1 of 17

Reduction Of Surgical Site Infections

Topic : Reduction of Surgical Site infections from 9.5 to 7.5 % among surgical patients done laparotomy at the Kenyatta National Hospital

2 of 17

��Team Members�-Caroline Malingu - Lead�-Dr .Alex Ndungu�-Triphosa Mutungi�-Elizabeth Koigu �-Joseph Ochieng �-Nelly Jepkemboi�-Dr Rhoda Kalondu�-Mary Muchiri��Mentor�-Dr .Kellen Kimani��Sponsors �-Dr. Kennedy Ondede: Director, Surgical �Services�-Dr Gibson Musila- HOD, General Surgery�-Mrs. Rael Oketch, SACN General Surgery�

3 of 17

Problem statement

Laparotomies contribute three-fourths of all surgeries developing surgical site infection(SSI) in the general surgical wards in KNH.
Emergency operations contributed to 68% of SSI.
SSI is a leading cause of morbidity and mortality : it contributes to increased length of hospital stay and cost of treatment which further puts strain on the hospital resources.

4 of 17

Background

The project aims to assure a higher quality of healthcare to patients at a cost that is affordable by reducing length of hospital stays, use of costly antibiotics and wound care products.

It will also showcase evidence based practices in reduction of SSI in resource constrained settings.

5 of 17

Target

To Increase the rate of utilization of cefazolin for surgical antimicrobial prophylaxis(SAP) from 14.5% to 90% by 31^st October 2021

6 of 17

��Baseline�at project start rate of Cefazolin use for SAP 14.5% �at start of intervention rate of Cefazolin use for SAP 43%��

7 of 17

Current State Analysis

8 of 17

Main Root Causes and Key Drivers

1.Staff workload and wasteful motions

2. Lack of awareness on SAP guidelines

3 Closure of floor pharmacy at night

Optimal utilization of staff to complete required tasks

All stakeholders are aware of Hospital Guidelines on SAP

Cefazolin is available in theatre pharmacy on 24 hour basis

9 of 17

Interventions

(1).Conduct sensitization seminars/webinars on AMS Guidelines to all stakeholders

(2)Shift task of ordering of antibiotics from ward nurse to the anesthetist in theatre

(3) Mainstream Policy on ordering of antibiotics for SAP from the Theatre Pharmacy

10 of 17

Results

Standard communication between front desk and medical assistants

New structure for managing add on patients and exams

11 of 17

Results

New structure for managing add on patients and exams

13 of 17

Results : reduction of wastage from process redesign

ELECTIVE ADMISSION

REVIEW & PRESCRIPTION OF ANTIOBIOTIC BY ANAESTHETIST

REQUISITION & ISSUING OF ANTIOBIOTIC BY PHARMACY 5

EMERGENCY ADMISSION

REVIEW AND PRESCRIPTION OF ANTIBIOTIC BY SURGEON

REQUISITION AND ISSUING OF ANTIBIOTIC BY A+ E PHARMACY

PRE-OP ANTIBIOTIC CHECKLIST COMPLETED AT THEATRE RECEIVING AREA

INTRA-OP ADMINISTRATION OF ANTIBIOTIC BY ANAESTHETIST

?? REPEAT DOSE NEEDED

Decision to operate( elective/ emergency)

Patient wheeled to receiving area

Anaesthetist orders antimicrobial with other anaesthetic drugs

Antimicrobial is dispensed by theatre pharmacy

Antibiotic administered by anaesthetist

14 of 17

Impact on Outcomes

Reducing number of motions to pharmacy has freed up time for nursing staff for other duties
Impact assessment on SSI rate pending

15 of 17

Sustain Plan

Interventions to sustain	Owner	Sustain method and frequency	Report to
Sensitize all new registrars on SAP guidelines	AMS Committee	Sensitize during induction to clinical areas	Hospital therapeutics Committee
Information , education and communication(IEC) materials are prominently displayed	Chair , SSI Committee of General Surgery	Adapt algorithms from the AMS Guidelines and display on noticeboards	HOD, General Surgery

16 of 17

Key Learning Points

Health care systems are complex, no improvement process is easy
Defining the problem is the most important factor in any QI initiative

Next Steps

Adapt decision algorithms for SAP for ease of reference
Spread the sensitization on AMS to other surgical departments
Embed QI teams/champions in all improvement initiatives
Utilize A3 to document process improvement programs in KNH