American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Reducing SSI Resources

Resources Used and Skills Needed

  • No additional staffing resources were needed; existing staffing levels used.
  • The new dressings have added costs of $35,000 per year.

What Were the Results?

VGH Cardiac surgery SSI NSQIP rates started to fall dramatically after implementing the new dressings and protocols. Our rates fell from 7% to 1.6% over 9 months. Cardiac SSI rates are tracked both by NSQIP and with tradition methods (infection control nurse tracks patients for 90 days). Since July 2013, only two sternal infections have been recorded. No sternal infection was observed for eight consecutive months from July 2013.

Setbacks

The barriers to implementing this program are largely other priorities that are competing for staff’s time. We extended our goal date to reflect these competing priorities.

The infection control nurse captured 4 harvest upper leg SSIs that were not sampled in NSQIP. These infections happened within a two week time frame. These cases were discussed with the team.

Cost Savings

The money invested is the cost of the new dressings is estimated to be $35,000 year.

Our hospital estimates that a cardiac surgery SSI costs approximately $30,000 per event. In the last year, we have an estimated cost avoidance of approximately $300,000.

Tips for Others

  • The manager from the surgical unit was very supportive of our quality improvement initiative and encouraged front line leaders and ward staff to attend the monthly meetings. The head of anesthesia has encouraged his team to attend the meetings. The surgeons are unable to attend mid day meetings but are engaged in the process.
  • Monthly meeting minutes were communicated to the team.
  • There is an information board on the Cardiac Surgery Intensive Care Unit and the Cardiac Ward that shares the progress of our work and the changes in practice.
  • We have celebrated our success by presenting at a local quality forum and will be presenting our work to other cardiac sites in our region.
  • Our infection control practitioner continues to monitor all cardiac surgery inpatients and reports to the nursing leaders.
  • NSQIP rates are posted on the surgical units. Updates are provided to the frontline staff and administrators.