Mr Simon R Dodds, a consultant general surgeon, at University Hospitals Birmingham, provides an insight into how a successful improvement initiative achieved a sustained 80% reduction in surgical site infection using a care bundle.
The pioneering work of Lord Lister, over 100 years ago, led to the adoption of aseptic techniques that make surgical procedures safer and more accessible to all. Despite the stringent aseptic protocols, surgical site infections (SSIs) still account for about 20% of hospital-acquired infections. In clean surgery, the primary reason is that surgical wounds are contaminated with the patient’s own skin bacteria. We continue to strive to reduce SSIs to near zero. Many approaches have been explored using multiple randomised controlled trials (RCTs) but no single intervention has been shown to be a clear game-changer. One plausible cause for this is that SSIs are multi-factorial, so addressing one factor at a time appears ineffective.
Over the last 25 years, there has been a steady rise in the adoption of continuous improvement methods, which differ from RCTs in that they are more pragmatic and use a before-and-after approach of measuring a baseline, introducing a plausible intervention, and observing the effect. This is called a ‘Context-MethodObservation’ (CMO) approach.1
In 2012, the US Institute of Healthcare Improvement (IHI) published a white paper that shared robust evidence of the benefits of an intervention called a ‘bundle of care’. The evidence came from studies in critical care where the risk of ventilator-acquired pneumonia had been dramatically reduced.2
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