Open | Clinical leadership aids surgical site infection improvement programme

Clinical leadership has made a real difference to the Health Quality & Safety Commission’s Surgical Site Infection Improvement (SSII) programme. Early on, it was recognised clinical leadership was crucial for communicating and engaging with front line health care workers, senior managers and consumers, and spreading change.

From October 2013 to March 2014, the Commission’s Open for better care campaign focused on the national SSII programme. Established by the Commission as a key component of the Infection Prevention & Control (IPC) programme, the SSII programme was piloted in eight district health boards (DHBs) before being rolled out nationally in July 2013.

Dr Arthur Morris (clinical lead, SSII) featured prominently throughout the programme’s six-month Open campaign focus. He was involved in a ‘road show’ of grand round presentations to DHB staff about surgical site infection (SSI) prevention, the SSII programme and the recommended interventions for reducing SSI risk. Arthur joined with clinical leaders in surgery, anaesthesia, clinical microbiology and nursing to host webinars and videos focused on the interventions and engaging with consumers.

Dr Morris and Dr Sally Roberts (clinical lead, IPC) consulted with the sector in late 2013 on the programme’s quality improvement interventions and the associated quality and safety marker (QSM) targets.

The targets are:

• antibiotic given 0–60 minutes before “knife to skin” – 100 percent
• right antibiotic in the right dose – cefazolin single dose ≥2g with cefuroxime ≥1.5g as an alternative prophylactic agent – 95 percent
• skin preparation using chlorhexidine or povidone iodine in alcohol – 100 percent.

The first national set of hip and knee replacement SSI QSM data (April 2014) provided a baseline for ongoing improvement. The SSII programme’s most recent December 2015 results, highlighted how multidisciplinary teamwork and commitment from clinicians and DHB management have achieved significantly improved performance since the programme began.

DHB performance for the recommended antibiotic prophylaxis dose was 95 percent (baseline: 64 percent), prophylaxis timing was 96 percent (baseline: 89 percent) and skin preparation was 99 percent (baseline: 97 percent). There has also been a significant improvement in the duration of post-operation antibiotic prophylaxis, which was stopped within 24 hours in 93 percent of cases (baseline: 56 percent).

For the past 12 months, the SSII programme also has been working with regional multidisciplinary IPC networks to develop and strengthen forums for peer support and opportunities to share learnings. They aim to encourage an integrated approach to IPC and patient safety, and create an environment to help sustain and spread ongoing improvements in practice.