Surgical Site Infection Reduction Abstract Presented at CSS 2020

Abstract presented at the Canadian Spine Society 2020 Conference: Surgical Site Infection Reduction – a 10 year Quality Improvement Journey Abstract #32, titled “Surgical Site Infection Reduction – a 10 year Quality Improvement Journey” was presented at the 20th Annual Scientific Conference of the Canadian Spine Society in Whistler, BC on Thursday, February 27, 2020. Surgical Site Infection Reduction – a 10 year Quality Improvement Journey Dr. Supriya Singh 1,2 , Dr. Dan Banaszek 1,2 , Dr. Titus Wong 2 , Dr. Christian Di Paola 2 , Dr. Tamir Ailon 1,2 , Dr. Raphaele Charest-Morin 1,2 , Dr. Nicolas Dea 1,2 , Dr Marcel Dvorak 1,2 , Dr. Charles Fisher 1,2 , Dr. Brian Kwon 1,2 , Dr. Scott Paquette 1,2 , Dr. John Street 1,2 1 Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada. 2 University of British Columbia, Vancouver, British Columbia, Canada. Objectives In 2007, the spine surgical site infection (sSSI) rate at our Canadian quaternary referral center was 8.1% As a result, a multidisciplinary team was created to identify and initiate quality improvement (QI) strategies to reduce this unacceptably high sSSI rate. This abstract outlines the institutional and divisional QI strategies that have been central to our ongoing efforts to reduce the incidence of sSSI. Method A framework for evaluating surgical safety, based on that proposed by Mirza, was adopted to identify risk factors for sSSI at our institution. Surgical [midline lumbar approach, Odds Ratio (OR) 4.2], microbiological [UTI, OR 5.8], patient [DM, Odds Ratio (OR) 4.2] and process [ICU, OR 1.75] factors were explored. A predictive model for sSSI was developed with an AUC of 0.88. Numerous QI initiatives were introduced and their effect on sSSI monitored by the institutional Infection Prevention and Control (IPAC) group. Results From 2008, the Wiltse approach was used, in favour of midline, for one and two level decompression and fusion of the lumbar spine. Total sSSI rate fell from 8.1% to 7.2%. Routine use of intra-operative navigation from 2009 did not adversely effect the sSSI rate. From 2011 to 2014, photodynamic nasal decolonization and chlorhexidine skin decontamination (PDT/CHG) was applied to all elective and emergency spine cases, with the sSSI rate falling from 7.2% to 2%. With routine use of intra-wound vancomycin power in posterior instrumented cases from 2016, total sSSI rates further reduced from 2% to 1.6%. With the routine use of silver coated indwelling urinary catheters in patients with acute traumatic SCI, sSSI rates were reduced to 0.8% by early 2019 and have remained <1% since. Conclusions We present our experience in addressing sSSI through risk identification and prophylactic quality improvement initiatives. We highlight the importance of a multidisciplinary team approach, the value of a safety framework model and the importance of continued use of the Plan-Do-Study-Act cycle model. Click here to read the abstract. Back to News For Media Information 5654 & Company Matthew Neal, Chris Gardner, Melissa Gardiner [email protected] + 44 (0)791 7800 011

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