The Path to Zero

Every surgery has its risk.

So, every patient, before going under, has explained to them the risks particular to the surgery at hand. The patient, if they�re worried, tends to focus on dramatic complications, however unlikely. They tend not to focus as much on the boilerplate stuff like post-operative infections. After all, those are preventable.

But healthcare-associated infections like surgical site infections (SSIs) or catheter-associated urinary tract infections (CAUTIs) affect hundreds of thousands of patients nationwide every year. The fact that they are, in many cases, preventable, only makes those infections that do occur more frustrating.

In 2015, the national SSI rate was between two and three percent (20-30 infections per 1,000 patients). At Saint Francis, that rate was 0.8 percent (eight infections per 1,000 patients). Process improvement coordinator Lori DeBrower, BSN, RN, explains that while keeping below the national average is generally considered acceptable, Saint Francis sta decided to make further reduction a priority.

�Bottom line, it�s a patient safety issue,� she says. �It can have a disastrous impact on the patient.�

SSIs, she says, can mean more time in the hospital for a patient, more strain on their family and more time away from work. Solving SSIs seemed an opportunity to significantly improve outcomes with relatively minor changes.

�We made that one of our main focuses in our operating room,� she says. �Obviously, it had always been an aim of ours, but it was in 2015 when we really started ramping up those efforts.�

The first step, she says, was a comprehensive audit of existing procedures. Could patients be better prepared for surgery? Were there better products or tools available?

Were there more efficient cleaning protocols?

�We went back and picked apart every single aspect of our care,� DeBrower says. �Just to see what we could do to change or improve our SSI rate.�

Surgical, nursing and performance improvement sta eventually identified more than a dozen ways to further minimize infection risk, including more specialized dosage guidelines for patients according to body weight, more and better resources to help patients keep sites clean after surgery, and an in-house push to make focus on SSI reduction a core part of the workplace culture.

�Collaboration was crucial�, DeBrower says, both in the development of better protocols and in their implementation.

�Now, it�s something we discuss more at staff meetings,� she says. �We�re always asking for input and the staff is more engaged. They�re more empowered to speak up if they see something that could be done better or if they need something.�

The SSI rate is now 0.3 percent, among the lowest in the nation. If you�re doing the math, that is three infections for every 1,000 patients.

�Year after year, our rates have continued to steadily go down,� DeBrower says.

And it�s not just SSIs, says chief performance improvement officer Stephanie LaPierre. Saint Francis has made similar progress in reducing other types of health-associated infections.

�We don�t believe being �pretty good� is an acceptable goal. We�re serious when we say our goal is to be the best in the nation,� she says. � e progress we�ve made in reducing health-associated infections is, I believe, proof that we are perfectly capable of reaching such a goal.�