Sunnybrook’s surgical infections
reduced by 40%
TORONTO – A team of Sunnybrook
nurses, surgeons, anesthesiologists, pharmacists and infection control
staff are working together to continue to reduce the hospital’s surgical
site infection rate, sparing many patients the grief and pain of a
post-operative infection and saving the healthcare system thousands of
dollars a year.
Dr. Claude Laflamme, Director, cardio-vascular anesthesia at Sunnybrook,
is known across the country for his work in reducing the rate of
surgical site infections (SSIs). After working with a multi-disciplinary
team to improve the SSI rate of cardiac surgeries, Dr. Laflamme is now
concentrating his efforts on general surgery at Sunnybrook, an
initiative that continues to generate favorable results since it began
just a few months ago.
From August to December 2006, Sunnybrook’s SSI rate was reduced by an
incredible 40 percent in general surgery and continues to decline,
thanks to the efforts of staff in general surgery, infection control,
pharmacy and anesthesiology, as well as nurses in wound-care, the OR
department, same-day admission, the post anesthesia care unit (PACU) and
Surgical site infections account for 17 percent of all hospital-acquired
infections in North America. Each SSI translates into huge costs,
including lengthened hospital stays, delays in chemotherapy treatment
for cancer patients and even death in severe cases.
Financially, each infection can cost the hospital an additional
$400-30,000, with an average cost of $3,500. Most importantly, 60-70
percent of SSIs are preventable.
The Sunnybrook SSI initiative concentrates its efforts on four key
areas: antibiotics, hypothermia, hair removal and glucose control. The
area that has contributed the most to the SSI rate decrease at
Sunnybrook is that of preventing hypothermia in patients during surgery.
Research conducted by Dr. Laflamme showed a 46.4 percent infection rate
in surgical patients who experienced a hypothermic state, compared to
only 12 percent of those who remained normothermic. “We were convinced
that this was the area we needed to invest our time in,” says Dr.
Because of the anesthetic, the body is unable to warm itself as well as
it does under normal circumstances. A 1-2 degree lowering of body
temperature means there is less oxygen flowing to the open wound and the
body is unable to fight infection to its full potential.
To prevent this temperature drop, OR staff were advised to use the
intraoperative warming blankets whenever possible to keep patients’ body
temperatures at a higher level during surgery. Since mid-January,
patients have been provided with a warming blanket before the surgery as
well, to ensure that the body temperature drop is kept at a minimum.
“The co-leader of this initiative, Shari Moura, an Advanced Practice
Nurse in surgical oncology, has been instrumental in the implementation
of this group,” says Laflamme. “We have a group of professionals that
are committed; they make a motivated team. I’m very confident that we
will reduce the SSI rate even more in the following months.”
The entire Sunnybrook SSI initiative is fueled by Safer Healthcare Now!
(SHN), a campaign launched in April 2005 to promote patient safety in
Canadian health facilities. Working under the Canadian Patient Safety
Institute (CPSI) umbrella, SHN focuses on six targeted interventions to
improve patient care. It challenges Canadian healthcare providers to
work at one or more of these interventions by applying evidence already
available in medical literature. Sunnybrook is one of the national
leaders in the Safer Healthcare Now! SSI intervention.
“The point is not to create new information, but instead implement the
theories and information that are already at our disposal,” says Dr.
Laflamme, who is also Assistant Professor in the department of
anesthesia at the University of Toronto. “Reducing the infection rate is
something that doesn’t take a lot of financial investment, but a change
in behavior, in culture. Communication and leadership are instrumental
in this initiative.”
Thanks to funding from Sunnybrook and a CPSI studentship award, Dr.
Laflamme is able to push this initiative even further with the help of
Ewen Weili Chen, a 4th year undergraduate thesis student in the human
biology, psychology and physiology programs at Victoria College,
University of Toronto.
Chen has been working full-time at the hospital, collecting and
analyzing data, helping with research protocol and coordinating staff
for the SSI initiative. “The whole process of preventing infections is
like making bread. If you don’t have one ingredient, the whole loaf is
ruined,” says Chen.
Dr. Laflamme was asked to present his data at the National SHN meeting,
held in Montreal on March 27th and 28th, to motivate other hospital
representatives with the success Sunnybrook has experienced so far with