A key aspect of many quality improvement programmes is that their success can’t be evaluated over a short time-span.
This is because building the momentum needed for sustainable improvements takes time. Changes tend to be incremental but with a cumulative benefit.
This year’s interim evaluation of the surgical site infection improvement programme (SSIIP) is a milestone for several reasons, including the timely overview it provides of the ways in which programmes at the Commission evolve and mature.
The evaluation report – independently undertaken by Sapere Research Group – covers the programme’s development and initial findings about its impact.
Tracing the programme’s history
As stated in the report, the use of surveillance systems as a means of reducing surgical site infection in New Zealand was a matter of national policy consideration for several decades.
Recommendations for a national surgical and procedural site infection surveillance programme were made in 2010 – several months before the Commission was established - and by June 2011 the Commission Board had agreed to establish a national programme with a staged approach to implementation.
The headlines of news updates on the Commission’s website tell a story of their own:
- pilot sites chosen to survey surgical site infections
- national roll-out: Surgical Site Infection Surveillance Programme
- information for surgical patients on avoiding infections
- surgical skin antisepsis
- regional infection prevention and control meetings
- automated data collection system being tested
- multidisciplinary focus on reducing surgical site infections
- change to orthopaedic surgery reporting
- systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery
- participants confirmed for anti-staphylococcal bundle collaborative for surgical site infection
A robust evaluation framework
The SSIP will complete its fifth year in 2018. Around mid-year a final, summative evaluation report will be delivered with conclusions about the benefits that have been achieved from the programme and lessons learned.
This will build on the interim report, which has identified consistent and on-going progress with programme implementation. A point that is highlighted is the enhancement of capability building with activities that have changed as the programme has matured and that are valued by DHB participants.
Importantly, the strong and clearly articulated purpose for the programme is credited with enabling the Commission Board and the wider sector to take a long-term view on continued investment in the programme.
Gary Tonkin, a senior portfolio manager at the Commission, says the interim report provides positive findings about the programme’s implementation and the difference it is making, as well as useful recommendations for ongoing improvements. Next year’s summative evaluation report will be an update on progress and add context to these findings, as well as providing further analysis of the programme’s impact.
This is the first time New Zealand has had a national patient safety initiative with the specific goal of reducing harm caused to patients by surgical site infections (SSIs).
“We know a significant number of SSIs are preventable. Through the SSIIP we now have a consistent and evidence-based approach for supporting and monitoring ongoing improvements.”
Hip and knee replacement surgeries were the first procedures included in the SSIIP.
Dr Arthur Morris, SSIIP clinical lead, says it is positive to see the evaluation report has found evidence of a 25 percent reduction in the SSI rate for hip and knee replacements.
“There is evidence that the uptake of the bundle of recommended practice interventions has steadily increased.
“This report indicates that when the three interventions of antibiotic prophylaxis timing and dose, and skin preparation, are delivered the odds of an SSI occurring in a procedure are 40 percent lower than the odds for a procedure that has not received all three.
“This speaks volumes for taking simple actions proven to help keep patients safe. Over time this approach is key to achieving a cycle of continuous quality improvement and converting interventions into everyday practice.”
Having already extended the procedure focus of the SSIIP into cardiac surgery in recent years, Gary Tonkin says it is equally positive that the evaluation report shows evidence that the SSIIP is fostering practice change for other surgical procedures.
“There is some evidence of DHBs using the SSIIP interventions in other procedures, such as general surgery, plastics and caesarean section surgery.“
“We have certainly come a long way and a pivotal factor in the successes to date has been the support and input from the people who have championed the SSIIP at a local level and nationally. This includes a range of clinical leadership – infection prevention control practitioners, surgeons, clinical microbiologists, perioperative nurses and others,” says Gary.
“There is a lot we can still do to improve and that, in fact, is the value of evaluation reports. With the insights and learnings in this interim report we have some very clear signposts for the design and planning of the next phase of programme activity.
“Refining and improving the SSIIP and supporting its evolution is no small feat and we thank everyone involved for all the enthusiasm and commitment they have put into it.”