Taking a Deeper Dive; Mitigating Modifiable Risk Factors for Spinal Fusion Surgical Site Infections

Background Surgical Site Infections (SSIs) are serious complications of spinal fusion surgery. Identifying modifiable risk factors unique to this population can provide insight into prevention strategies. Evidence demonstrates that intradisciplinary process improvement teams can be helpful in identifying gaps in processes. Methods In response to a 12 month spinal fusion standardized infection ratio (SIR) of 3.0 (P=.003) we formed an interdisciplinary improvement team. Personnel representing all phase of surgery, infection prevention, infectious disease, and sterile processing were represented .Members assessed all elements of perioperative care to identify compliance with evidence based guidelines, cleaning and sterilization processes, postoperative management, and transitions of care. SSI data was presented and reviewed. A process flow map was used to identify risk points and gaps. As opportunities were identified, they were rank ordered based upon infection risk and likelihood of successful intervention. The top five issues were addressed and an implementation plan was developed. Results Review of records identified skin and fecal flora as predominate organisms. Gaps in timeliness of vendor tray delivery, inability to effectively clean kerrisons prior to sterilization, staff turnover for break relief during implantation, variations in skin prep and use of patient's dirty back braces brought from home were prioritized based upon the pre-established criteria.The following interventions were implemented: Chlorohexidine Body Wipe process in Pre-Op revised (Nose to Toes application) Vendor Consigned/Loaned Trays in Sterile Processing changed to required 48 hour turnaround OR staff scheduling adjustments for break and lunch relief Purchased take –apart Kerrison rongeurs New back braces were ordered for specified patients Fiscal year 2019 SIR decreased from 3.0 to 1.1 after interventions (P=.03) Conclusions Interdisciplinary teams are effective in identifying gaps in practice that are unique to specialized surgical populations. Interventions based upon process gaps can result in improved patient outcomes.