Surgical Site Infections (Class I and II)
Surgical Site Infections Per 100 Procedure Days
The most important single recommendation of the IHI bundle for preventing surgical site infection (SSI) is the proper administration of prophylactic antibiotics for selected "clean" (class I and class II) surgical cases: right drug, right dose, right timing and proper redosing when needed.
| |
March 2008 |
Surgical Site Infections (Class I and II): How often do patients acquire an infection as a result of surgery?
(The number of surgical cases per 100 procedure days where patients developed an infection following surgery)
View our performance over time. (.pdf, 21k) |
0.4 |
When we began our initiative, we were correctly administering prophylactic antibiotics less than 65 percent of the time. Today, nearly 100 percent of our class I and class II surgical patients receive antibiotics within 60 minutes before the initial incision and timely redosing during procedures that last more than four hours.
Creating a reliable system for ordering the antibiotic in advance and administering it in the correct sequence took cooperation from surgeons, nurses and anesthesiologists.
Multiple safeguards were built into the operating room system to achieve success.
- A new field in the computer screen used by our surgical schedulers identifies the procedures for which antibiotics are required. This reminder is placed in the OR schedule for nurses and anesthesiologists to see.
- The referring surgeon must specify the antibiotic when the OR time is scheduled, and an order is sent to the Same Day Surgery nurses, who forward it to the Pharmacy.
- On the day of surgery, a medication nurse confirms that the Pharmacy has sent the right antibiotic and double checks the accuracy of the dose and the patient weight.
- During the pre-op checkup, the nurse puts an orange bracelet on the child as a reminder to the anesthesiologist, who gives the medicine after the child has fallen asleep.
- The administration of the antibiotic is confirmed during the surgical "time-out" prior to beginning the procedure.
In addition to these important process changes, the improvement team focused on reducing bacteria on the skin. Based on evidence, the team approved three skin preps for use by Cincinnati Children's surgeons.
Parents are involved in the prevention process. For selected high-risk procedures, parents are given a small bottle of "special soap" containing chlorhexadine and asked to give their child an antibacterial bath or shower the day before surgery. For all surgical patients, on the day of the operation, parents wipe the site with a chlorhexadine cloth.
We also have focused particular attention on specific procedures known to be at higher risk for infection.
As a result of consistent application of these and other improved processes, there has been a significant reduction in surgical site infections in class I and class II cases.
Back to Top
Surgical Wound Classifications
We use the wound classification system developed by the Centers for Disease Control:
A class I surgical wound is a clean wound. This means that the wound is free from infection and inflammation. With class I surgical wounds, the respiratory, alimentary (digestive tract), genital or uninfected urinary tract is not part of the surgical procedure.
A class II surgical wound is a clean-contaminated wound. This is a wound in which the respiratory, alimentary (digestive tract), genital or urinary tracts are entered under controlled conditions and without unusual contamination. Operations involving the biliary tract, appendix, vagina and oropharynx are considered class II wounds.
Back to Top
We Want Your Feedback
We would like to know what you think of the information presented here. Please send us an email to let us know if you found this web page helpful and easy to understand, or if you there's any additional information you need but couldn't find (childrens-quality@cchmc.org).
Back to Top
Last updated May 2008.
