NAME: Mirian Nnah STUDENT NUMBER: 100780566 Part A: Topic: Quality Improvement plan to reduce surgical site infections at an acute care for post-surgical patients. AIM What is the rationale for this QI project? Currently Surgical site infections is now the most common in healthcare associated infections in post surgical patients. These infections depend on the type of operation that was performed by the surgeon, this triggers 7-11 extra postoperative days in the hospital; and results in 2-11 times higher risk of death than noninfected patients. Unit: Skel/Musc medicine unit Date: 22/10/2022 Who is on your team? The interprofessional team’s members involved would include the surgeon, Anesthesiologist, operating room nurse, surgical tech, physician assistant, physical therapist, pharmacist, and social workers. It is very essential to obtain opinions and views from the team members above regarding the problem and the solutions to the problem. The collaboration of the interprofessional team Up to 60% of surgical infections can be members will obtain the insights and then team prevented. Prevention of this can be done by collaboration is unlocked. general good hand hygiene. Effective barriers against the transmission of infections, before, Durning and after surgery, the hospital leaders, knowledge and skill of the surgical team, enough resource, excellent treatment of the complete patient admission and monitoring of the patients after discharge may lead to significant reduction of surgical site infections, lower death rates and less expensive health system. What is your AIM (ensure your AIM statement is clear, timely, stretchable & value) the AIM for this is that they would be a reduction in surgical site infections after using the strategies like building a proper hand hygiene. From 60%-10%. We would reach this goal in one year. MEASURES What will you measure? (consider: outcome, process & balancing measures); consider pre & post measures. 1. The rate of surgical site incidence after 2 months pf implementing thorough handwashing protocol. 2. Feedback from the interprofessional team members and staff members about the hand hygiene protocol before, during and after surgery. 3. 95% of clean and clean-contaminated patients with timely propylitic antibiotic administration. PROCESS TOOL Insert your Process tool below: Process- assessment of current practice and prevention of surgical site infections. Using the check sheets tool Bringing the idea of hand- hygiene protocol Review the relevant literature Discuss the idea with Management team and staff members. Assess the whether the protocol; can be easily done Organize introduction and orientation sessions Application of the idea using the written protocol Gather data, resources, and information. Seek advice and help Rectifying the mistakes See hand-hygiene protocol is seen through and followed up with Keep gathering information and data on surgical site infections on post-surgical patients Review the data from your QI Process Tool. Based on your analysis of the problem what are your top three ideas for change? 1. Care planning and interventions label the risk factors with the care plan of the patient. 2. Make agreement upon antibiotic available in the operating room 3. Educate OR staff regarding the importance and reasoning on effective hand- washing protocols Which (1) idea would you like to test through a rapid PDSA cycle? The one idea I would like to test through a rapid PDSA cycle is the Standardized assessment of surgical site infections risk factors. Hand- washing protocol. Since it involves set of intervention as 1. check the dressing for drainage 2. perform hand-hygiene 3. Strict sterile asepsis during dressing changes 4. Monitor the patients vital signs And risk factors which includes - Smoking - Having diabetes - Having a weak immune system Being Overweight - Having a history of other medical problems and diseases. References - Admin. (2020, January 3). Preventing surgical-site infections. American Nurse. Retrieved October 22, 2022, from https://www.myamericannurse.com/preventingsurgical-site-infections/ - Changes to prevent surgical site infection: IHI. Institute for Healthcare Improvement. (n.d.). Retrieved October 22, 2022, from https://www.ihi.org/resources/Pages/Changes/ChangestoPreventSurgicalSiteInfection.asp x - Quality standards and CQI. Quality Standards and CQI - Expanded Learning (CA Dept of Education). (n.d.). Retrieved October 22, 2022, from https://www.cde.ca.gov/ls/ex/qualstandcqi.asp - Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A.-C., Saiman, L., Yokoe, D. S., Maragakis, L. L., & Kaye, K. S. (2014, June). Strategies to prevent surgical site infections in Acute Care Hospitals: 2014 update. Infection control and hospital epidemiology. Retrieved October 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267723/ - Patient safety metrics: CPSI. Measures: Surgical Site Infections (SSI). (n.d.). Retrieved October 22, 2022, from https://www.patientsafetyinstitute.ca/en/toolsResources/psm/Pages/SSImeasurement.aspx - Mathur, P. (2011, November). Hand hygiene: Back to the basics of infection control. The Indian journal of medical research. Retrieved October 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/ - Part B: PLAN The purpose of this cycle is to: The purpose of this cycle is in the reduction surgical infection after using the hand hygiene protocol from a 60%-10% Develop Development of hand hygiene strategies and protocols. What question do you want to answer? 1. Is there reduction in surgical infection after implementation of hand hygiene protocol among the health care workers and patients. Implement Implementation of hand hygiene checklist through the various personnel. What do you think will happen (what are your predictions?) After appropriate implementation of the hand hygiene protocol components, there would be reduction of surgical infections from the current rate of 60% -10% in the acute care population. Plan to collect data to answer your questions: What data will be How? Who? (role) collected 1. The rate of Observations Team Leader, surgical and reporting Manager, infections the incidence hospital after two related to Coordinator months of surgical implementatio infection n of the hand hygiene protocol. Test Testing the implementation of hand hygiene protocol. When? Where? During the period of two months. Musc/Skel 6E unit. 2. The feedback of staff and the interprofessio nal team members concerning the implementatio n of the hand hygiene protocol. 3. Accepting the hand hygiene protocol among the heath care workers and the financial implementatio n. List tasks necessary to set up the test: What is the task How? Surgical site infections register update and maintenance. Making maintenance of the incidences register. Who? (role) When? Where? Team Leader, Hospital Coordinator. During the time Musc/Skel 6E of two months. unit. DO What did you observe during the test? Were there any unexpected observations? Use evidenced based resources to identify what you would expect to observe during the test. Be sure to cite & reference using APA formatting Health care providers ensure the use of safe, effective, and ethnical infection prevention and control measures is an important component of nursing care. This can make them practice within their scope and know the limits they can work in. To do so, nurses are expected to be aware of applicable CNO standards, relevant legislation, best practice, and organizational policies related to infection prevention and control. As outlined by the infection Prevention and Control Canada, proper hand hygiene is the single most important infection prevention and control practice, in doing so, nurses provide and promote the best possible patient care. ( College Nurses of Ontario, 2022) if you had the opportunity to implement your PDSA cycle, What did you observe during the test? Were there any unexpected observations? Carrying out the hand hygiene protocol components is obtainable and getting the staff feedback is positive, the team members were following the hand hygiene protocol. STUDY Analyze your data & describe the results? How do the results compare with your predictions? What did you learn from this cycle? Use evidenced based resources to identify what data you would expect. Be sure to cite & reference using APA formatting. Using the TAP tool developed by the CDC (Centres for Disease Control and prevention), this data is used for the action to prevent health care associated infections. The TAP strategy targets the healthcare facilities and specific units in those facilities with disproportionate burden of HAIs so that gaps in infection can be addressed. These reports are available for catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), Clostridioides difficile infections (CDI), and Methicillinresistant Staphylococcus aureus (MRSA). Acute Care Hospitals can run TAP Reports for CAUTI, CLABSI, CDI, and MRSA; Long Term Acute Care Hospitals are able to run TAP Reports for CAUTI, CLABSI, and CDI; and Inpatient Rehab Facilities (IRFs) and IRF Units are able to run TAP Reports for CAUTI and CDI. The TAP Facility Assessment Tools and TAP Implementation Guides were developed in 2016 and are now available for CAUTI, CLABSI, and CDI. (Control for Disease Control and Prevention, August 2022) If you chose to implement your PDSA cycle, analyze your data & describe the results? How do the results compare with your predictions? What did you learn from this cycle? There was a reduction in surgical site infections from 60% to 10% after implementing the hand hygiene protocol, not 13%. It was hard implementing the protocol as we encountered some feedback and problems in implementing the hand hygiene protocol components because of the lack of the encouragement and support from the team members. I have learnt to improve the gaps in implementation, and it is essential to look over the protocol and the PDSA cycle again. ACT Are you ready to implement? Yes (I am confident that there is measured improvement, changes have been tested under different conditions & questions answered). No (I have more questions, need to make adjustments and test again, OR risks outweigh benefits – new ideas are required) Yes (I am confident that there is a measured improvement and change that have been tested under different conditions and questions answered). What is your plan for the next cycle? In conducting the next cycle with more understanding, more involvement from the team members, and avaiable resources and education with a systematic approach. References. Infection prevention and control. (n.d.). Retrieved November 12, 2022, from https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/infectionprevention-and-control/ Centers for Disease Control and Prevention. (2022, August 5). The targeted assessment for prevention (TAP) strategy. Centers for Disease Control and Prevention. Retrieved November 12, 2022, from https://www.cdc.gov/hai/prevent/tap.html -