Aim: To reduce the Surgical Site Infection(SSI) rate in the paediatric cardiac surgical patient from 2.9% to zero% within 12 months.
Method: A review of the medical literature was performed and identified that the following care components can help to reduce the incidence of SSI:
• Preoperative screening for MRSA and staphylococcus,
• Appropriate use of prophylactic antibiotics
• Implementation of a strict dressing protocol
• Wound surveillance in the postoperative period.
The agreed components were combined as a bundle of care. This approach works on the knowledge that when multiple evidence based interventions are “bundled”, the reduction in SSI incidence is likely to exceed that which could be produced by any single component in isolation. A range of stakeholders were engaged in the project. An evidence based protocol checklist was developed, these are analysed weekly to provide feedback to clinicians.
Results: Following implementation, the incidence of SSI has reduced from 2.9% to 1.3% (p=0.03). The flow on benefits of the project revealed a reduction in returns to theatre from 3.6% to 1.7% (p=0.05) and a reduction in days spent to treat SSIs with IV antibiotics from 57 days/quarter to 20 days/quarter.
Conclusion: As hospitals fight to reduce SSI's, the example set by CHW provides direction on how to eliminate the gap between evidence and current practice. Identification of evidence versus practice gap and a “bundle of care” approach, supported by strong clinical leadership and good engagement of stakeholders helps to reduce the incidence of SSIs and improve patient experiences