Providence Alaska Medical Center Surgical Infection Prevention Collaborative team members included (from left):
Betty Gwaltney, RN; Peter Jensen, MD; Kelly Foreman, RN; Kim Mynes-Spring, RN; Barbara Chen, MD; Paula Case, RN, and Gary Welch, RN.

This story originally appeared in Qualis Health Quarterly, Summer 2003.

As one hospital that pioneered new approaches to reducing surgical infections, Providence Alaska Medical Center (Anchorage, Alaska, USA) has proven that determination, focus, and motivation make a difference when it comes to improving health care quality.

Through participationin the National Surgical Infection Prevention (SIP) Collaborative in 2002-2003, Providence Alaska met or exceeded the improvement goals of the project — such as timely and appropriate administration of antibiotics and maintenance of proper body temperature — and now is in a position to teach other hospitals how to do likewise. 

Surgical infection is a major cause of patient injury, mortality, and health care cost. Each surgical infection is estimated to add roughly seven days to the patient’s hospital stay and more than $6,000 in costs.

"We’ve raised our level of consciousness and put systems into place that will result in improvements in the operating room," according to Gary Welch, RN, assistant chief nurse who served as team leader at Providence. "We’re not talking about earth-shattering, ground-breaking results. It was a lot of subtle changes."

These are the quality of care goals that Providence Alaska focused on in the Collaborative, and their results in the yearlong initiative that ended in March 2003:

• Eighty percent of eligible surgical patients will receive prophylactic antibiotic within one hour before surgery. Baseline: 49 percent; final: 88 percent.
• Sixty-five percent of prophylactic antibiotics given before surgery will be discontinued within 24 hours of surgery. Baseline: 54 percent; final: 61 percent.
• Eighty percent of patients will have proper body temperature before, during and after surgery. Baseline: 67 percent; final: 64 percent.
• Half of cardiac patients will have proper blood glucose levels through second post-operative day. Baseline: 19 percent; final: 69 percent.
• All eligible surgical patients will get timely, appropriate prophylactic antibiotics. Baseline: 49 percent; final: 88 percent.
• All patients who have hair removed for surgery will have their hair clipped, not shaved. Baseline: 46 percent; final: 99 percent.
• The percentage of surgical staff who achieve a 90 percent proficiency in surgical infection prevention knowledge will double: Baseline: 2 percent; final: 99 percent.

At a statewide meeting in February 2003, clinical leaders from Providence Alaska shared their results and methodologies with more than 100 participants from other hospitals around the state. Through this "spread" process, improvements in the health care delivery system will reach more providers and patients.

Examples of change concepts used by teams to ensure appropriate use of prophylactic antibiotics include designating responsibility for antibiotic administration; educating operating room staff; revising orders, clinical pathways, and order sheets; and standardizing antibiotic administration to occur with a commonly performed activity that occurs within one hour before surgery.

"The Providence Alaska team definitely demonstrated the kind of breakthrough results that can occur when there is the will to make changes and the evidence-based ideas for change are executed in an effective manner," according to Rosa Johnson, ARNP, MN, CPHQ, of Qualis Health, a member of the leadership team.