Location
Philadelphia, PA
Start Date
8-5-2019 1:00 PM
End Date
8-5-2019 4:00 PM
Description
Background: Surgical site infections (SSI) remain a common complication of colorectal surgery and are associated with an increase in cost, hospital LOS and an increased risk of postoperative morbidity and mortality. It is well studied that surgical care bundles reduce infection, there is no established consensus on the optimal amalgamation of variables. Increasing the number of measures within the bundle is associated with a stepwise reduction in SSI. This review presents the efficacy and implementation of a detailed surgical bundle to reduce SSIs in patients undergoing colorectal surgery. We illustrate how the use of EMR aids in implementation and the ability to easily record and track compliance, leading to dramatic reductions in SSIs during colon surgery.
Methods: Our 700+ bed tertiary care center performs over 25,000 surgeries per year and approximately 280 colon cases. In 2015 our institution had a rise in the rate of SSI in colorectal surgeries prompting our institution to reevaluate their practices and initiate a Colon Bundle. A multidisciplinary team evaluated the current process and reviewed best practice guidelines and prevention bundles at other high performing institutions. The current Colon Bundle consists of various features including; standardized preoperative bowel prep, hair removal outside of OR, CHG prep, intraop wound protectors and an incision closing protocol . The benefit of this bundle focuses on continued surveillance of compliance with the incorporation directly into the EMR system. Intraop nursing staff are required to document key components of the bundle as part of their intraop paperwork, generating monthly reports that track surgeon specific compliance and fallouts.
Results: The rate of SSI prior to implementation of the Colon Bundle, was 7.82% for 243 colon cases with a SIR of 2.431. The bundle was implemented in 2015 and the rate of SSI dropped to 3.52% with a SIR of 1.25 in 2016. The SSI rate continued to drop, in 2017 to 1.96% with a decrease in SIR to 0.68. When compliance was evaluated for specific components, most showed an increase between July 2017 and September 2018. Adherence to the intraop closure went from an average of 93% to 97%, wound protector use went from 85% to 90%. Preop CHG wipes went from 89% to 92%. A few areas had a decrease in compliance, including changing of gown and gloves intraop at the initiation of closing bundle from 99% to 97% and use of new instruments intraop when closing went from 98% to 96%.
Conclusions: The implementation of a unique colon bundle at hospital dramatically reduced the incidence of SSI. Ongoing surveillance of compliance is tracked through the EMR allowing for immediate recognition of fall outs, reporting of SSI directly to the surgeons and a way to quickly address issues with compliance. We show that EMR is a helpful tool to track compliance and can be used effectively to improve adherence to aspects of a Colon Bundle in order to effectively reduce SSI.
Embargo Period
5-28-2019
Using EMR to Implement and Track Compliance of a Unique Colon Bundle That Reduced Surgical Site Infection in Colorectal Surgery: A Single Institution Review
Philadelphia, PA
Background: Surgical site infections (SSI) remain a common complication of colorectal surgery and are associated with an increase in cost, hospital LOS and an increased risk of postoperative morbidity and mortality. It is well studied that surgical care bundles reduce infection, there is no established consensus on the optimal amalgamation of variables. Increasing the number of measures within the bundle is associated with a stepwise reduction in SSI. This review presents the efficacy and implementation of a detailed surgical bundle to reduce SSIs in patients undergoing colorectal surgery. We illustrate how the use of EMR aids in implementation and the ability to easily record and track compliance, leading to dramatic reductions in SSIs during colon surgery.
Methods: Our 700+ bed tertiary care center performs over 25,000 surgeries per year and approximately 280 colon cases. In 2015 our institution had a rise in the rate of SSI in colorectal surgeries prompting our institution to reevaluate their practices and initiate a Colon Bundle. A multidisciplinary team evaluated the current process and reviewed best practice guidelines and prevention bundles at other high performing institutions. The current Colon Bundle consists of various features including; standardized preoperative bowel prep, hair removal outside of OR, CHG prep, intraop wound protectors and an incision closing protocol . The benefit of this bundle focuses on continued surveillance of compliance with the incorporation directly into the EMR system. Intraop nursing staff are required to document key components of the bundle as part of their intraop paperwork, generating monthly reports that track surgeon specific compliance and fallouts.
Results: The rate of SSI prior to implementation of the Colon Bundle, was 7.82% for 243 colon cases with a SIR of 2.431. The bundle was implemented in 2015 and the rate of SSI dropped to 3.52% with a SIR of 1.25 in 2016. The SSI rate continued to drop, in 2017 to 1.96% with a decrease in SIR to 0.68. When compliance was evaluated for specific components, most showed an increase between July 2017 and September 2018. Adherence to the intraop closure went from an average of 93% to 97%, wound protector use went from 85% to 90%. Preop CHG wipes went from 89% to 92%. A few areas had a decrease in compliance, including changing of gown and gloves intraop at the initiation of closing bundle from 99% to 97% and use of new instruments intraop when closing went from 98% to 96%.
Conclusions: The implementation of a unique colon bundle at hospital dramatically reduced the incidence of SSI. Ongoing surveillance of compliance is tracked through the EMR allowing for immediate recognition of fall outs, reporting of SSI directly to the surgeons and a way to quickly address issues with compliance. We show that EMR is a helpful tool to track compliance and can be used effectively to improve adherence to aspects of a Colon Bundle in order to effectively reduce SSI.