Abstract #32, titled “Surgical Site Infection Reduction – a 10 year Quality Improvement Journey” was presented at the 20th Annual Scientific Conference of the Canadian Spine Society in Whistler, BC on Thursday, February 27, 2020.
Surgical Site Infection Reduction – a 10 year Quality Improvement Journey
Dr. Supriya Singh1,2, Dr. Dan Banaszek1,2, Dr. Titus Wong2, Dr. Christian Di Paola2, Dr. Tamir Ailon1,2, Dr. Raphaele Charest-Morin1,2, Dr. Nicolas Dea1,2, Dr Marcel Dvorak1,2, Dr. Charles Fisher1,2, Dr. Brian Kwon1,2, Dr. Scott Paquette1,2, Dr. John Street1,2
1Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada. 2University of British Columbia, Vancouver, British Columbia, Canada.
In 2007, the spine surgical site infection (sSSI) rate at our Canadian quaternary referral center was 8.1% As a result, a multidisciplinary team was created to identify and initiate quality improvement (QI) strategies to reduce this unacceptably high sSSI rate. This abstract outlines the institutional and divisional QI strategies that have been central to our ongoing efforts to reduce the incidence of sSSI.
A framework for evaluating surgical safety, based on that proposed by Mirza, was adopted to identify risk factors for sSSI at our institution. Surgical [midline lumbar approach, Odds Ratio (OR) 4.2], microbiological [UTI, OR 5.8], patient [DM, Odds Ratio (OR) 4.2] and process [ICU, OR 1.75] factors were explored. A predictive model for sSSI was developed with an AUC of 0.88. Numerous QI initiatives were introduced and their effect on sSSI monitored by the institutional Infection Prevention and Control (IPAC) group.
From 2008, the Wiltse approach was used, in favour of midline, for one and two level decompression and fusion of the lumbar spine. Total sSSI rate fell from 8.1% to 7.2%. Routine use of intra-operative navigation from 2009 did not adversely effect the sSSI rate. From 2011 to 2014, photodynamic nasal decolonization and chlorhexidine skin decontamination (PDT/CHG) was applied to all elective and emergency spine cases, with the sSSI rate falling from 7.2% to 2%. With routine use of intra-wound vancomycin power in posterior instrumented cases from 2016, total sSSI rates further reduced from 2% to 1.6%. With the routine use of silver coated indwelling urinary catheters in patients with acute traumatic SCI, sSSI rates were reduced to 0.8% by early 2019 and have remained <1% since.
We present our experience in addressing sSSI through risk identification and prophylactic quality improvement initiatives. We highlight the importance of a multidisciplinary team approach, the value of a safety framework model and the importance of continued use of the Plan-Do-Study-Act cycle model.
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