Leveraging a Novel Comprehensive Program to Implement a Surgical Site Infection Reduction Bundle in a Statewide Quality Improvement Collaborative
Michael F. McGee*, Lindsey Kreutzer*, Christopher M. Quinn*, Anthony Yang*, Ying Shan*, Amy L. Halverson*, Remi Love*, Julie Johnson*, Karl Y. Bilimoria
Illinois Surgical Quality Improvement Collaborative (ISQIC) and Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, IL
Bundled perioperative interventions reduce colorectal surgical site infection (SSI) rates when enacted at individual hospitals, but how to implement a comprehensive SSI bundle across a large, diverse population of hospitals is unknown. Our objective was to examine the implementation and outcomes of a comprehensive SSI reduction bundle in a large statewide surgical quality improvement collaborative.
A multifaceted bundle of 18 colorectal SSI reduction components was developed and implemented in a 55-hospital statewide surgical quality improvement collaborative utilizing a novel implementation program: guided implementation, data feedback, mentorship, process improvement training/coaching, and targeted-implementation toolkits. Bundle adherence and ACS-NSQIP outcomes were examined pre-implementation vs. post-implementation.
Among 35 hospitals, there was a 70% relative increase in the proportion of patients completing at least 12 bundle elements (pre-implementation=40.3% vs. post-implementation=69.0%, p=0.006). Largest adherence gains were seen in wound closure re-gowning/re-gloving (24% vs. 62%, p<0.001), use of clean closing instruments (32% vs. 66%, p=0.005), and pre-operative chlorhexidine bathing (46% vs. 77%, p<0.001). The superficial SSI rate improved from pre-implementation to post-implementation (3.9% to 2.4%, p=0.028). As the adherence in the number of bundle components increased, there was a significant decrease in overall SSI rates (12.9% vs. 4.79%, p=0.008) and superficial SSI rates (5.56% vs. 1.10%, p=0.009).
A comprehensive SSI reduction bundle can be implemented throughout a large quality improvement learning collaborative when coordinated quality improvement activities are leveraged. Lower SSI rates are associated with number of adherent bundle elements, rendering considerable benefits to institutions capable of implementing more components of the bundle.
* By Invitation
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