Colorectal Bundle: A Multi-disciplinary Teamwork Approach to Reduce Surgical Site Infections

Rena Thompson, APN, MSN, CNS-BC, Rachel Marrs, RN, MSN, Sandra Schulz, RN, BSN , Konstantin Umanskiy, MD, and Vivek Prachand, MD, FACS

Background Aims

The Intervention

Lessons Learned

The  Surgical  Quality  and  Pa3ent  Safety  Improvement  Commi;ee  implemented  the  colorectal  bundles  to  reduce  the  SSI  rates  by  20%    to  improve  pa3ent  safety  in  the  periopera3ve  phase  of  care.    

The  Surgical  Quality  and  Pa3ent  Safety  Improvement  Commi;ee  proposed  the  Colorectal  Bundle.  The  colorectal  surgeons  met  collec3vely  to  develop  and  implement  a  cohesive    Colorectal  Bundle.  •  The  surgical  providers  in  the  clinic  should  prescribe  mechanical  

bowel  prep,  An3bio3c  Prophylaxis  (if  indicated),  Clear  liquid  diet,  Pre-­‐opera3ve  bathing,  and  Educa3on.      

•  In  the  preopera3ve  phase  of  care,  the  RN  should  ensure  the  pa3ent  had  taken  oral  an3bio3cs,  mechanical  bowel  prepara3on  and  pre-­‐opera3ve  bathing.      

•  In  the  intraopera3ve  phase  of  care,  the  surgical  team  should  provide  consistent  applica3on  of  the  skin  prepara3on  to  the  surgical  incision  area.  The  scrub  nurse/technician  should  ensure  a  set  of  closing  instruments  and  an  addi3onal  protec3on  of  ioban  drape  was  used  for  open  and  laparoscopic  cases.  During  the  surgical  procedure,  the  surgical  team  should  not  cross  contaminate  instruments  and/or  supplies.  At  the  closure  of  the  surgical  procedure,  the  surgical  team  should  change  gloves  and  gowns  depending  on  a  clean-­‐contaminated  versus  contaminated  case.    

The  implemen3ng  of  the  colorectal  bundle  provided  an  opportunity  for  mul3disciplinary  teams  to  work.      •  Interdisciplinary  team  work  is  important  in  implemen3ng  an  

ini3a3ve  that  crosses  mul3ple  departments  and  surgical  providers.    •  Communica3on  is  necessary  when  implemen3ng  a  quality  project  

across  the  surgical  and  nursing  service.    •  The  use  of  consistent  audits  provided  the  surgical  providers  and  

nursing  a  benchmark  of  the  necessary  steps  to  improve  the  ini3a3ve.    

Next Steps

Results

The  Infec3on  Control  (IC)  department  facilitated  audits  to  ensure  the  Colorectal  bundle  was  being  appropriately  followed  in  the  periopera3ve  seRngs.  The  IC  personnel  performed  chart  reviews  to  monitor  the  clinic  implementa3on  of  the  colorectal  bundle.    ASer  the  full  implementa3on  of  the  colorectal  bundles,  the  SSI  rates  have  decreased.  The  impact  of  the  colorectal  bundle  has  decreased  colorectal  pa3ent  complica3ons.    The  SSI  rate  has  reduced  to  2.2%  from  21.8%.  The  goal  of  the  surgical  quality  commi;ee  is  to  reduce  the  current  rate  from  10%  .  The  colorectal  bundle  provided  a  consistent  prac3ce  of  colorectal  pa3ents  and  ul3mately  reduced  the  SSI  rate.    

The  Surgical  Services  annual  Surgical  Site  Infec3ons  (SSI)  rate  was  increasing  in  colorectal  cases  at  the  UCM.    In  the  first  month  of  the  2014  fiscal  year  the  SSI  rate  was  at  21.8%.  The  2014  goal  of  the  Surgical  Quality  and  Pa3ent  Safety  Improvement  Commi;ee  was  to  have  a  20%  reduc3on  in  SSI  rates.    Before  implementa3on  of  the  colorectal  bundle,  the  colorectal  pa3ent  did  not  receive  the  following  consistent  prac3ce:    Clinic  visit:  prescribe  mechanical  bowel  preps  and  oral  an3bio3cs  Intraopera3ve  phase  of  care:  •  Pa3ent’s  surgical  skin  prepara3on  was  not  applied  in  a  consistent  

manner.  Draping  and  isola3ng  of  contaminated  supplies  was  not  a  consistent  prac3ce  across  surgical  providers  and  surgical  team  members.    

This  inconsistency  created  a  poten3al  for  SSI  rates  to  increase.

The  Surgical  Quality  and  Pa3ent  Safety  Improvement  Commi;ee  will  con3nue  to  monitor  and  audit  SSI  rates  for  colorectal  cases.    •  Promote  Pa3ent  teaching  in  the  clinics  regarding  the  Colorectal  

interven3ons.    •  Create  consistent  colorectal  pa3ent  care  workflow  among  the  

residents  and  pre-­‐opera3ve  nursing  

Contact: Rena Thompson, APN, MSN, CNS-BC; rena.thompson@uchospitals.edu

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Baseline: 58.0% Standard HH Campaign: 72.3%, p<0.001 Giving for Performance: 83.9%, p=0.003