Colorectal Multidisciplinary team quality improvement initiative wins award at Sepsis Summit – a project undertaken to reduce surgical site infection and sepsis in the elective colorectal patient.
It is widely recognised that development of Health care associated infection is one of the most common avoidable, adverse events experienced by hospitalised patients. These infections represent a significant burden in terms of patient morbidity and mortality with associated increase in length of hospital stay and higher health care costs. Surgical site infection is the second most common type of HCAI accounting for 18.1% of all HCAI and affecting 1.2% of all inpatients in Irish hospitals (HPSC, 2017). It is acknowledged and accepted that a significant proportion of infections are preventable when effective strategies are in place to recognise and manage risks which contribute to development of infection. While no single intervention will prevent all SSI, evidence-based interventions informed by robust well organised SSI surveillance systems have been shown to substantially reduce the rate of infection with a reduction in associated health care costs, improved patient experience and outcomes.
International guidelines from the European Centre for Disease Prevention and Control, World Health Organisation and the National Institute for Health and Care Excellence recommend that hospitals engage in surgical site infection surveillance. The Irish Health Protection Surveillance Centre (HPSC) and the Health Information and Quality Authority have all recommended that surveillance be undertaken.
In the absence of a national protocol, a colorectal multidisciplinary team was convened in August 2018 with the primary objective to design and implement a sustainable surgical site infection surveillance programme. The project was supported by the Executive Management Board, the Infection Prevention and Control Committee and the South/South West Hospital Group. The primary objective was to design and build a data driven SSIS system to determine and communicate the rate of SSI and demonstrate trends associated with the development of infection.
Colorectal Service in CUH
The colorectal service in Cork University Hospital manage and treat many complex patients all of which are at risk of surgical site infection due to the very nature of their surgeries and their pre-existing comorbidities. It is because of this that the colorectal Multidisciplinary team have started to examine their surgical site infection rates and implement simple interventions to reduce rates. A retrospective review of cases in the first 6 months of 2018 compared with the prospective data collected in the same period of 2019 showed a 10% reduction in SSI rate. Their work was recognised on the 2nd of September 2019 in Dublin Castle when the project received best oral presentation award at the Sepsis Summit.
The team includes colorectal surgeons, colorectal ANP & CNS, surveillance scientist, Stoma CNSs, Dietician, pain CNSs, CNMs and staff nurses from wards 4A & 4B, CNMs and staff from theatre 6 & 7, Wound care ANP & CNS, infection control, antimicrobial pharmacists, ward pharmacists, Day of Surgery Admission, Pre Admissions Assessment Clinic, Anaesthetics, physiotherapy, Clinical Nurse Facilitator, CNM Anaesthetics, theatre reception, theatre recovery, DON from the Centre of Nurse Education and ADON from Nurse Practice Development.
The project included development of an education programme which included design of posters displayed in theatres/wards/laboratory, a MS Access database and a SSIS share-folder containing all information relating to SSIS, accessible to all users through a desktop icon. Many important initiatives were undertaken by the team to address some of the identified opportunities for improvement from the data collected. These initiatives were in the areas of
- Patient warming
- Timing of surgical antimicrobial prophylaxis
- Hair removal practices
- Monitoring blood glucose levels
- Patient preparation – washing, bowel preparation, antimicrobials
- Nutritional support
- Greater patient collaboration in the post-operative period to gather data on how the patient’s wounds healed – this is achieved through a post discharge questionnaire.
- Development of a care bundle
- Development of a patient information booklet is underway
Some Members of the SSIS Committee
Subgroup members examining evidence based recommendations for Care bundles
What next
The success of the Colorectal SSIS multidisciplinary team is evidenced through the delivery of a Surgical Site Infection Surveillance programme with proven ability to determine the rate of SSI and trends associated with the development of infection, using the information generated to further develop a Colorectal care bundle and implement targeted infection control actions. To further develop and ensure sustainability of the programme in the hospital it is important to
- Build on the SSIS system developed through this multidisciplinary project further engage with IT to develop an integrated data capture platform. The primary objective would be to reduce reliance on the surveillance form to a minimum number of data sets and increase usability.
- Hospital-wide roll out of the SSIS education and awareness programme with emphasis on data governance.
- Using the outputs delivered through this project build an evidence-based business case to support the appointment of a dedicated surveillance nurse, who will over-see consistent data collection and reporting resulting in a robust sustainable SSIS system.
The strength of this project is the collaboration from all disciplines and the shared goal of this team.
Ní neart go cur le chéile
There is no strength without unity.