Surgical-site infections (SSIs) are a national problem, occurring in an estimated 2.8 percent of all procedures in the country. For certain types of operations, SSI rates of up to 11 percent have been reported.
These infections, which result in complications ranging from redness around an incision to dangerous sepsis, are also costly, adding an estimated seven days to a patient’s hospital stay.
Like many complications, SSIs can be prevented by following seemingly simple steps that are backed by scientific evidence. However, the complex systems of health care delivery, as well as workplace cultures, often make it a practical challenge to follow some of these steps.
Johns Hopkins, we introduced a program to increase adherence to evidence-based practice and improve culture of safety and teamwork; and consequently, produced reductions in surgical site infections.
The program’s elements include:
- Educating staff on the CDC guidelines and SCIP (Surgical Care Improvement Project) guidelines to prevent surgical site infections—such as use of timeouts, briefings, prophylactic antibiotics, appropriate hair removal and glucose control—and incorporating them into standing order sets and checklists similar to those used by aviation crews.
- Encouraging nurses to speak up, and even stop the procedure, if surgeons deviate from the guidelines.
- Fostering the development of a workplace culture of safety in which caregivers feel welcome to bring up concerns.
- Ongoing measurement and feedback of procedure-specific infection rates to surgeons, OR staff and departmental chairs.
Our Track Record
By increasing compliance with evidence-based measures for patients undergoing surgery—such as proper selection, timing and redosing of antibiotics, using the correct skin preparation methods and maintaining perioperative normothermia—The Johns Hopkins Hospital has been able to decrease these stubborn infections. Year over year since 2007, surgical site infections at the hospital have been reduced.
Key to the program’s success has been engaging clinicians and improving the entire process of perioperative care to ensure compliance with these measures.
We have also piloted new measures, such as sending antiseptic-soaked wipes to patients’ homes so that they can remove flora from their bodies before their procedures, or treating MRSA-colonized patients prior to their surgeries.