Poster - #VH-46631 - Keywords: Surgery, SSI, infection, Infection Prevention

Bacteria in Brain Surgery: The Infection Preventionist's Response

Charles Vickery Jr MSN, RN, CIC, CRCST, Nicholas DeStefano BSN, RN, CNOR, Luz Caicedo MPH, CPH, CIC, CRCST, VA-BC
AdventHealth Celebration

ABSTRACT:
Abstract Title: Bacteria in Brain Surgery: The Infection Preventionists' Response The team will describe how a 357-bed acute care hospital identified gaps in infection prevention practices in the operating room (OR) and successfully developed a surgical (IP) role to lower SSIs. Having a dedicated surgical IP resulted in rapid detection of the SSI cluster and enabled the surgical team to swiftly respond and mitigate gaps. In 2021, the Surgical IP in our facility identified an increase in cranial infections that resulted in two patient deaths. The surgical IP collaborated with OR stakeholders to minimize the risks for developing an infection. Our focus shifted to increasing OR observations, instrument tracers, environmental services audits, and enhancing education. Our collaborative efforts resulted in the elimination of craniotomy SSIs, and our facility has maintained an infection rate of zero for 2022, and 2023. Our executive leadership supported the creation of the Surgical IP, which was formally implemented in January of 2021. Our surgical IP’s primary focus is caring for the procedural areas, by bringing expertise surrounding standards of practice, infection prevention, patient safety, and documentation. According to the Centers for Disease Control and Prevention (CDC) SSIs account for 20% of all healthcare-associated infections, and are associated with increased morbidity, mortality, length of say, and readmissions. CDC estimates that SSIs cost the United States healthcare system approximately $3.3 billion annually. Prior to the creation of the surgical IP role, the infection prevention department would attempt to visit the operating room (OR) once per month. Regrettably, this led to a response-oriented approach to SSIs, rather than a proactive one. With over 10,000 surgeries performed in 2020, it became evident that our hospital urgently required a dedicated infection preventionist focusing on SSIs. In 2020, our facility performed 55 craniotomies with one attributed SSI with an infection rate of 1.82. In 2021, we experienced a significant increase in our craniotomy SSIs, with a total of 115 procedures performed and five infections (rate: 4.35). In three of our five craniotomy SSIs, Serratia marcescens was identified as a pathogen causing the infection. Tragically, 40% of infected patients had a fatal outcome which highlighted the critical need for effective infection prevention measures. The surgical infection preventionist (IP) plays an important role on the whole continuum of care for surgical patients. The participants can advocate for adding a dedicated surgical IP. The surgical IP can add value to the surgical team by collaborating with operating room staff, surgeons, physicians, and patients to improve outcomes. The implementation of this role led to estimated savings of $421,770 as well impacts on key metrics such as mortality, length of stay, and readmissions. A devoted surgical IP is a role that every hospita land patient can benefit from. Since adding this dedicated resource to the operating room (OR) team, our team has been able to collaborate with OR staff, physicians and patients to improve outcomes. However, the current state of infection prevention (IP) demonstrates minimal IP support to OR teams. Our facility has the mindset of using collaboration to eliminate surgical site infections. However, very few healthcare facilities will invest in as specific infection preventionist to focus on surgical and procedural areas.