title: Surgical Site Infection Reduction by the Solutions for Patient Safety Hospital Engagement Network.
abstract: OBJECTIVE
  Surgical site infections (SSIs) negatively affect patients and the health care system. National standards for SSI prevention do not exist in pediatric settings. We sought to reduce SSI-related harm by implementing a prevention bundle through the Solutions for Patient Safety (SPS) national hospital engagement network.
  
  
  METHODS
  Our study period was January 2011 to December 2013. We formed a national workgroup of content and quality improvement experts. We focused on 3 procedure types at high risk for SSIs: cardiothoracic, neurosurgical shunt, and spinal fusion surgeries. We used the Model for Improvement methodology and the Centers for Disease Control and Prevention SSI definition. After literature review and consultation with experts, we distributed a recommended bundle among network partners. Institutions were permitted to adopt all or part of the bundle and reported local bundle adherence and SSI rates monthly. Our learning network used webinars, discussion boards, targeted leader messaging, and in-person learning sessions.
  
  
  RESULTS
  Recommended bundle elements encompassed proper preoperative bathing, intraoperative skin antisepsis, and antibiotic delivery. Within 6 months, the network achieved 96.7% reliability among institutions reporting adherence data. A 21% reduction in SSI rate was reported across network hospitals, from a mean baseline rate of 2.5 SSIs per 100 procedures to a mean rate of 1.8 SSIs per 100 procedures. The reduced rate was sustained for 15 months.
  
  
  CONCLUSIONS
  Adoption of a SSI prevention bundle with concomitant reliability measurement reduced the network SSI rate. Linking reliability measurement to standardization at an institutional level may lead to safer care.
authors.affiliation: Division of Hospital Medicine, and joshua.schaffzin@cchmc.org.
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Schaffzin
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; and.
authors.forename: Lory
authors.initials: L
authors.lastname: Harte
authors.affiliation: CS Mott Hospital Administration, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan.
authors.forename: Scott
authors.initials: S
authors.lastname: Marquette
authors.affiliation: Children's Hospitals' Solutions for Patient Safety National Network, James M Anderson Center for Healthcare Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Karen
authors.initials: K
authors.lastname: Zieker
authors.affiliation: Children's Hospitals' Solutions for Patient Safety National Network, James M Anderson Center for Healthcare Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Sharyl
authors.initials: S
authors.lastname: Wooton
authors.affiliation: Children's Hospitals' Solutions for Patient Safety National Network, James M Anderson Center for Healthcare Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Kathleen
authors.initials: K
authors.lastname: Walsh
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; and.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
mesh_terms: D002648:Child; D006776:Hospitals, Pediatric; D006801:Humans; D064872:Patient Care Bundles; D061214:Patient Safety; D013530:Surgical Wound Infection / Q000517:prevention & control*