QAPI 123 - Comprehensive Multidisciplinary Performance Improvement Teams Effectively Reduce Colon Surgical Site Infections

Background: Surgical site infections (SSIs) make up 16% of healthcare-associated infections and are a leading cause of postoperative morbidity and mortality. Upwards of 15-30% of colorectal (COLO) surgeries develop SSIs. Between 2018 and 2022, our facility experienced nearly two times the expected COLO SSIs based on the standardized infection ratio (SIR). This study examines the hypothesis that multidisciplinary teams and multiphase interventions reduce the burden of COLO SSIs.

Methods: In May 2020, a multidisciplinary team formed consisting of infection preventionists, general surgeons, anesthesia providers, nursing, surgery schedulers, sterile processing technicians, pharmacists, environmental services, and electronic medical record (EMR) analysts. After an evidence-based practice literature review, an eight-phase quality improvement intervention project was launched between July 2020 and November 2022. Interventions implemented included: a preoperative prophylactic antibiotic administration audit, a standardized preoperative bathing protocol, the addition of a preoperative nasal decolonization protocol with an alcohol-based antiseptic, an intraoperative surgical practices bundle, an EMR COLO anesthesia macro, expansion of the anesthesia macro to all bowel procedures, a standardized COLO SSI investigation tool, and multidisciplinary event reviews of Centers for Medicare and Medicaid reportable COLO SSIs. Outcomes were measured using the National Health and Safety Network (NHSN) 2015 baseline complex 30-day SSI SIR model for adult patients.

Results: Prior to completion of the phased intervention (January 2018-November 2022), the hospital observed 51 COLO SSIs with a calculated SIR of 1.757. Post implementation (December 2022-November 2023) the hospital has observed 1 COLO SSI with a calculated SIR of 0.168: a 90.4% decrease from the pre-intervention baseline SIR (two-tailed p-value: 0.0008, 95% confidence interval: -99.5, -51).

Conclusions: Our study shows COLO SSI reduction can be achieved with a multidisciplinary collaborative and comprehensive approach. Implementation of best practices across all phases of care is critical for effectively reducing COLO SSIs.