SUSP Talking Points

SUSP is an opportunity for your team to lead a national effort to reduce surgical site
infections, beginning with colorectal SSIs. Our proven strategy engages frontline caregivers to
identify the underlying causes of surgical complications in their clinical areas, then gives them
the training and tools to fix them. Engaged teams can transform care when they own a problem,
apply proven strategies, and learn from each other.

Our approach has been successful elsewhere. You may have heard of On the CUSP: Stop BSI, a
national project to reduce central line-associated blood stream infections (CLABSI) in intensive
care units. Improvement teams and clinicians in thousands of hospitals saved hundreds of
patient lives by reducing median CLABSI rates to zero. Those teams tied the Comprehensive
Unit-based Safety Program (CUSP) to improve safety culture with concrete interventions to
reduce CLABSI. In CUSP for Safe Surgery, we will be tying CUSP with concrete interventions to
reduce surgical complications.

CUSP was used at Johns Hopkins to reduce colorectal SSIs. The colorectal surgical team at
Johns Hopkins Hospital applied these methods, and reduced SSIs by 33 percent. By asking
frontline caregivers how to improve care, the team discovered risk factors for infections that we
never would have otherwise considered. Frontline clinicians explained why patients might not
receive enough of the right antibiotic or how a contaminated instrument might accidentally be
used to close a surgical wound. Then, as a team, they figured out how to fix those problems.

We have to mine the wisdom of caregivers because there is no proven checklist or bundle for
preventing SSIs. Meeting SCIP measures is necessary but not sufficient for SSI reduction. We
have to empower frontline caregivers to voice concerns about surgical care, dig deeper to
evaluate whether adherence to SCIP processes is more about checking a box than keeping
patients safe, and look at emerging evidence for how to prevent SSI. Only your team
understands your obstacles and opportunities for improvement.
Questions
What time commitment is required?
Each participating team will have a physician leader, a nurse leader and an anesthesiology leader. As a
general rule of thumb, each of them will spend about 2-4 hours per week on project-related work.
However, that workload can vary based on factors like whether your hospital has participated in similar
projects, such as On the CUSP: Stop BSI. Infection control experts and hospital executives also have a
role, but will likely contribute less time. Depending on the structure of your organization, nurse
educators, quality improvement experts and patient safety officers may also play a role. While 2-4 hours
seems like a lot of time now, you will earn it back through increased work efficiency once your
improvements take hold.
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Will you focus on other complications?
We initially focused on surgical site infections in colorectal surgery. Preventing SSIs in the bacteria-rich
colon is a challenge, and if we can make an impact in this area, we can likely translate many of these
lessons to other types of procedures. In the fall of 2013, we expanded SUSP to all types of surgery.
How is this program different from other SSI reduction efforts?
Many of the programs focusing on SSI reduction focus on a handful of evidence based therapies. SCIP
measures are very important but they have not translated into SSI reductions nationally. Even when you
follow these measures consistently, there are still defects in care that may contribute to infections. Our
approach taps into frontline staff to identify what those defects are. The realities at your hospital will be
different from those facing other surgical teams, so your interventions must be tailored to your
environment.
Are all hospitals invited to participate?
Every hospital in the country is welcome to participate in SUSP. We want to connect participating
hospitals in each state, to create networks that exist after the project is completed. Contact Lisa
Lubomski at lluboms1@jhmi.edu for more information about how to get in touch with the person
coordinating this project in your state.
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