicine, Philadelphia, PA, Philadelphia, PA, (7)Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA

    Disclosures:

    L. Farrell, None

    C. Hoegg, None

    M. A. Gibbons, None

    L. Satchell, None

    R. Osadchuk, None

    T. A. Metjian, None

    S. Joiner Jones, None

    G. Heuer, None

    J. S. Sammons, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.