June 6, 2008

Infection control efforts recognized

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(photo by Neil Brake)

Infection control efforts recognized

Vanderbilt's ongoing efforts to reduce surgical site infections have drawn high praise from the University Healthcare Consortium (UHC), an alliance of 101 academic medical centers and 178 of their affiliated hospitals dedicated to quality improvement measures.

“The UHC has recognized that Vanderbilt has made significant improvements in performance … specifically in antibiotic administration,” said Barbara Martin, R.N., M.B.A., Quality Consultant at the Center for Clinical Improvement. “We have improved by roughly 35 percent.”

The Perioperative Leadership team, including Daniel Beauchamp, M.D., Michael Higgins, M.D., M.P.H., and Nancye Feistritzer, M.S.N., R.N., will present the methodology and results of their initiative — called the Antibiotic Ordering and Administration Improvement Project — during an upcoming teleconference with UHC members.

The antibiotic initiative is part of a larger program called the Surgical Care Improvement Project (SCIP). SCIP is a national campaign and partnership of both public and private health care organizations. Its goal is to reduce surgical complications by 25 percent by the year 2010.

SCIP provides methods for improving patient safety during surgery in four key areas: infection, blood clots, and adverse cardiac and respiratory events. These comprise 40 percent of the most common complications after major inpatient surgery.

One important aspect of the program is the implementation of checklists that must be completed before surgery is performed. Like checklists in aviation, they target known sources of failure. Most important to the prevention of surgical site infection is correct antibiotic delivery.

The steps are simple: make sure that the antibiotic is given within one hour prior to surgical incision, verify that the antibiotic given corresponds to current recommendations, and discontinue antibiotic use at the appropriate time — all known ways to prevent surgical site infection. However, for knowledge to become praxis it must first be practiced. That's where SCIP comes in.

SCIP seeks to standardize surgery and reduce its most vexing complications. It demands that results be tracked, reported and analyzed. Vanderbilt, however, has long recognized the power of collecting such information.

“We did submit data before it was tied to paid participation,” said Martin.

“Without the data, we couldn't make the improvements,” said Susie Leming-Lee, R.N., M.S.N., director of Perioperative Quality Management.

Martin provides clinical oversight for SCIP metrics at Vanderbilt, using performance reports to analyze progress and plan improvement measures. If there is a driving force behind improvements, it is the surgical staff's hunger for betterment.

“Everybody — the faculty and the house staff — wants to see those reports. They want to know how we are doing,” said Martin.

Excellence in the SCIP protocol requires teamwork as well as sound leadership. Vanderbilt's success reflects its response to the changing face of medicine, one that requires effective communication and collaboration. If there is one maxim to be gleaned from the results, it is that communication saves lives, said Leming-Lee.