Teams continue to work together to lower risk of surgical site infections

Working together to improve quality and safety for our patients and their families is an ongoing process. Our goal is to continually improve quality care by creating an environment that empowers everyone to make improvements every day. In perioperative services, this means focusing on how to reduce surgical site infection (SSI) rates in our patients.

Over the last year and a half, representatives from colorectal surgery, anesthesia, obstetrics and gynecology, pharmacy, nursing, endocrinology, cardiothoracic surgery, and the Quality Improvement Program have come together to outline the common causes for these infections and determine ways to prevent them.

“Processes in hospitals are very complex,” says Jorge Salinas, MD, clinical assistant professor of internal medicine and hospital epidemiologist at University of Iowa Hospitals & Clinics. “It’s rare for processes to live in a silo. It’s so important for interdisciplinary groups to regularly come together to study how to constantly improve these processes across the care continuum for our patients.”

As a result, the team launched a new protocol that required a more stringent checking of blood glucose levels pre-surgery and post-surgery for patients needing colon and cardiac bypass surgeries. If a patient’s blood glucose reaches a certain level, the patient is required to receive insulin to help bring the blood glucose level back down.

The goal was to reduce the risk of SSIs by lowering the risk of hyperglycemia. A patient with hyperglycemia has a raised blood glucose level because there is too much sugar in the bloodstream. Patients with or without diabetes can experience hyperglycemia on the day of surgery because of stress or other reasons. Treatment of hyperglycemia with insulin is purported to reduce the risk of complications, including infections, and is supported by research.

Since implementing the new policy and in conjunction with other quality improvement initiatives, the infection rate in patients needing colon surgery has decreased by 40%, and there have been no reported instances of hypoglycemia. Seeing the positive impact in one patient population, the multidisciplinary team began looking at how to apply this new protocol to procedures across the institution.

In July, the cardiothoracic surgery team implemented the blood glucose protocol for patients needing a coronary artery bypass graft surgery. It is still too early to measure the impact, but we will continue to monitor the rate of infection in these patients and review and update the protocol to ensure we continue to provide safe care for our patients.

“This is one example of successful cooperation of an interdisciplinary team to achieve a common goal,” Salinas says. “We all care about our patients and their safety and have prioritized how to make our procedures better.”

The implementation of this policy showcases how teams across the institution are working together every day to successfully implement innovative solutions. Do you have ideas to help improve quality and safety in your work area? Share them with your leader or reach out the Quality Improvement Program (


    • Tracey, The Loop is an open website, so you can just copy the web address/URL and send that to them.

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