Western Node Collaborative
Northeast HSDA (NH)
Surgical Site Infection
Reducing SSI in Orthopedics, Colorectal &
Gynecology Surgery
Updated September 2006
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Background
)

The Northeast HSDA is the smallest HSDA
within Northern Health and has two acute
care hospitals:
– Dawson Creek & District Hospital
– Fort St.John Hospital and Health Centre

Population approx. 68,000 (northern/rural
BC)

Infection control surveillance measures
already underway used for SSI (hysterectomy,
hips & knees plus colorectal surgery)
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Aim
Purpose
To prevent surgical site infections through
implementation of 3 known components of
care that are supported by medical
literature;
a)
b)
c)
appropriate use of antibiotics
appropriate hair removal
maintenance of post operative
normothermia for colorectal surgery
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Aim
Goals & Objectives or Aim Statements
1.
To improve prophylactic antibiotic
timing by administering the antibiotic
between >1 to 60 minutes prior to
surgical incision;
 To 75% of all surgical cases by May 1, 2006
 To 95% of all surgical cases by Dec. 31,
2006
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Aim
2.
To achieve normothermia for all
colorectal surgical patients by:
 Recording the temperature of patients either
on leaving the OR or entering the PAR
100% of the time by May 1, 2006
 Addressing the issue of patients with
temperatures of less than 36.0 by Dec. 31,
2006
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Aim
3.
To achieve appropriate hair removal
on all surgical patients by:
 Documenting hair removal 100% of the time
in all surgical cases
 Eliminating any inappropriate hair removal
(e.g. shaving) by Dec. 31, 2006
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Results –
Baseline measures only
1.
2.
3.
4.
Appropriate antibiotic prophylaxis (n=40) 95%
Appropriate timing of prophylactic
61%
antibiotics (n=38/some documentation issues)
Appropriate hair removal (n=40)
0%
(issue is no documentation)
Normothermia (colo-rectal only n=10/some
documentation issues)
40%
* Hip (10) & Knee (10) Replacements, Hysterectomy (10) &
Colo-rectal Surgery (10)
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Changes Tested

NE QI Toolbox includes
– 11 Commandments for Team Success
– Team member roles/responsibilities

Documentation issues addressed immediately by
revision of related forms to trigger documentation of:
 Hair removal techniques, or indication of no hair
removal
 Time of antibiotic administration
 Temperature on discharge from OR/arrival in
PARR
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Changes Tested

Education/awareness of 3 key components
SHCN SSI initiative to appropriate personnel
(e.g. Anesthetists, Surgeons, Operating
Room Staff, etc.)
 Brief presentation to communicate broadly
 Official communication to key positions and
groups (e.g. Chief of Staffs, Chief of Anesthesia,
Medical Director, COO, HSAs, etc.)
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Data Collection


Data for all of 2005 was collected retrospectively
with assistance of Health Records staff and
showed some variance from the small baseline
data originally collected.
Data up to July 31, 2006 was collected both
retrospectively and concurrently (also by Health
Records staff) to see if the improvement goals
set had been achieved.
10
SSI for Hips in NE
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Hips 2005
Hips 2006
Appr.
Antibiotics
(2005 n = 62 and 2006 n = 32)
Timing
Hair Removal
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SSI for Knees in NE
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Knees 2005
Knees 2006
Appr.
Antibiotics
(2005 n = 60 and 2006 n = 40)
Timing
Hair Removal
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SSI for Hysts in NE
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Hysts 2005
Hysts 2006
Appr.
Antibiotics
Timing
Hair Removal
(2005 n = 32 and 2006 n = 50 - both sets of data incomplete)
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SSI for Colorectals in NE
90%
80%
70%
60%
50%
2005
2006
40%
30%
20%
10%
0%
Appr.
Antibiotics
(2005 n = 25 and 2006 n = 14)
Timing
Hair Rem.
Normther.
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Challenges
• Old forms making their way back into
system (impacting data collection)
• New anesthetists and surgeons
• New nursing staff
• Limited resources to collect and analyze
data in a timely way (e.g. monthly)
• Limited resources to attend to follow-up
processes
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Key Learnings
• Method to educate/inform new staff and
physicians must be implemented
• Follow-up is required on a regular basis to
both data collection staff and care
providers
• Feedback must be frequent and constant
in order to reinforce learning and sustain
improvements
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Team Members &
Contact Information
Core team members:
• Lexie Gordon – NE SHCN Team Lead
(Lexie.gordon@northernhealth.ca)
• Angela DeSmit, RN, DON, FSJH&HC
• Bernada Clark, RN, ICP, FSJH&HC
• Brenda DeVuyst, RN, ICP, DCDH
• Kathyrn Peters, RN, Unit Mgr OR, FSJH&HC
• Kyla Chruikshanks, RN, DCDH
• Louise Bougie, RN, FSJH&HC
• Sponsor = NE Surgical Care Team (Chaired by General
Surgeons)
Updated September 2006
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