As the sole Infection Control Practitioner for the Yukon Hospital Corporation, Samantha Stewart is pulled in many directions addressing infections and finding ways to keep infection rates down. Whitehorse General Hospital (WGH) was looking to develop a system for timelier reporting so that they could respond quicker when infections surface. When plans for the Surgical Site Infection (SSI) Audit were announced, Samantha eagerly signed-up to participate.
"The audit was our jumping off point," says Samantha Stewart. "There was no formal tracking system in place and we really did not know if we were compliant with any of the SSI prevention best practices, or just one or two components of them. We were having trouble getting data, we did not know how we compared with other hospitals, and we were not sure how to benchmark, other than against ourselves. The audit provided a good baseline to see how we were doing with best practices and recommendations outlined in the Safer Healthcare Now! SSI Getting Started Kit."
Samantha led the charge for the audit, first getting buy-in from the OR, Surgical Unit and Surgical Daycare Managers. Forms were placed on patient charts and she had quick information sessions with front-line staff so that they would know what they were auditing. An envelope system was created where completed forms were placed on the unit, to be collected and verified by Samantha prior to being submitted to Patient Safety Metrics. If information was missed, or had to be redone, it was easy to update to ensure the data was as accurate as possible. With the help of front-line staff, 133 patient charts were audited during the month of February 2016.
"Our staff were more receptive and accepting of the audit form once they could see the end goal and better understand what they were participating in would help us to improve care for the safety of our patients," says Samantha. "Generally, people did not find it a difficult form to fill out, but some had challenges finding the time to do it during their busy work day."
Samantha noted several key learnings as a result of participating in the audit. Often, staff will presume that the infection may have been caused by the surgeon or the OR team. However, when the audit information is broken down to the pre-operative, peri-operative and post-operative stage, staff hopefully had that ah-ha moment that surgical site infection and prevention applies across the continuum of care, from before the patient is admitted -- straight through to discharge home.
"Amongst all of our best efforts and the best practices put forward in the SSI Getting Started Kit, it is also important to emphasize the role of the patient," says Samantha. "Specifically, hand hygiene and wound care after discharge, can also play a role in infection rates. We are currently focussing on how to empower patients and emphasize their role in infection prevention as it relates to performing hand hygiene."
The audit also identified what they do well and what they need to improve on. "The audit provided the opportunity to benchmark against other participants, as well as specific aspects in the Getting Started Kit," says Samantha. "Based on national trends, we now know we can do better with pre-warming patients and will be looking at best practices for accomplishing that. Another, was improving documentation of a pre-operative bath/shower and glucose monitoring, and whether it is being done appropriately, or if the information was not readily noted on the chart. These are just some of the pieces we need to look at to ensure we are in compliance with the bundle approach outlined in the SSI Getting Started Kit."
Some procedural changes under consideration are to standardize 2g Cefazolin/Ancef for applicable pre-operative patients; investigate the use of Povodine Iodine with alcohol; and to consider the discontinuation of prophylactic antibiotics appropriately. Documentation will also be improved to note the completion time of the antibiotic infusion pre-op; the patient's temperature at end of surgery; and if the patient had a pre-operative shower.
Overall, Samantha was quite pleased to see that Whitehorse General matched larger jurisdictions and several other hospitals on their results. "I am quite proud of our team," says Samantha. "We are in the process of packaging the results and presenting the information back to those stakeholders who took all that effort and energy to gather the data for us. We want to make it meaningful so that they know that all of their efforts are appreciated. If staff do not know how we are using the data, it fosters negativity. If they can see that we are using the information for quality improvement, they too will see the value in participating in an audit like this.
"In my mind, the SSI Audit is a nice, tidy parcel with a bow on it," says Samantha. "You are provided with the audit tool to compare with national best practices, it is easy to use, and the data analysis is provided for you. It makes it very easy to get and use the information effectively. If I had to do all of the auditing, data collection, analyzing and reporting, an audit like this would not have been a feasible option.