Drawing on our experiences from the successful national Surgical Infection Prevention (SIP) Collaborative, Qualis Health joined together with OMPRO, the Medicare Quality Improvement Organizations for Oregon, to bring a regional collaborative to hospitals in Idaho, Oregon, and Washington.
Physician leader for SIP Collaborative northwest was E. Patchen ("Patch") Dellinger, MD, professor of surgery at the University of Washington School of Medicine, vice chairman of the department of surgery and chief of the division of general surgery at the University of Washington Medical Center.
The yearlong Collaborative consisted of 19 teams from Washington, Idaho, and Oregon, tracking the outcome of more than 6,400 surgeries from March 2003 through January 2004.
Goals for all teams:
| • | Double the number of surgical cases between surgical site infections |
| • | Achieve 100% compliance with appropriate selection and timing of prophylactic antibiotic administration |
| • | Improve preventive antibiotic therapy |
Some teams took on
Supplemental Goals such as:
| • | Preventing hypothermia during surgical procedure |
| • | Maintaining high levels of inspired oxygen |
| • | Controlling serum glucose within certain limits |
| • | Avoiding shaving the operative site |
| • | Other basic prevention strategies |
Key Changes included:
| • | Using antibiotic standing orders specific to the surgical site |
| • | Administering prophylactic antibiotics according to guidelines based on local consensus |
| • | Standardizing antibiotic administration process to occur with commonly performed activity within one hour of administration |
| • | Designating responsibility and accountability of antibiotic administration to a specific person (e.g., preoperative nurse, circulating nurse, anesthesiologist) |
Targeted procedures included:
| • | Coronary artery bypass grafts (CABG) |
| • | Cardiac, colon, abdominal, and vaginal hysterectomy |
| • | Selected vascular surgery procedures |
| • | Hip and knee arthroplasty |
Successes: | • | Appropriate selection of antibiotics improved by 5% |
| • | Hospital rate for appropriate timing of antibiotics improved by 13% |
| • | Appropriate antibiotic duration improved by 11% |
| • | Proper patient oxygenation improved by 31% |
| • | Maintenance of proper patient temperature during surgery improved by 37% |
| • | Appropriate hair removal during surgery improved by 24%. |
Spread
Outcomes were measured by the number of cases between surgical site infections. This measure encouraged review of the case facts when an infection did occur.
By January 2004, three-fourths of reporting hospitals had spread innovations to other surgical populations. Back to top
