March 25, 2003
Genesis Leads The Way In Preventing Surgical Infections
Results Of Year-Long Study To Be Presented At National Conference In April
Davenport, IA - Genesis Medical Center (GMC) is one of just three hospitals in the country selected to present the results of a year-long study into methods of preventing infections during surgery. A Genesis team will address the Final Outcomes Congress of the Surgical Infection Prevention Collaborative in Baltimore, MD., April 15 and 16. GMC is the only Iowa hospital and one of only 55 hospitals across the country invited to participate in the breakthrough project. The Collaborative was launched to improve the quality of care delivered to patients before, during and after surgery.
The GMC results will be used in the development of new national health care quality improvement standards to prevent post-operative infections. The Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention and the Joint Commission on Accreditation of Healthcare Organizations are strongly encouraging hospitals to adopt the standards, which could eventually become requirements. Additionally, members of the GMC team will serve as faculty to other Iowa hospitals implementing the standards.
"We're going to be able to demonstrate the results that we've achieved over the last year with specific interventions and indicators," says Vicki Felger, Manager of Quality at Genesis and senior leader for the Genesis team. "Just as importantly, the collaborative is looking at us as an example of how to develop a culture of patient safety."
The study used a pilot population of nearly 550 general, orthopedic and gynecological surgery patients. Many of the interventions had already been a part of patient care in the hospital, but changes were made to ensure consistent, effective use. The GMC team focused on the following proven infection prevention interventions:
Appropriate selection and on-time administration of antibiotics
An estimated 40-60 percent of surgical infections are preventable with selection of the proper prophylactic antibiotic, given at the right time, no more than one hour prior to incision. Discontinuing the antibiotic within 24 hours after surgery prevents resistant strains of bacteria without increasing infection rates and reduces costs. During the study, changes including physician rewording of pre-op orders and surgery staff education about the importance of antibiotic selection and timing resulted in 100 percent of the patients receiving the appropriate prophylactic antibiotic. Additionally, 100 percent of the patients had those antibiotics discontinued within 24 hours post-op. The study also saw an improvement in the timing of pre-op prophylactic antibiotics.
Clipping, instead of shaving operative sites
Staff was educated on the increased infection rates associated with perioperative shaving. All razors were removed from stock carts and surgical prep kits. Heavy-duty clippers were purchased for hair removal by neurosurgeons. As a result, 100 percent of the patients in the study had hair at the surgical site removed without shaving.
Aggressive oxygen supplementation
Providing patients with supplemental oxygen during and after a surgery has been shown to decrease infections. Educating the postoperative staff and increasing the number of facemasks available in the Post-Anesthesia Care Unit (PACU) significantly improved the number of study patients who received oxygen via facemask.
Patient and operating room temperatures
Surgical patients with core temperatures 96.8 degrees Fahrenheit or greater are less likely to get an infection. During the study, special Bair Hugger and other blankets were made available in all operating room suites and Post Anesthesia Care Unit (PACU) to help maintain body temperatures of patients. Also, the OR temperature was elevated during surgery and when not in use. Trial use of cooling vests by physicians and staff is underway in response to increased OR temperatures. Those steps resulted in improved patient and OR temperatures.
The interventions and methods now are being used as standard practice for general surgeries, and are being adapted by the OB/Gyn surgical staff for hysterectomies. Their use is expanding to include total knee and hip procedures and, later this year, cardiovascular surgeries.
"We are way ahead of the crowd," says general surgeon Daniel Congreve, M.D., Davenport Surgical Group, and clinical champion for the Genesis team. "We've been doing this right for a long time. I believe that's why we were asked to participate in this project in the first place - because we are progressive in our approach to health care and quality improvement."
Nearly 2.6 million of the 30 million operations done yearly across the country are complicated by surgical site infections. Infection rates, up to 11 percent, are reported for certain types of operations. Each infection is estimated to increase a hospital stay by an average of seven days and add more than $3,000 in charges.
"Surgical infection prevention may not be as glamorous as starting up a heart again, but I think the impact is huge in terms of quality of care and cost. It affects so many people," says Felger. "The interventions we've used and others will soon use are very practical applications that don't take a lot of time or cost a lot of money. We just want to ensure that these proven guidelines are consistently practiced for our surgical patients."
Members of the GMC Surgical Infection Prevention Collaborative Team were selected based on their expertise in perioperative care and infection control. Members are: Jim Lehman, M.D., Vice President, Quality; Louis Katz, M.D., Hospital Epidemiologist; Vicki Felger, RN, Manager, Quality; Daniel Congreve, M.D., Davenport Surgical Group; Lisa Caffery, RN, Epidemiology Specialist; Vari Nelson, RN, Perioperative Nurse Manager-East campus; Jennifer Hollenback, RN, Perioperative Nurse Manager-West campus and Nancy Bleur, RN, Nurse Educator-East campus.
