Methods for improvement

COACH -Dr. Poonam Gupta

Ms. Catherine Marshall - Director of Nursing

Dr.Lateef Wani - CT Specialist

Ms. Shiny Shiju - Head Nurse

Ms. Joby Cyriac - Staff Nurse

Ms. Smitha Anny - Staff Nurse

Ms. Sheba Christy - Staff Nurse

Ms. Elsayeda Mohd - Staff Nurse

Ms. Akhila Ajithkumar - Staff Nurse

Ms. Sunitha - Wound care nurse

Ms. Marifie - Wound care nurse

Ms. Leni B. Garcia - Head of Infection Control

Ms. Cheryln Simbulan - Infection Control Practitioner

Interventions

C

Clean hands. Chlorhexidine 2% bath pre operative, on the day of surgery and post operative as

per protocol. Chlorhexidine packs given during discharge. Nasal de colonization – MSSA/MRSA screening of all patients undergoing surgery

and once positive, de colonization process starts preoperatively. Used clippers for hair removal.

L

Left the wound dressing without exposing for 48 hours postoperatively. Observed wound for any oozing which leads to infection.

E Emphasized client and staff on best practices for postoperative wound care and

prevention of surgical site infection as per protocol.

A

Appropriate antibiotics used pre operative, intra operative and post operative for

24 hours.

N

Normal body temperature (Normothermia) maintained from 36.1- 37.8C as per

protocol.

Normal blood glucose level (Normoglycemia) maintained from 6- 8.1 mmol/L as per protocol. A continuous integrated insulin infusion system is used to keep blood glucose level within the range. Monitored temperature and blood glucose hourly for the immediate postoperative day.

Educated the client to have nutritious food. Explained the importance of stop smoking to a client who is smoker, if needed

given referral to smoking cessation clinic.

Problem

Surgical site infection rate was zero from 2015 to first quarter

of 2016. Surveillance and monitoring continued. Resurge of

one surgical site infection identified in the second quarter

2016. Contributing factors for developing infections were

identified. It was due to uncontrolled blood glucose and not

maintaining the body temperature as per protocol pre

operative and in the immediate post operative.

1. Followed appropriate antimicrobial prescribing practices before and after surgery.

2. Followed protocols for hair removal, preoperative skin disinfection, and control of blood glucose levels

pre operatively.

3. Educated them about the symptoms which is leading to a surgical site infection and the earliest time to

approach wound care department.

4. Emphasised the significance of hand hygiene to all the team members including all health care workers.

5. Completed hand hygiene competency for all the staff.

6. Surgical site infections protocols are reviewed periodically.

Acknowledgement

Prof. Mckenna - Chief Executive Officer-HH

Mr. Paul Mavin - Executive Director of Nursing-HH

Mr. Ian McDonald - Assistant Executive Director of Nursing-HH

MS. Fadia Ali - Assistant Executive Director of Quality-HH

Achievement

Achieved Stars of Excellence Merit Award in 2015 for surgical site infection project.

Cardio Thoracic Intensive Care Unit received Stars Of Excellence Award in 2016 for Multidisciplinary

Team Work-An Innovative Culture.

Conclusion

We hypothesized that glycemic control in postoperative cardiac patients reduced

the incidence of surgical site infection. We achieved zero infections for Coronary

Artery Bypass Graft chest incision risk index x 1 for 304 calendar days, Coronary

Artery Bypass Graft chest incision risk index x 2 for 1447 calendar days.

Next Steps

1. Audit on post discharge glucose control level for those who undergo Coronary Artery Bypass

Graft.

2. To implement a Handbook for Cardiac Surgery Patient - “A New Life For Your Heart Enhancing

Your Recovery Together.”

Reference: www.ihi.org

A strive towards “zero surgical site infection rate” in Cardio Thoracic Intensive Care Unit - Heart Hospital.

Authors: Akhila Ajithkumar (SN), Sheba Christy (SN), Smitha Anny (SN)

Introduction

High rate of surgical site infections identified after the cardiac surgery

since beginning of heart hospital. A diversified approach in preventing

Surgical Site Infection was developed and implemented to address and

mitigate the key issues behind the infections. We gained zero infections

for Coronary Artery Bypass Graft Incision Index x 1 for 954 calendar days

and Coronary Artery Bypass Graft Incision Index x 2 for 1143 calendar

days.

AIM

The incident rate of surgical site infection were Zero in 2015, though

to keep a stagnancy and sustain zero rate by December 2016.

To maintain normothermia and normoglycemia above 90% in CTICU

after cardiac surgery .

With strict compliance to temperature and glycemic control we set foot to zero infection rate from 2nd quarter to 4th-quarter of 2016.

This graph turn up the compliance range

of temperature and glycemic level in the

post cardiac surgery clients from Jan

2016 - Jan 2017.

0

10

20

30

40

50

60

70

80

90

100

%

o

f

p

a

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i

e

n

t

s

Surgical site infection indicator

Normothermia (36.1-37.8C)

Normo glycemia(6-8.1 mmol/L)