Performing an SSI Investigation

1. Performing an SSI Investigation Deb Hobson, RN BSN

2. What is your current role? Polling Question • Surgeon • Quality improvement practitioner • Infection preventionist • OR nurse • OR technician • Anesthesiologist • OR manager • Educator • Other

3. Objectives • Distinguish between process and outcome data. • Describe how the SSI Investigation Tool can guide improvement work even when SSI rates are low. • Adapt an SSI Investigation Tool to reflect the care processes in your SSI Prevention Bundle.

4. SUSP Readiness Bridge • Are your frontline SUSP team members aware of the SUSP project? • Have you completed a safety culture survey (e.g. HSOPS) and debriefed your frontline SUSP team members? • Has your staff received the Science of Safety Training? • Have you collated Perioperative Staff Safety Assessment responses from your staff? • Have you held your Executive Safety Rounds Kickoff meeting?

5. Assess Your Performance Collect process and outcome data to assess current performance and progress towards improving patient care.

6. Getting SSI Data from the SUSP Website • Log onto the SUSP Website • Locate the SSI Data Registry • Access your SSI Data Report

7. Login to the SUSP Website https://armstrongresearch.hopkinsmedicine.org/login.aspx

8. Locate the SSI Data Registry

9. Access your SSI Data Report

10. Sample SSI Data Report

11. Always Room for Improvement

12. A SingleOrgan Space SSI Means… • 4.9% mortality rate • $14,448 additional cost of care • 24 additional length of stay

13. Because a multitude of factors influence outcome, it is not possible to know for certain, even after extensive adjustments for differences in case mix are made, the extent to which an observed outcome is attributable to an antecedent process of care. Confirmation is needed by a direct assessment of the process itself…” AvedisDonabedian (1998)

14. Uncover Defects withSSI Investigation Tool • Identify lapses in infection prevention processes that may have contributed to your SSI case. • Assess adherence to your local SSI Prevention Bundle.

15. Patient or Provider Factors

16. Normothermia Maintenance

17. Glucose Control

18. Antibiotic Redosing

19. Adapt the SSI Investigation Tool • Johns Hopkins Hospital clinicians designed this tool to assess adherence to their local SSI Prevention Bundle. • Your team may want to investigate care processes that are not included in this tool. • This tool may include processes that your team does not use. • Please modify this tool to best fit your team’s needs.

20. What Your Team Can Do • Abstract this information from the patient’s chart. • Use SSI Audit tools to dig deeper into your care delivery system. • Present process data to the team at a routine SUSP meeting. • Share investigation results monthly or quarterly with your frontline staff and OR leadership.

21. Next Steps • Complete an SSI investigation of your most recent SSIs. • Share your findings on your next coaching call.

22. What Questions Do You Have? Remember you have a support network • Post questions any time on MedConcert • Ask questions during coaching calls • Contact the SUSP helpdesk at susp@jhmi.edu

23. Content Call Evaluation We want to ensure that the content calls provide useful and pertinent information for the SUSP teams. For this reason we request that you complete a brief evaluation following each call. The evaluation may be found at the following link: https://www.surveymonkey.com/s/cohort_5_onboarding