title: Surgical care improvement project and surgical site infections: can integration in the surgical safety checklist improve quality performance and clinical outcomes?
abstract: BACKGROUND
  The World Health Organization Surgical Safety Checklist (SSC) has been shown to decrease surgical site infections (SSI). The Surgical Care Improvement Project (SCIP) SSI reduction bundle (SCIP Inf) contains elements to improve SSI rates. We wanted to determine if integration of SCIP measures within our SSC would improve SCIP performance and patient outcomes for SSI.
  
  
  METHODS
  An integrated SSC that included perioperative SCIP Inf measures (antibiotic selection, antibiotic timing, and temperature management) was implemented. We compared SCIP Inf compliance and patient outcomes for 1-y before and 1-y after SSC implementation. Outcomes included number of patients with initial post-anesthesia care unit temperature <98.6°F and SSI rates according to our National Surgical Quality Improvement Program data.
  
  
  RESULTS
  Implementation of a SCIP integrated SSC resulted in a significant improvement in antibiotic infusion timing (92.7% [670/723] versus 95.4% [557/584]; P < 0.05), antibiotic selection (96.2% [707/735] versus 98.7% [584/592]; P < 0.01), and temperature management (93.8% [723/771] versus 97.7% [693/709]; P < 0.001). Furthermore, we found a significant reduction in number of patients with initial post-anesthesia care unit temperature <98.6°F from 9.7% (982/10,126) to 6.9% (671/9676) (P < 0.001). Institutional SSI rates decreased from 3.13% (104/3319) to 2.96% (107/3616), but was not significant (P = 0.72). SSI rates according to specialty service were similar for all groups except colorectal surgery (24.1% [19/79] versus 11.5% [12/104]; P < 0.05).
  
  
  CONCLUSIONS
  Implementation of an integrated SSC can improve compliance of SSI reduction strategies such as SCIP Inf performance and maintenance of normothermia. This did not, however, correlate with an improvement in overall SSI at our institution. Further investigation is required to determine other factors that may influence SSI at an institutional level.
authors.affiliation: Department of Surgery, Scott and White Memorial Hospital and Clinic, Texas A&M University System Health Science Center College of Medicine, Temple, Texas 76508, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Tillman
authors.forename: Hania
authors.initials: H
authors.lastname: Wehbe-Janek
authors.forename: Bonnie
authors.initials: B
authors.lastname: Hodges
authors.forename: W Roy
authors.initials: WR
authors.lastname: Smythe
authors.forename: Harry T
authors.initials: HT
authors.lastname: Papaconstantinou
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D057189:Checklist / Q000592:standards*; D005500:Follow-Up Studies; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D007035:Hypothermia / Q000401:mortality; D009873:Operating Rooms; D010043:Outcome and Process Assessment, Health Care; D019990:Perioperative Care / Q000592:standards; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D013696:Temperature
chemical_list: D000900:Anti-Bacterial Agents
keywords: Mortality; National surgical quality improvement project; Normothermia; Outcomes; Quality performance; Surgical care improvement project; Surgical safety checklist; Surgical site infection