PC150. A Comprehensive Quality Improvement Initiative to Reduce Surgical Site Infections Following Peripheral Vascular Surgery

Surgical site infections (SSIs) are one of the leading causes of thirty-day readmissions following vascular surgery, add to patient morbidity, and increase cost. The reported incidence of SSIs following vascular surgery ranges from 2% to 30% and is higher than many other "clean" procedures. The rate of SSIs following lower extremity vascular surgery at our institution was well above the national benchmark of 7% to 10%. This prompted development and implementation of a comprehensive quality improvement initiative (QII) initiative to reduce SSIs. This study analyzes and compares preoperative, intraoperative and postoperative factors previously identified as predictors of SSIs before and after the implementation of our QII. The vascular surgery department at our institution developed a change in clinical practice in all aspects of the care of the vascular surgery patient as a QII to reduce the incidence of SSIs. After performing a literature review and identifying factors linked to SSIs, we developed protocols and provided education to physicians and ancillary staff regarding these goals of care. We then developed a retrospective database of all vascular bypass surgeries involving an infrainguinal incision in the 12-month periods before and after introduction of our initiative to identify factors most influential in reducing SSIs. During the study period 294 patients met the inclusion criteria. The percentage of patients with development of SSI decreased postimplementation (5% vs 13% pre-implementation; P = .0217). In comparing pre-implementation and postimplementation of our initiative, there were significant differences in the following: histories of insulin dependent diabetes mellitus (DM), cardiovascular accident (CVA), claudication, tissue loss, or trauma as indication for procedure; long duration of procedure, stapled wound closure; preoperative hair removal, preoperative/postoperative bactroban, preoperative antibiotics, recommended antibiotics dosage change, use of postoperative order set, discharge with anticoagulants and discharge with home health. In comparing development of SSI versus no SSI, after adjusting for implementation (pre-initiative and postinitiative) accordingly, the following risk factors were found to be significant: diabetes mellitus (odds ratio [OR], 7.061; 95% confidence interval [CI], 2.805-17.774); readmission within 30 days from surgery (OR, 14.787; 95% CI, 5.724-38.200); gender female at higher risk (OR, 3.064; 95% CI, 1.353-6.938); and preoperative hair removal (OR, 0.251; 95% CI, 0.087-0.726). Change in recommended preoperative antibiotics also led to decrease in SSI, although not statistically significant. Implementation of a comprehensive QII, increased awareness, and education of physicians and ancillary staff led to a significant reduction in the incidence of SSIs.