QAPI 157 - The Power Is in the Cards – Utilizing K Card Elements in the Operating Rooms to Prevent Surgical Site Infections

Background: Surgical site infections (SSI) are significant contributors to morbidity and mortality in patients after surgery. Evidence-based guidelines and recommendations can prevent SSIs; however, ensuring adherence to these prevention strategies is often a challenge. Kamishibai Cards (K Cards) are a well-known quality improvement tool used for preventing device-associated infections but have been less described for use in SSI prevention. We wanted to trial the use of K cards in the pediatric neurosurgery service to determine their feasibility in SSI prevention and impact on SSI rates.

Methods: An SSI prevention K card was developed and implemented in March 2023 for a six-month trial in the intraoperative setting for pediatric neurosurgery cases. The K card contained elements from our institutional SSI prevention bundle and assessed for intraoperative alcohol-based surgical skin preparation, preoperative antibiotic prophylaxis, and intraoperative normothermia. The surgical team completed and reviewed the K cards and turned them in at the end of the case. Bundle compliance and SSI rates were analyzed.

Results: During the six-month trial (March 2023 – August 2023), the SSI rate was 1.0 SSI per 100 tracked surgical procedures, a decrease from the rate of 1.9 SSIs per 100 tracked surgical procedures during the same timeframe a year prior (March 2022 – August 2022) without the K cards. K card compliance data also demonstrated that the service appropriately used an alcohol-based surgical skin preparation when not contraindicated (96%) and administered preoperative antibiotic prophylaxis on time (97%). Maintaining intraoperative normothermia (68%) is an area of opportunity. Users found the K card format to be simple and quick to complete.

Conclusions: K cards are feasible to implement for tracking and ensuring compliance with standard SSI prevention practices and continuously identifies areas of opportunity for improvement to prevent SSIs.