Nursing News

Evidence-Based Practices Reduce Surgical Site Infections

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By Christina Orlovsky, senior staff writer

Toward its effort to save 100,000 lives in American hospitals, the Institute for Healthcare Improvement enlisted hospitals across the nation to implement six key interventions to improve patient care. This fifth in a series of six articles spotlighting these interventions focuses on the efforts one California hospital has made to reduce surgical site infections in its vulnerable patients.

Back in 2001, Sequoia Hospital, in Redwood City, California, was selected to represent California in a collaborative designed to implement evidence-based interventions in the critical-care setting. Many of these interventions were aimed at reducing surgical site infections, explained Julie Boone, RN, BSN, CCRN, manager of the intensive care unit at Sequoia Hospital, who took several critical-care nurses with her to the collaborative meeting and returned to the hospital ready to make changes.

“We thought about what area we would be successful in and decided to go to the cardiovascular group first,” Boone said. “We didn’t have a huge incidence of surgical site infections in our heart patients, but we wanted to create a standard of care to make sure everyone was doing the same thing.”

The staff implemented the recommended practices, which included four components of care, as listed by the Institute for Healthcare Improvement. Three of these components applied in the cardiovascular setting, including appropriate use of antibiotics; appropriate hair removal; maintenance of postoperative glucose control for major cardiac patients. The fourth component is the establishment of postoperative normothermia for colorectal surgery patients.

The staff at Sequoia Hospital began implementing these measures by throwing away all shavers and switching instead to clipping hair, reducing the infection-prone nicks caused by shaving. They also made sure every patient received antibiotics 60 minutes prior to surgery time and had great success in this area, Boone explained.

“Our biggest success, however, has been for hyperglycemia,” she said. “We have a protocol in the ICU that if their glucose is over 180 we place a drip to keep them between 110 and 150.”

The interventions have resulted in positive infection rates for the hospital and positive feelings among staff.

“In all, we have cut our surgical site infection rate to 0.2 percent—the national average is 0.4 percent to 2 percent,” Boone added. “Plus, it’s very positive for staff to see that the little you do for patients can decrease their risk of infection.”

Boone also credits the presence of staff nurses at the initial collaborative for the success of the team.

“It was important to take them so they could understand the purpose of what we were doing and get the passion behind it,” she said. “The ICU nurses are autonomous,self-driven critical thinkers. They were able to come back and talk about it and get everyone else passionate about it.”

For more information, visit the IHI or Sequoia Hospital Web sites.

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