title: Achieving and Sustaining Zero: Preventing Surgical Site Infections After Isolated Coronary Artery Bypass With Saphenous Vein Harvest Site Through Implementation of a Staff-Driven Quality Improvement Process.
abstract: BACKGROUND
  Surgical site infections (SSI) increase morbidity and mortality, hospital costs, length of stay, readmissions, and risk of litigation and may impact a facility's reputation.
  
  
  METHODS
  Through implementation of a Six Sigma, interdisciplinary team process and the Contextual Model for change engaged all stakeholders. A total of 44 perioperative processes were evaluated, with 15 processes ultimately altered. Revisions involved identifying inconsistent implementation of procedures and standardizing processes, as well as utilizing new suture techniques and products including disposable electrocardiogram leads and pacing wires, antibiotic-coated sutures, and silver-impregnated midsternal dressings.
  
  
  RESULTS
  In isolated coronary artery bypass grafting with donor-site procedures, an incidence of 3.74 per 100 procedures was reduced to 0.7 and ultimately to 0. No patients who underwent coronary artery bypass grafting developed a deep sternal wound infection in over 30 months and 590 procedures, resulting in an estimated cost savings of more than $600 000, from May 2012 through December 2014.
  
  
  CONCLUSIONS
  A significant reduction in deep sternal wound infections was achieved by working at all levels of the organization through a multidisciplinary approach to create sustained change. Using real-time observations for current practices, areas for improvement were identified. By engaging frontline staff in the process, ownership of the outcomes and adherence to practice change were promoted. The result was a dramatic, rapid, and sustainable improvement in the prevention of deep sternal wound infection.
authors.affiliation: Candis Lee Kles, RN, CCRN, is a interim director cardiac and adult critical care services at Athens Regional Health System Athens, Georgia Area Hospital & Health Care, and in speakers bureau for Molnlycke Healthcare. C. Patrick Murrah, MD, is a thoracic and cardiac surgeon in Athens, GA. Kerry Smith, BSN; Elizabeth Baugus-Wellmeier, MSN, CCRN, is a critical care nurse in Atlanta and Athens Georgia. Terri Hurry, MSN-NICNOR, is a operation room services, Athens Regional Medical Center. Cullen D. Morris, MD, Athens Regional Medical Center, Athens, Georgia.
authors.forename: Candis Lee
authors.initials: CL
authors.lastname: Kles
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Murrah
authors.forename: Kerry
authors.initials: K
authors.lastname: Smith
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Baugus-Wellmeier
authors.forename: Terri
authors.initials: T
authors.lastname: Hurry
authors.forename: Cullen D
authors.initials: CD
authors.lastname: Morris
mesh_terms: D001026:Coronary Artery Bypass; D005845:Georgia; D006801:Humans; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012501:Saphenous Vein / Q000637:transplantation; D013530:Surgical Wound Infection / Q000517:prevention & control*