Reducing Surgical Site Infections (SSI) Following Craniotomy: Utilizing the Entire Patient Experience
Background: Surgical site infections [SSI] increase mortality, morbidity, length of hospital stay, and cost. Craniotomy SSIs can have a major impact on patient outcomes and are often expensive and difficult to treat. Methods to reduce SSIs, specifically craniotomy infections, are needed.
Methods: From June 2015-Sept 2015, the entire patient experience was followed through a series of clinic conversations with Advanced Practice nurses, intra-operative observations, inpatient observations and staff conversations, and chart reviews. Using the information collected, in conjunction with reviewing published best practices, a list of Infection Prevention recommendations were provided to the care team and implemented between October 2015 and December 2015. Interventions included: standardizing pre-op and post-op care instructions, skin prep in-servicing and standardization, implementing pre-op Chlorhexidine (CHG) bathing and shampoo the night before and morning of surgery, assigning a clear responsibility and schedule for OR equipment cleaning, standardizing and teaching post-op hair and head care, and discontinuing EVD drain prophylaxis.
Results: Infection rates for craniotomy SSI decreased from 3.40 in fiscal year 2015 to 2.04 in fiscal year 2016 to date (Sept through March). Standardized infection ratio (SIR) for these infections decreased from 1.3 to 0.78 within the same time frame resulting in a percent change of 40%.
Conclusion: Evaluating the care the patient receives throughout the clinic, operating room, hospital, and post-discharge can lead to identification of opportunities for improvement. Standardizing care and implementing best practices can lead to reduction of surgical site infections.
C. Silkaitis, None
M. A. Sotelo, None
S. Ward-Fore, None
S. Aranas, None