Performing an SSI Investigation
Deb Hobson, RN BSN
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Polling Question
What is your current role?
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Surgeon
Quality improvement practitioner
Infection preventionist
OR nurse
OR technician
Anesthesiologist
OR manager
Educator
Other
Objectives
• Distinguish between process and outcome data.
• Describe how the SSI Investigation Tool can guide
improvement work even when SSI rates are low.
• Adapt an SSI Investigation Tool to reflect the care
processes in your SSI Prevention Bundle.
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 3
SUSP Readiness Bridge
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Are your frontline SUSP team members aware of the SUSP
project?
Have you completed a safety culture survey (e.g. HSOPS)
and debriefed your frontline SUSP team members?
Has your staff received the Science of Safety Training?
Have you collated Perioperative Staff Safety Assessment
responses from your staff?
Have you held your Executive Safety Rounds Kickoff
meeting?
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 4
Assess Your Performance
Collect process and
outcome data to
assess current
performance and
progress towards
improving patient
care.
Process Data
Outcome Data
What we do to patients
What happens to patients
Depends on your local SSI
Prevention Bundle
Every hospital in SUSP is
tracking the same
outcome data
e.g. Percentage of
patients receiving
appropriate antibiotic redosing
e.g. SSI Rate
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 5
Getting SSI Data
from the SUSP Website
• Log onto the SUSP Website
• Locate the SSI Data Registry
• Access your SSI Data Report
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Pending AHRQ approval
Performing an SSI Investigation 6
Login to the SUSP Website
https://armstrongresearch.hopkinsmedicine.org/login.aspx
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Locate the SSI Data Registry
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Access your SSI Data Report
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Pending AHRQ approval
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Sample SSI Data Report
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Always Room for Improvement
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A Single Organ Space SSI Means…
• 4.9% mortality rate
• $14,448 additional cost of care
• 24 additional length of stay
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Pending AHRQ approval
Performing an SSI Investigation 12
Because a multitude of factors influence
outcome, it is not possible to know for certain,
even after extensive adjustments for differences
in case mix are made, the extent to which an
observed outcome is attributable to an
antecedent process of care. Confirmation is
needed by a direct assessment of the process
itself…”
Avedis Donabedian (1998)
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 13
Uncover Defects with
SSI Investigation Tool
• Identify lapses in infection prevention
processes that may have contributed to your
SSI case.
• Assess adherence to your local SSI Prevention
Bundle.
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 14
Patient or Provider Factors
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 15
Normothermia Maintenance
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 16
Glucose Control
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Pending AHRQ approval
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Antibiotic Redosing
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 18
Adapt the SSI Investigation Tool
• Johns Hopkins Hospital clinicians designed this
tool to assess adherence to their local SSI
Prevention Bundle.
– Your team may want to investigate care processes that
are not included in this tool.
– This tool may include processes that your team does
not use.
• Please modify this tool to best fit your team’s
needs.
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 19
What Your Team Can Do
• Abstract this information from the patient’s chart.
• Use SSI Audit tools to dig deeper into your care
delivery system.
• Present process data to the team at a routine
SUSP meeting.
• Share investigation results monthly or quarterly
with your frontline staff and OR leadership.
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Pending AHRQ approval
Performing an SSI Investigation 20
Next Steps
• Complete an SSI investigation of your most
recent SSIs.
• Share your findings on your next coaching call.
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Pending AHRQ approval
Performing an SSI Investigation 21
What Questions Do You Have?
Remember you have a support network
– Post questions any time on MedConcert
– Ask questions during coaching calls
– Contact the SUSP helpdesk at susp@jhmi.edu
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 22
Content Call Evaluation
We want to ensure that the content calls provide useful and
pertinent information for the SUSP teams. For this reason
we request that you complete a brief evaluation following
each call. The evaluation may be found at the following link:
https://www.surveymonkey.com/s/cohort_5_onboarding
DRAFT
Pending AHRQ approval
Performing an SSI Investigation 23