Friday, August 3, 2012

CUSP and Surgical Site Infections

A Comprehensive Unit Safety Program (CUSP) in the OR can result in positive outcomes as published recently in the Journal of the American College of Surgeons.

One year of pre- and post-CUSP intervention SSI rates were collected using the high-risk pilot module of the American College of Surgeons National Surgical Quality Improvement Program. Surgical Care Improvement Project process measure compliance was monitored using standardized methods. 

The surgical best practices intervention were as follows:

  • standardization of skin preparation
  • administration of preoperative chlorhexidine showers
  • selective elimination of mechanical bowel preparation
  • warming of patients in the preanesthesia area
  • adoption of enhanced sterile techniques for skin and fascial closure
  • addressing previously unrecognized lapses in antibiotic prophylaxis. 

The results? Not surprisingly, the SSI rate improved. The mean baslinee SSI rate was 27.3% (76 of 278 patients). Following the intervention the the rate was 18.2% (59 of 324 patients)-a 33.3% decrease (95% CI, 9-58%; p < 0.05).  There was no difference in surgical process measure compliance as measured by the Surgical Care Improvement Project during the same time period, suggesting that this was not a coonfounding variable.

One paper does not define science, however, this quasi-experimental study suggests that evidence based interventions can help reduce the rate of SSIs. The challenge is to implement and sustain the interventions. The CUSP model is a viable implementation strategy, even in the OR.

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