Surgical Site Infection Reduction in the Outpatient Surgery Department
Surgical site infections (SSIs) are the most common health care-related complication. These develop in 2-5% of the more than 30 million patients undergoing a surgical procedure every year. This complication delays the healing process and can consequently keep patients from returning to work and their everyday lives. It is also associated with increased costs and a higher risk of postoperative mortality.
Following the National Health and Safety Network (NHSN) guidelines for identifying a SSI, Marshfield Clinic Health System’s Infection Prevention noted 11 SSIs in the NHSN BRST (breast) category from 11/2018 to 10/2019 in procedures spanning anywhere from a lumpectomy to breast reconstruction with an implant.
Infection Prevention began an investigation into the BRST SSIs in the fall of 2019 to identify areas for improvement. This involved a thorough examination of medical records and direct observation of BRST cases in the operating room (OR). During the record review it was noted that 100% of the patients had low body temperatures throughout surgery and 50% of the patients who had a culture collected grew bacteria that was resistant to the pre-operative antibiotic. In most cases this was Clindamycin, which was given due to allergy concerns. A bit surprisingly, none of the patients were diabetic (See Figure 1.)
Infection Prevention presented the findings from the record reviews and direct OR observations with recommendations to the surgery team in the winter of 2020. Several initiatives were implemented that included chlorhexidine gluconate bathing prior to surgery, maintaining normothermia, antibiotic stewardship, and limiting OR traffic (including not allowing relief of the surgical technologist during handling of breast implants).
Even with the challenges brought by the COVID-19 pandemic the Outpatient Surgery Center team has been successful in making significant improvements in the number of BRST SSIs with only two SSIs identified in 2022.