Study Aims to Stop SSIs

Groundbreaking research in HCA Healthcare facilities leads to reduced post-op infections

A recent collaboration between HCA Healthcare and the University of Iowa has led to better, safer care for patients – and done so in record time.

The Study To Optimally Prevent Surgical Site Infections in select cardiac and orthopedic procedures, or STOP-SSI, was conducted in 20 HCA Healthcare hospitals. It focused on individuals who were undergoing cardiac or joint-replacement procedures, and put into place a series of advanced procedures designed to reduce the opportunity for infection to take root in their surgical sites, says Edward Septimus, MD, medical director of infection prevention and epidemiology with HCA Healthcare’s Clinical Services Group.

“We were looking at joint replacement and open-heart surgeries, because if someone is colonized with Staph aureus (MSSA or MRSA), then their chances of having a post-operative infection is significantly higher than someone who is not colonized with these organisms,” Dr. Septimus says. “What we wanted to do was find a way to lower that risk, and we were able to do so.”

The most common and effective way to get rid of the staph bacteria on the skin and nose before surgery is to put a specific ointment, Mupirocin, into a patient’s nose. That’s followed by an antiseptic bath in a chlorhexidine (CHG) solution for optimum effect. The study, which was completed by researchers at HCA Healthcare and University of Iowa, with funding from the U.S. Agency for Healthcare Research and Quality and in collaboration with the research arm of The Joint Commission, set out to establish protocols for the duration and frequency of these pre-op measures.

“If someone tested positive for either MSSA or MRSA by nasal swab before surgery, then we began a five-day decolonization regimen,” Dr. Septimus explains. “And if a patient wasn’t colonized with MSSA or MRSA, they still received a bath the night before and the morning of their surgery, as a preventive measure.”

Major outcomes in record time

Because of its size, HCA Healthcare is able to bring a lot — in this case, 20 facilities — to the table. That meant that the study could be done in a much shorter timeframe than is usually possible. It also meant that significant data was collected, and outcomes reported, quickly.

“We were able to show that these efforts reduced complex, deep infections by 42 percent,” Dr. Septimus says. “And we were able to do this in 20 hospitals, over a year and a half, because we had access to more than 40,000 surgical procedures.”

HCA Healthcare has a long and successful track record for these types of major studies, and is routinely sought out by academic institutions, government agencies and private entities as a collaborative partner.

“We are very efficient and respected, and our partners know they will obtain meaningful data and support from us,” Dr. Septimus says. “And these collaborations are great not just for HCA Healthcare, but the patients who entrust us with their care. Because many of our hospitals are medium-sized, community-based facilities, our results are generalizable to most hospitals in the United States. They are very proud that they get to take part in creating better ways to take care of patients, and, more importantly, the patients benefit since we will implement these new care regimens in all of our facilities.”

In facility terms, more is better

“As a learning healthcare organization, we can bring to the table the ability to conduct these studies at lightning speed in terms of the amount of data, patient volumes and statistical significance produced as outcomes,” adds Julia Moody, director, infection prevention. “We are able to provide central coordination from our corporate headquarters, and from there, reach out to all the hospitals by way of webinars, coaching calls, tool kits and lots of other communication. We also can create compliance-checking tools and other rapid adoption assessment tools so that we can make sure all the staff involved know what’s going on. The big winners are the patients with infections avoided based on the care delivered by the healthcare teams.”

Now the new procedures will be rolled out to all HCA Healthcare hospitals offering these types of surgeries, adds Jason Hickok, AVP, research and academic affairs, infection prevention and lab.

“As was proven with our ‘Reduce MRSA’ study, leadership participation at the local level is key, because leaders become highly engaged with relationship-building with staff and surgeons and provide the support needed for high protocol compliance,” Hickok says. “Now our goal is to get the protocol training completed enterprise-wide, so that we can hard-wire these infection-prevention practices throughout HCA Healthcare.”