Contact:
Spencer Vibbert
(516) 326-7767
Dennis Tartaglia
(212) 481-7000
IPRO is Successfully Working with New York Hospitals to Lower Surgical Infection Rates(Lake Success, NY) - IPRO today announced progress in surgical infection prevention after the Archives of Surgery published a study highlighting the need for better, more consistent practices to address infection risk factors. IPRO plans to intensify its work with local hospitals to redesign procedures and protocols so that surgical patients are given antibiotics within sixty minutes before surgery begins, the timeframe most effective for preventing infections.
The precise timing of administering antibiotics to prevent surgical infections is critical, but often not strictly regulated. In the Archives of Surgery study titled "Use of Antimicrobial Prophylaxis for Major Surgery: Baseline Results From the National Surgical Infection Prevention Project," researchers found that only a little more than half of Medicare beneficiaries undergoing major surgery received antibiotics in the optimal timeframe.
In the article, researchers report the results of their analysis of medical records from 2965 acute care hospitals throughout the United States, involving a random sample of 34,133 Medicare inpatients undergoing major surgeries during 2001-including open cardiac, vascular, colorectal, total hip, total knee, and hysterectomy. Data was collected in conjunction with the 2002 launch of a surgical infection prevention project jointly sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).
"IPRO recognizes the importance of this research and, seeing the opportunity for significant improvement, already has efforts underway to address the problem of surgical infection prevention," says Clare B. Bradley MD, MPH, Chief Medical Officer, IPRO.
As IPRO works with local hospitals to improve delivery and administration of preventative antibiotics, it is reporting progress across the state as well as plans for an expanded focus on surgical infection prevention in the near future.
IPRO conducted a New York Statewide voluntary SIP collaborative with 22 hospitals; attached is a description of one hospital's success.As part of Medicare's Hospital Quality Initiative, Quality Improvement Organizations (QIOs) like IPRO promote rapid resolution of hospital quality issues and sharing of "best practices" to assist hospitals in improving their quality of care in several areas. In addition to surgical infection prevention, focus areas include heart attack, heart failure and pneumonia.
With 20 years of experience in health care quality improvement and evaluation, IPRO holds major contracts with state and federal governments to review the cost and quality of services provided to Medicaid recipients, Medicare beneficiaries, and patients enrolled in managed care organizations, and to work with the health care community to improve those services. Based in Lake Success, New York, IPRO also holds contracts with private-sector clients to improve the quality of privately financed services.
Surgical Infection Prevention Success Story:Glen Cove Hospital enthusiastically participated in IPRO's voluntary Surgical Infection Prevention (SIP) Collaborative, which ran from July 2003 through March 2004. The objective of this collaborative was to reduce surgical infections by improving the selection and timing of prophylactic antibiotics. Glen Cove started with an excellent rate of appropriate selection of antibiotics, so they focused on timing issues. They targeted their efforts initially on their primary hip and knee arthroplasty patients, intending to spread improvements throughout their institution once established in this population.
Team members came together from many different departments, including surgery, pharmacy, infection control, and quality management. Of great importance was the active involvement of the leadership in several departments, including Dr. Eugene Krauss, Chairman of Orthopedics, the Chairman of Anesthesia, the Director of Perioperative Services, the Director and Assistant Director of Pharmacy, Physician's Assistants and the Manager of their Total Joint Program.
The team used a series of Plan, Do, Study, Act (PDSA) cycles to develop their strategy. Thanks to the involvement of senior administration and clinical directors, improvements came rapidly. A previous policy, which stipulated that the pre-operative antibiotic was to be given in the holding area, was changed so it could now be given in the OR. The pharmacy researched the availability of ready-mix Cefazolin to facilitate its administration and the anesthesia department accepted the primary role for antibiotic pre-operative administration. An almost immediate improvement in the timing of the first dose of antibiotic was measured, with the performance improving from a baseline rate of 46% in July 2003 to over 90% by September 2003, and reaching 100% by January 2004 where it remained until the end of the collaborative.
The team also focused on the other challenging performance measurement, namely discontinuing antibiotic prophylaxis within 24 hours of the end of surgery. During the fall, meetings were held with the surgeons to discuss the length of postoperative antibiotics and infection control also started to monitor post-op antibiotics. Shortly after, a meeting between the division leaders resulted in the development of a new protocol for timely discontinuance of prophylactic antibiotics that was presented to the QA and P&T Committees. Finally, the changes were finalized and written into the pre-op sheet, pre-printed orders, care maps, and the OR tracking tool. Very rapid improvements were noted in the performance measure, which rose from under 50% in the fall of 2003 to 100% by the beginning of 2004.
The team is strongly dedicated to building on the progressive momentum that they have started through this collaboration; by the middle of 2004 they had already begun to examine and track colon surgeries for these same performance measures. For more information about IPRO's quality improvement resources for surgical infection prevention, contact Dr. Charles Stimler, Medical Officer, IPRO, (516) 326-7767, ext. 634, email Cstimler@nyqio.sdps.org.
Glen Cove Hospital is one of 15 hospitals of the North Shore-LIJ Health System, the nation's third largest, non-profit, secular health care system. North Shore-LIJ provides care for people at all stages of illness throughout Long Island, Queens and Staten Island -- a service area encompassing more than five million people. The health system includes four long-term care facilities, a medical research institute, three trauma centers, six home health agencies and dozens of outpatient centers. North Shore-LIJ facilities house more than 5,576 beds, and are staffed by over 7,000 physicians, 7,000 nurses and a total workforce of more than 35,000 -- the largest employer on Long Island and the seventh largest in New York City.