Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115366

Consuelo Dungca, RN, EdD, Office of Clinical Affairs, NYC Health and Hospitals Corporation, Office of Clinical Affairs, Central Office, 125 Worth Street , Suite 427, New York, NY 10013, 212 7883397, dungcac@NYCHHC.ORG and Kathie Rones, MD, Medical Director, Kings County Hospital Center, 451 Clarkson Ave, Brooklyn, NY 11203.

NYC Health & Hospitals Corporation (HHC) is a public health corporation with 11 acute care, 4 long term care, 6 diagnostic and treatment centers, a health and home care agency, a managed care agency and over a 100 community health care clinics. HHC provides health care services to a largely disadvantaged, multicultural and multiethnic population (42% Hispanic, 37% African American, 6% Asian, 8% other minority and 7% Caucasian) with a variety of chronic diseases and little attention to preventive care. Scientific-and evidence - based studies have shown that Quality Improvement (QI) process has made significant impact on improving clinical management approaches and outcomes.

Approximately 27 million surgical procedures are performed each year. The Center for Disease Control and Prevention (CDC) reports post surgical site infections (SSIs) as the third most frequently reported nosocomial infection among hospitalized patients. Hospital acquired infections increase the length of hospital stay by an average of 7.3 days and adds approximately $3,153 to the hospital bill.

HHC Quality Assurance Committee (QAC) of the Board of Directors identified prevention of surgical infections as one of several opportunities to improve care. A task force was created for the purpose of improving care and outcomes of peri-operative surgical patients. The goal is to develop and implement corporate-wide evidence based best practice guidelines and standardizes Quality Improvement measurement methodologies. Upon implementation of established best practice guidelines, the following measures were monitored to ensure compliance to the guidelines:

1. Prophylactic antibiotic within one hour prior to surgical incision 2. Prophylactic antibiotic selection for surgical patients 3. Prophylactic antibiotic discontinued within 24 hours post surgery end time.

RESULT: Implementation of these measures resulted in improved systems, processes, practice and outcomes, e.g. anesthesiology assumed increased responsibility for ensuring administration of prophylaxis; antibiotics are being ordered the night before surgery; and nurses are monitoring antibiotics being discontinued timely. The three measures noted above resulted in improvement in compliance, 85%, 96% and 89% as of April – June 2004.

LEARNING OBJECTIVES: 1. Identify evidence based practices in prevention of post surgical infection. 2. Describe QI monitoring approach to prevent surgical infections. 3. Discuss measurement methodologies and Best Practice Guidelines.

CONCLUSION: A quality improvement approach on improving the management of surgical infections entails a high level of cooperation and commitment from the Governing Body to the clinicians.

Learning Objectives:

• 1.Identify evidence based practices in prevention of post surgical infection.
• 2.Describe QI monitoring approach to prevent surgical infections.
• 3.Discuss measurement methodologies and Best Practice Guidelines.

Keywords: Quality Improvement,

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation