Strategies for active OR quality improvement
Using improvement science to drive change in the operating room
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With rigorous surveillance measures, OR teams can reduce their infection rates and understand where in their OR workflow practices are working or not. In this podcast, our guest Jennie Wilson takes an objective look at OR practice and examines the practical resources and best practices available for preventing SSI and the change management and improvement science processes needed to make change across the practice.
In this podcast, Professor Jennie Wilson shares insights from her work with surgical site infection surveillance and quality improvement processes. Surveillance is key. Starting in the 1980s, epidemiologist Dr Robert Haley started talking extensively on surveillance and measuring rates of infection, arguing that feeding that input back to clinicians was critical to improving practice and reducing infection.
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Why construct a culture of safety?
Hospitals with low infection rates have a strong safety culture within their OR teams, always reinforce best practice, and have good leadership in place to ensure that from the top down, safety is everyone’s responsibility.
Implementing a safety culture
Basic techniques and safety concepts can be applied in real-world practice. These include everything from skin protection and cleansing to patient warming, from draping to instrument handling.
Overcoming barriers safety culture
It’s necessary to think about how things are done to be able to do them better by demonstrating there is a problem (which requires surveillance and data), process mapping and plan-do-study-act (PDSA) processes. Driving change and new ways of working in the operating room is a challenge, but these improvements have a significant impact on reducing SSI and other patient outcomes.
Driving change in the OR can make a big difference. Ready to learn more?
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Resources:
- Hollnagel E., Wears R.L. and Braithwaite J. From Safety-I to Safety-II: A White Paper. The Resilient Health Care Net: Published simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia 2015. https://www.england.nhs.uk/signuptosafety/wp-content/uploads/sites/16/2015/10/safety-1-safety-2-whte-papr.pdf
- Haley Robert W. Et.al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospital. American Journal of Epidemiology 1985;121:2:182–205. https://doi.org/10.1093/oxfordjournals.aje.a113990 Only abstract available.
- Cambell D, A. Et.al. Surgical Site Infection Prevention: The Importance of Operative Duration and Blood Transfusion—Results of the First American College of Surgeons–National Surgical Quality Improvement Program Best Practices Initiative. 2008;207;6:810-820. https://www.sciencedirect.com/science/article/abs/pii/S1072751508013185
- US CDC website for SSI surveillance. https://www.cdc.gov/nhsn/index.html
- CDC’s National Healthcare Safety Network is the nation’s most widely used healthcare-associated infection tracking system. www.cdc.gov
- UK SHA ( Health Security Agency) https://www.gov.uk/guidance/surgical-site-infection-surveillance-service-ssiss
- Simon F.E. Harald K Guy A.M E.Al. Patient safety in the operating theatre: how A3 thinking can help reduce door movement. International Journal for Quality in Health Care. 2014;26:4:366-371. https://www.jstor.org/stable/45128004
- Crolla RMPH, van der Laan L, Veen EJ, Hendriks Y, van Schendel C, et al. (2012) Reduction of Surgical Site Infections after Implementation of a Bundle of Care. PLoS ONE 7(9): e44599. doi:10.1371/journal.pone.0044599. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0044599
- Dixon-Woods M, McNicol S, Martin G. Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature. BMJ Qual Saf 2012;21:876–884. doi:10.1136/bmjqs-2011-000760. https://qualitysafety.bmj.com/content/21/10/876.short
- The one together website https://www.onetogether.org.uk/home/
- European Centre for Disease Prevention and Control. Healthcare-associated infections: surgical site infections. In: ECDC. Annual epidemiological report for 2017. Stockholm: ECDC; 2019. https://www.ecdc.europa.eu/en/publications-data/healthcare-associated-infections-surgical-site-infections-annual-1
- World Health Organization. (2018). Global guidelines for the prevention of surgical site infection, 2nd ed. World Health Organization. https://apps.who.int/iris/handle/10665/277399. License: CC BY-NC-SA 3.0 IGO.
