Reducing adult cardiac surgical site infections and the economic impact of using multidisciplinary collaboration

Reducing adult cardiac surgical site infections and the economic impact of using multidisciplinary collaboration

Cardiac surgical site infections (SSIs) have devastating consequences and present several challenges for patients and healthcare providers. Adult cardiac SSI surveillance commenced in 2009 at our hospitals, Guy's & St Thomas' NHS Foundation Trust, London, as a patient safety initiative...

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Bibliographic Details
Published in:The Journal of hospital infection Vol. 100; no. 4; pp. 428 - 436
Main Authors: Chiwera, L., Wigglesworth, N., McCoskery, C., Lucchese, G., Newsholme, W.
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01-12-2018
Subjects:
Adult
Aged
Aged, 80 and over
Antimicrobial resistance
Cardiac
Cardiac Surgical Procedures - adverse effects
Care bundles
Costs and Cost Analysis
Data Collection - standards
Epidemiological Monitoring
Female
Hospitals
Humans
Incidence
Infection Control - methods
Interdisciplinary Communication
London - epidemiology
Male
Middle Aged
Prospective Studies
Surgical site infection
Surgical Wound Infection - epidemiology
Surgical Wound Infection - prevention & control
Surveillance
London
Surgical site infection
Antimicrobial resistance
Surveillance
Care bundles
Cardiac
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Summary:Cardiac surgical site infections (SSIs) have devastating consequences and present several challenges for patients and healthcare providers. Adult cardiac SSI surveillance commenced in 2009 at our hospitals, Guy's & St Thomas' NHS Foundation Trust, London, as a patient safety initiative amid reported increased incidence of SSIs. Before this time, infection incidence was unclear because data collection was not standardized. To standardize SSI data collection and establish baseline SSI rates to facilitate deployment of evidence-based targeted interventions within clinical governance structures to improve quality, safety, and efficiency in line with our organizational targets. We standardized local data collection protocols in line with Public Health England recommendations and identified local champions. We undertook prospective SSI surveillance collaboratively to enable us to identify potential practice concerns and address them more effectively through a series of initiatives. Clinical staff completed dedicated surveillance forms intraoperatively and postoperatively. Overall adult cardiac SSI rates fell from 5.4% in 2009 to 1.2% in 2016 and coronary artery bypass graft rates from 6.5% in 2009 to 1.7% in 2016 (P < 0.001). Gram-negative bacteria were recognized as important SSI causative organisms and were better controlled after introducing stringent infection control measures. Comprehensive, evidence-based infection control practices were successfully implemented through a multidisciplinary collaborative approach, which may have great potential to reduce Gram-negative, Staphylococcus aureus, polymicrobial and overall SSI burden and/or associated costs. We now investigate all SSIs using an established SSI detailed investigation protocol to promote continual quality improvement that aligns us perfectly with global efforts to fight antimicrobial resistance.
Bibliography:ObjectType-Article-1
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ISSN:0195-6701
1532-2939
DOI:10.1016/j.jhin.2018.03.028