Tallahassee Memorial Hospital achieved striking results as a participant in IHI's Breakthrough Series Collaborative: Reducing Surgical Site Infections — Deploying a High-Reliability System.

The recommended team composition for organizations participating in the Collaborative was as follows:

Core Team 

• Cardiac Surgeon
• Nurse Manager of Operating Room
• Anesthesiologist
• Patient Safety Officer (if the organization has one)

Additional Team Members

• Infection Control Nurse
• Quality Director
• Risk Manager

Number of cases between surgical site infections

Tallahassee Memorial Hospital employed a mix of the standard changes taught within the Collaborative and custom changes adapted for use within their organization.

Standard changes (part of the Collaborative change package):

• Appropriate pre- and postoperative use of antibiotics
• No preoperative use of razors at the surgical site
• Keeping the patient warm during surgery
• Postoperative monitoring of blood surgar

Customized strategies:

• Stopped ordering razors
• Educated physicians about the change in policy
• Involved a wide variety of staff members in the team and made sure that all involved in the improvement effort were able to explain the reasoning behind any of the changes

Detailed description of changes:

Pre-Procedural Briefings

• Key learning
• White boards in rooms were integral to make successful
• White boards keep everyone (including relief staff) aware
• White boards make the briefing a more interactive experience
• Other cultural changes we made
• Allow everyone (RN, MD, Anesthesia) to write on the board

Prophylactic Antibiotic Use

• Holding Room Nurse hangs antibiotic
• Highlighting OR schedule for eligible patients
• Changing pre-op order sets
• Discussed with specific MD groups regarding selection
• Created a Recommended Antibiotic Selection information sheet
• Created specific timelines for Open Heart

Appropriate Hair Removal

• Removed all razors
• Eliminated razors from the order sheet
• Continued to monitor and check for razors
• Required surgeon to shave their own patients
• Added a field in online documentation to document shaving

Normothermia

• Continued use of established Bair Hugger criteria and warm IV fluids
• Identified CABG patients as area of opportunity
• Analyzed data to determine time at which temperature decreases significantly

Glycemic Control

• Peformed data collection on 100 percent of patients for one week
• Identified very few undiagnosed diabetics
• Identified most opportunity with managing blood sugar of known diabetics
• Plan to begin working with known diabetics in CABG

The number of cases between surgical site infections, which had averaged well under 100 cases since September 2004, recently increased to 180.

03/06/2006