In the yearlong national SIP Collaborative, Qualis Health-led hospital teams and staff from Quality Improvement Organizations (QIOs) across the country worked to improve timely administration of appropriate prophylactic antibiotics and other clinical interventions that help prevent surgical infections.

QIOs in each state helped recruit team members and served as resources to the hospital teams that participated in SIPC. QIOs helped the teams select interventions, research and analyze reference materials, collect data, and prepare reports. During the collaborative all QIOs received training to run subsequent collaboratives in their respective states.

Of the 56 teams that participated, 41 consistently reported results, tracking the outcome of more than 30,000 surgeries from March 2002 through February 2003.

"This is what can be accomplished when hospital teams work together to improve procedures involved in preventing surgical infections," said Dr. E. Patchen Dellinger, SIPC chair and chief of general surgery at the University of Washington Medical Center.

The SIP Collaborative was sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) at the Department of Health and Human Services.

To ensure appropriate use of prophylactic antibiotics, hospital teams in the Collaborative implemented changes that included designating specific responsibility for antibiotic administration; educating operating room staff; revising orders and clinical pathways; and standardizing antibiotic administration to coincide with an activity regularly performed within one hour before surgery, such as an order to move a patient to the operating room.

Targeted surgical procedures included coronary artery bypass graft (CABG) surgery; colon, hip and knee arthroplasty; abdominal surgery; and vaginal hysterectomies.

"The results of the Collaborative have exceeded our expectations," said Jonathan Sugarman, MD, MPH, President and CEO of Qualis Health. "QIOs nationwide are already building on what they learned at the SIP Collaborative and are moving to rapidly disseminate effective methods to prevent surgical infections."

Most teams made significant progress in care procedures. For example,

• the median hospital rate for appropriate timing of antibiotics improved by 17%;
• the median rate for appropriate antibiotic duration improved by 14%;
• the median rate for proper patient oxygenation improved by 18%; and
• the median rate for maintaining proper patient temperature during surgery improved by 30%.

QIOs in every state launched a three-year campaign to prevent surgical site infections modeled on the SIP Collaborative.

Goals
The goal of the Collaborative was to have 100 percent of eligible patients in every participating hospital receive appropriate and timely prophylactic antibiotics, clinical interventions known to have a significant impact on preventing infections. All participating teams reviewed and worked to improve preventive antibiotic therapy. Many of the teams also worked on implementing other clinical interventions known to have an impact, such as

• maintaining patient body temperature,
• controlling blood glucose levels during surgery,
• clipping rather than shaving hair at the surgical site, and
• providing patients with appropriate levels of oxygen.