title: Implementation of a Pediatric Orthopaedic Bundle to Reduce Surgical Site Infections.
abstract: Surgical site infections (SSIs) cost an estimated $27,288 per case. An analysis of the National Surgical Quality Improvement Program data at the University of Rochester Medical Center suggested that rates of SSIs could be lowered in comparison with both peers and baseline. The aim of this study was to reduce the number of SSIs to zero through the implementation of a "bundle" or a combination of practices. Meetings were held with the multidisciplinary care team that includes surgeons and staff from pediatric pharmacy, pediatric infectious diseases, anesthesia, and nursing to create a care bundle for all pediatric orthopaedic surgery patients. Bundle elements included use of chlorhexidine gluconate wipes the night before surgery and the day of surgery, use of preoperative nutrition screens, development and use of a prophylactic antibiotic dosing chart, use of methicillin-resistant Staphylococcus aureus screening, maintenance of normal patient temperature, and use of nasal swabs in the operating room. The SSI rate dropped from a baseline figure of 4% in 2013 (n = 154) and 3.2% in 2014 (n = 189) to 0.0% (n = 198) in 2015 after the bundles were implemented. Both compliance with the bundle and SSI rates must be monitored monthly. Staff and providers should be offered monthly feedback on SSI rates and care bundle compliance. If an SSI does occur, a root-cause analysis is performed with the multidisciplinary care team using a standardized review form.
authors.affiliation: Jan Schriefer, DrPH, MSN, MBA, Associate Professor of Pediatrics and Professor of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, NY. James Sanders, MD, Professor of Orthopedics, University of Rochester School of Medicine and Dentistry, Rochester, NY. Julie Michels, MS, RN-BC, Pediatric Surgery QA/PI Specialist, University of Rochester School of Medicine and Dentistry, Rochester, NY. Kori Wolcott, BSN, RN, Pediatric Surgical Clinical Reviewer, Pediatric Surgery QA Liaison, University of Rochester School of Medicine and Dentistry, Rochester, NY. Connor Ruddy, Student Intern, from Loyola University Chicago, Chicago, IL. Jenna Hanson, Student Intern, from Colorado College, Colorado Springs, CO.
authors.forename: Jan
authors.initials: J
authors.lastname: Schriefer
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hilt
authors.forename: James
authors.initials: J
authors.lastname: Sanders
authors.forename: Julie
authors.initials: J
authors.lastname: Michels
authors.forename: Kori
authors.initials: K
authors.lastname: Wolcott
authors.forename: Connor
authors.initials: C
authors.lastname: Ruddy
authors.forename: Jenna
authors.initials: J
authors.lastname: Hanson
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods; D002710:Chlorhexidine / Q000627:therapeutic use; D003266:Continuity of Patient Care; D006801:Humans; D009985:Orthopedics; D064872:Patient Care Bundles / Q000592:standards*; D010372:Pediatrics; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine