Reducing surgical-site infections for coronary artery bypass graft patients

This study focuses on reducing SSI for coronary artery bypass graft(CABG) patients at a large safety-net hospital. The SSI rate in 2010–11 hovered around 20%. The overall goal is to reduce CABG-SSI incidence by 25% (to < 15%) and measure its sustainability. A system-approach is employed which takes into account the interdependency of preoperative, intraoperative and postoperative processes. A decision tree model and a simulation-optimization model are developed to identify critical infection factors. Implemented changes involve pre-op sterilization, aggressive nasal cleaning, proper hair-clipping, and optimized antibiotics prophylaxis timing and dosage. E-alerts are also implemented for documentation to facilitate compliance and training. The site realized a drop of 65% in SSI (from 23% to 8%) in the first six months. It achieved zero percentage thereafter and sustained that rate for 18 months. The system-approach is generalizable and is currently being explored for rectal-colon cancer and hysterectomy, the second most common elective surgery among American women.