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A Novel Prevention Bundle to Reduce Surgical Site Infections in Pediatric Spinal Fusion Patients

Published online by Cambridge University Press:  28 January 2016

Jane M. Gould ,
Patricia Hennessey ,
Andrea Kiernan ,
Shannon Safier  and
Martin Herman
Jane M. Gould*
Affiliation:
Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania Section of Infectious Diseases, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Patricia Hennessey
Affiliation:
Infection Prevention, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Andrea Kiernan
Affiliation:
Infection Prevention, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Shannon Safier
Affiliation:
Orthopedic Surgery, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Martin Herman
Affiliation:
Orthopedic Surgery, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
*
Address correspondence to Jane M. Gould, MD, Section of Pediatric Infectious Diseases, St. Christopher’s Hospital for Children, 160 E. Erie Ave, Philadelphia, PA 19134 ([email protected]).
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Abstract

BACKGROUND

The Surgical Care Improvement Project bundle emphasizes operative infection prevention practices. Despite implementing the Surgical Care Improvement Project bundle in 2008, spinal fusion surgical site infections (SF-SSI) continued to be prevalent for this low-volume, high-risk surgery.

OBJECTIVE

To design a combined pre-, peri-, and postoperative bundle (PPPB) that would lead to sustained reductions in SF-SSI rates.

DESIGN

Quality improvement project, before-after trial with cost-effectiveness analysis.

SETTING

Children’s hospital.

PATIENTS

All spinal fusion patients, 2008–2015.

INTERVENTION

A multidisciplinary team developed the PPPB composed of Surgical Care Improvement Project elements plus improved wound care practices, nursing standard of care, dedicated nursing unit, dermatology assessment tool and consultation, nursing education tool using “teach back” technique, and a “Back Home” kit. SF-SSI rates were compared before (2008–2010) and after (2011-February 2015) implementation of PPPB. PPPB compliance was monitored.

RESULTS

A total of 224 SF surgeries were performed from 2008 to February 2015. Pre-PPPB analysis revealed median time to SF-SSI of 28 days, secondary to skin and bowel flora. Mean 3-year pre-PPPB SF-SSI rate per 100 SF surgeries was 8.2 (8/98) (2008: 13.3 [4/30], 2009: 2.7 [1/37], 2010: 9.7 [3/31]). Mean SF-SSI rate after PPPB was 2.4 (3/126) (January 2011-February 2015); there was a 71% reduction in mean SSI rate (P=.0695). No SF-SSI occurred in neuromuscular patients (P=.008) after PPPB. Compliance with PPPB elements has been 100%.

CONCLUSIONS

PPPB led to sustained improvement in SF-SSI rates over 50 months. The PPPB could be reproduced for other surgeries.

Infect Control Hosp Epidemiol 2016;37:527–534

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 5 , May 2016 , pp. 527 - 534
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: Pediatric Academic Societies Annual Meeting; Washington, DC; May 4, 2013 (Abstract 751654).

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