QAPI 151 - Reducing Hysterectomy Surgical Site Infections Through Updated Best Practice Guidelines for Vaginal/abdominal Skin Preparation

Background: Surgical site infections (SSIs) are a primary focus for the infection preventionist as they are preventable and can cause significant harm to patients. SSIs are avoidable when utilizing evidence-based prevention strategies. Hysterectomy SSIs were identified as an opportunity for improvement at a community hospital. A thorough analysis of SSIs and direct observations of surgeries led to an educational intervention focused on vaginal and abdominal skin preparation.

Methods: A comprehensive analysis of hysterectomy SSIs from the previous 20 months along with nine surgery observations were completed. Data was collected from the electronic health record for each infection to review patient risk factors, providers, symptoms of infection, and compliance with best practices. Results were reported to the SSI taskforce, a multidisciplinary team who regularly identifies trends and opportunities for improvement. The team identified the primary opportunity for quality improvement as updated education on vaginal and abdominal skin preparation to reduce practice variations. Educators directly observed each team member prepping a hysterectomy surgical patient and provided necessary feedback in real time.

Results: Data analyzed showed that 67% of patients had a body mass index (BMI) greater than 30 and 100% of organisms cultured are part of natural urogenital and gastrointestinal tract flora. Bacteria harbored in the vagina and perineal region, especially in higher BMI patients, increases risk for infection. Combined with direct observations demonstrating inconsistences in skin preparation, this data indicated a need for education on current best practice. During and after intervention, there was a sustained decline in the number of hysterectomy SSIs. The facility achieved a 78% reduction in hysterectomy SSIs year over year after implementing recommended education.

Conclusions: This project shows that analysis of SSIs combined with procedure observations can highlight areas of opportunity, allowing facilities to provide tailored education on evidence-based practice to improve patient outcomes.