Wash the Bugs Away! A Team Approach to Prevent Surgical Site Infections in Cardiovascular Surgery Patients

Purpose:
The purpose of the project was to reduce surgical site infections caused by skin bacteria in cardiovascular surgery patients. This was accomplished by focusing on standardization of nursing practice regarding skin prep, incision care, hand hygiene, pre & postop showers, and patients' education.

Significance:
In the United States yearly approximately 500,000 surgical site infections (SSI) occurred resulting in 7-10 additional hospital days, attributing to 77% of SSI deaths, and costing up to $10 billion. In 2011, this facility saw its SSI rate of cardiovascular surgery patients up at 3.5% per 100 cases.

Strategy and Implementation:
The improvement process began with the formation of a nursing team to complete in-depth cases analysis and perform direct observation of practice provided on each nursing department. The team identified the following trends: infections were caused by skin bacteria and there were no standardized protocol and processes for nursing staff throughout the many phases of care to decrease skin bacteria and contamination risk. Subsequently, departments involved in the project included: Pre-Admit, Pre-Op, Intra-Op, Post-Op, CICU, Cardiac Unit, Cardiac Rehab, CV surgeons, Quality, and Infection Control. Each nursing unit used rapid improvement event process lead by their shared governance team to make improvements. Changes made included development of new or updated evidence based protocols, new work-flow processes, provided re-education and new education for staff, improved patient education formats, and close monitoring of compliance with data communicated back monthly to departments.

Evaluation:
After implementation, SSI rate of cardiovascular surgery patients decreased from 3.5% in 2011 to 0.7% in Feb 2013. Data regarding incision care and post op showers on Cardiac unit were collected to monitor compliance to the new protocol. Compliance rate has improved from 56.8% to 82.00% by Feb 2013.

Implications for Practice:
This process improvement demonstrated a multidisciplinary approach using evidence based practice along the continuum of care to decrease surgical site infections for cardiovascular patients. Future plan is to share the knowledge and apply the new process to other types of surgeries in the facility.