CHAPTER 1 – INTRODUCTION TO ACCESS Akhila Kondai September 30, 2013.
Authors: Akhila Ajithkumar SN, Sheba Christy SN, … Akhila Ajithkumar SN, Sheba Christy SN, Smitha...
Transcript of Authors: Akhila Ajithkumar SN, Sheba Christy SN, … Akhila Ajithkumar SN, Sheba Christy SN, Smitha...
Methods for improvement
COACH -Dr. Poonam Gupta
Ms. Catherine Marshall - Director of Nursing
Dr.Lateef Wani - CT Specialist
Ms. Shiny Shiju - Head Nurse
Ms. Joby Cyriac - Staff Nurse
Ms. Smitha Anny - Staff Nurse
Ms. Sheba Christy - Staff Nurse
Ms. Elsayeda Mohd - Staff Nurse
Ms. Akhila Ajithkumar - Staff Nurse
Ms. Sunitha - Wound care nurse
Ms. Marifie - Wound care nurse
Ms. Leni B. Garcia - Head of Infection Control
Ms. Cheryln Simbulan - Infection Control Practitioner
Interventions
C
Clean hands. Chlorhexidine 2% bath pre operative, on the day of surgery and post operative as
per protocol. Chlorhexidine packs given during discharge. Nasal de colonization – MSSA/MRSA screening of all patients undergoing surgery
and once positive, de colonization process starts preoperatively. Used clippers for hair removal.
L
Left the wound dressing without exposing for 48 hours postoperatively. Observed wound for any oozing which leads to infection.
E Emphasized client and staff on best practices for postoperative wound care and
prevention of surgical site infection as per protocol.
A
Appropriate antibiotics used pre operative, intra operative and post operative for
24 hours.
N
Normal body temperature (Normothermia) maintained from 36.1- 37.8C as per
protocol.
Normal blood glucose level (Normoglycemia) maintained from 6- 8.1 mmol/L as per protocol. A continuous integrated insulin infusion system is used to keep blood glucose level within the range. Monitored temperature and blood glucose hourly for the immediate postoperative day.
Educated the client to have nutritious food. Explained the importance of stop smoking to a client who is smoker, if needed
given referral to smoking cessation clinic.
Problem
Surgical site infection rate was zero from 2015 to first quarter
of 2016. Surveillance and monitoring continued. Resurge of
one surgical site infection identified in the second quarter
2016. Contributing factors for developing infections were
identified. It was due to uncontrolled blood glucose and not
maintaining the body temperature as per protocol pre
operative and in the immediate post operative.
1. Followed appropriate antimicrobial prescribing practices before and after surgery.
2. Followed protocols for hair removal, preoperative skin disinfection, and control of blood glucose levels
pre operatively.
3. Educated them about the symptoms which is leading to a surgical site infection and the earliest time to
approach wound care department.
4. Emphasised the significance of hand hygiene to all the team members including all health care workers.
5. Completed hand hygiene competency for all the staff.
6. Surgical site infections protocols are reviewed periodically.
Acknowledgement
Prof. Mckenna - Chief Executive Officer-HH
Mr. Paul Mavin - Executive Director of Nursing-HH
Mr. Ian McDonald - Assistant Executive Director of Nursing-HH
MS. Fadia Ali - Assistant Executive Director of Quality-HH
Achievement
Achieved Stars of Excellence Merit Award in 2015 for surgical site infection project.
Cardio Thoracic Intensive Care Unit received Stars Of Excellence Award in 2016 for Multidisciplinary
Team Work-An Innovative Culture.
Conclusion
We hypothesized that glycemic control in postoperative cardiac patients reduced
the incidence of surgical site infection. We achieved zero infections for Coronary
Artery Bypass Graft chest incision risk index x 1 for 304 calendar days, Coronary
Artery Bypass Graft chest incision risk index x 2 for 1447 calendar days.
Next Steps
1. Audit on post discharge glucose control level for those who undergo Coronary Artery Bypass
Graft.
2. To implement a Handbook for Cardiac Surgery Patient - “A New Life For Your Heart Enhancing
Your Recovery Together.”
Reference: www.ihi.org
A strive towards “zero surgical site infection rate” in Cardio Thoracic Intensive Care Unit - Heart Hospital.
Authors: Akhila Ajithkumar (SN), Sheba Christy (SN), Smitha Anny (SN)
Introduction
High rate of surgical site infections identified after the cardiac surgery
since beginning of heart hospital. A diversified approach in preventing
Surgical Site Infection was developed and implemented to address and
mitigate the key issues behind the infections. We gained zero infections
for Coronary Artery Bypass Graft Incision Index x 1 for 954 calendar days
and Coronary Artery Bypass Graft Incision Index x 2 for 1143 calendar
days.
AIM
The incident rate of surgical site infection were Zero in 2015, though
to keep a stagnancy and sustain zero rate by December 2016.
To maintain normothermia and normoglycemia above 90% in CTICU
after cardiac surgery .
With strict compliance to temperature and glycemic control we set foot to zero infection rate from 2nd quarter to 4th-quarter of 2016.
This graph turn up the compliance range
of temperature and glycemic level in the
post cardiac surgery clients from Jan
2016 - Jan 2017.
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%
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Surgical site infection indicator
Normothermia (36.1-37.8C)
Normo glycemia(6-8.1 mmol/L)