New steps reduce infection rates
Washington University colorectal surgeons have significantly lowered surgical site infection (SSI) rates for patients at Barnes-Jewish Hospital by implementing an expanded, standardized set of infection-control procedures.
The effort is one of many patient safety and quality-improvement initiatives at Barnes-Jewish, undertaken primarily for patient benefit, but also to address the closer scrutiny of patient outcomes by government and private insurance companies. In refining the implementation of clinical care, the work represents T3 translational research.
The effort includes a group of procedures, or interventions, generally thought to be effective, with the goal of identifying which are best.
“We started the bundle of interventions in January 2013 when our SSI rate was higher than the national average,” says colorectal surgeon Matthew Silviera, MD. “Then we looked at outcomes data from the American College of Surgeons National Surgical Quality Improvement Program® (NSQIP) to determine which interventions actually affected surgical site infection rates in our patients.”
Since implementation, the overall rate of SSIs for colorectal procedures at Barnes-Jewish has dropped from 26 percent in 2010 to 8 percent in 2014. That level is better than the NSQIP benchmark for Barnes-Jewish based on the hospital’s patient population and other factors.
To gauge the effectiveness of each intervention, the surgeons examined the NSQIP data and compared outcomes in Barnes-Jewish patients who received a given intervention vs. those who did not. Examples of specific interventions and the resulting 2014 SSI rates:
- Washing abdomen preoperatively with antimicrobial soap chlorhexidine — If performed: 4.8 percent. If not performed: 15.6 percent
- “Clean closure:” using all new instruments, changing gloves and gowns, and redraping patient prior to beginning the closing procedure — If performed: 5 percent. If not performed: 12.1 percent
- Patient takes oral antibiotics as part of bowel prep — If performed: 4.5 percent. If not performed: 12.9 percent
The surgeons plan to refine their intervention bundle and improve compliance. They also are implementing protocols to address other surgical complications and reduce hospital length of stays. (See Highlights.)
Mutch named section chief
Matthew Mutch, MD, who is nationally known as a clinician and educator in the laparoscopic treatment of colorectal cancer, has been named chief of the Section of Colon and Rectal Surgery. Mutch succeeds James Fleshman Jr., MD, who left to become chair of the Department of Surgery at Baylor University Medical Center.
Mutch treats a broad spectrum of benign and malignant colorectal disease. His research focuses on identification of molecular markers to predict cancer-related outcomes in patients with rectal cancer, clinical outcomes in laparoscopic colorectal surgery and enhanced recovery after surgery. He completed his medical doctoral and residency training at Washington University and a colon and rectal fellowship at Lahey Clinic in Burlington, Massachusetts.
Mutch is program director of the Colon and Rectal Surgery Fellowship and serves on the Siteman Cancer Center Quality Assessment and Safety Monitoring Committee. On a national level, he is vice chair of the Colon and Rectal Surgery Residency Review Committee and secretary of the Association of Program Directors for Colon and Rectal Surgery.
Highlights
- After implementing a successful initiative to reduce surgical site infections at Barnes-Jewish Hospital and Barnes-Jewish West County Hospital, colorectal surgeons are taking the next step with an Enhanced Recovery Program designed to reduce other complications, hospital length of stay and readmissions. It includes: patient education, special nutrition, exercise and bowel preparation before the operation; infection-control procedures and fluid administration during the operation; and walking, breathing exercises, nutrition and multimodal pain medication after the operation.
- The Section of Colon and Rectal Surgery is the leading accruer in a nationwide clinical trial looking at wound irrigation to minimize surgical site infections. Colorectal surgeons also are participating in the national multicenter Perfusion Assessment in Laparoscopic Left Anterior Resection study evaluating use of perfusion imaging to evaluate blood flow in patients undergoing laparoscopic removal of the rectum. The goal is to see how the use of perfusion imaging affects surgical decision-making and outcomes.
- The section is planning a study to see which follow-up method works best to prevent readmission of patients who receive an ileostomy at Barnes-Jewish Hospital as part of their colorectal operation. The study is being conducted by principal investigator Steven Hunt, MD, and clinical nurse coordinator Bonnie Johnston, RN, CWOCN.