Columbus, OH - May 2016
A large team quality improvement effort has enabled the Department of Orthopaedics at Nationwide Children's Hospital to surpass the milestone of 1,100 days without a surgical site infection in spinal fusion operations.
The streak is still going. So far, 343 patients have undergone 355 surgeries, many lasting six to eight hours.
The majority of patients had idiopathic scoliosis. A small number were diagnosed with congenital scoliosis, and 107 suffered from cerebral palsy, myelomeningoceles or other forms of neuromuscular scoliosis that were often complicated by compromised immune systems and other comorbidities.
"There's not one person in charge of this; it's really the hospital and all the players involved with the surgery who see this as a priority," Allan C. Beebe, MD, director of Pediatric Orthopaedic Trauma at Nationwide Children's, says of the zero infection effort.
"Infections are costly, no matter the cause," continues Beebe, who is also president of the hospital's Medical Staff and an assistant professor of Orthopaedics at The Ohio State University College of Medicine. "We try to address everything we have control over."
"A surgical site infection can result in increased patient morbidity, longer hospital stays, an increased financial burden on the family , repeated antibiotic treatment, multiple operations and even removal of hardware," says Crystal Seilhamer, MSN, RN, CNP, CNOR, spine coordinator in the Department of Orthopaedics at Nationwide Children's.
"It's a huge, huge deal for the patient and family," Seilhamer says. "To reduce the number of infections, developing and maintaining a team that consistently cares for patients is the key."
That team includes orthopedic surgeons, physician assistants, nurse practitioners, circulating and scrub nurses and technicians. The rest of the operating room and post-operation staffs, and anesthetic, neuro-monitoring and perfusion specialists have roles as well. Essentially, everyone involved has a responsibility to minimize infection risk.
The spinal team began looking hard at improvement after the hospital began the Zero Hero patient safety program in 2008. The program challenges all Nationwide Children’s employees to think of complications as events that can be reduced, prevented and ultimately eliminated.
At Nationwide Children's, spinal fusion surgeries averaged about one surgical site infection every nine months from 2008 until late 2013. Then the current zero-infection streak began.
Among the reasons for success, team members say, is the practice of using two spine surgeons to operate on each patient, which helps minimize time in the operating room and blood loss.
Further, the team adheres tightly to guidelines for the application of prep solutions used to reduce microorganisms on the skin, antibiotic usage and dosage, sterile draping measures and incision management. The guidelines are based on the most recent national data and local experience.
After fine-tuning their protocols, the team learned to measure their consistency, which has helped them reach the milestone.
"We know we'll have an infection at some point — we can't go forever without one," Seilhamer says. "But what we know works will get done in each surgery."