scholarly journals Prevention of spinal fusion post-operative wound infections in pediatric patients with scoliosis: a quality improvement initiative

2021 ◽  
Author(s):  
Elizabeth Partridge ◽  
Dean Blumberg ◽  
Rolando F. Roberto
Keyword(s):  
Quality Improvement ◽  
Spinal Fusion ◽  
Infection Rate ◽  
Neuromuscular Scoliosis ◽  
Quality Improvement Intervention ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Wound Infections ◽  
Deep Wound ◽  
Operative Wound

Abstract Purpose Post-operative wound infections increase patient morbidity and mortality as well as the length of hospital stay, with a profound personal and institutional cost. The aim of this study was to decrease post-operative infections through development of a surgical antibiotic prophylaxis policy based on institution-specific risk factors and microbiology data. Methods We conducted a retrospective review of deep wound infections at our institution over a 5-year period (2014–2018). 399 spinal fusion procedures were performed with a 2.5% post-operative infection rate. Patients with neuromuscular scoliosis were six times more likely to develop deep wound infections (7.6%) compared to patients with congenital and idiopathic scoliosis (combined rate of 1.25%). The microbiology data revealed that polymicrobial, extended spectrum beta-lactamase (ESBL) gram negative organisms predominated in patients with neuromuscular scoliosis. Based on these findings, we implemented an evidence-based quality improvement intervention: all patients with neuromuscular scoliosis undergoing spinal fusion were given a single 15 mg/kg dose of amikacin, in addition to our standard practice of perioperative cefazolin plus vancomycin with intra-operative betadine wash and vancomycin powder application. This intervention was put into practice in January 2019. Results Since the implementation of our quality improvement initiative, the overall post-operative infection rate decreased to 1.1% (2 infections in 176 cases). Ninety-eight percent of the 43 neuromuscular scoliosis patients who underwent spinal fusion in the post-intervention time frame have remained infection free. Conclusion Examination of post-operative infection and microbiology data at the institution level can guide the development of institution specific, evidence-based quality improvement initiatives that reduce post-operative wound infections.

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

2021 ◽  
Author(s):  
Marcus Rickert ◽  
Michael Rauschmann ◽  
Nizar Latif-Richter ◽  
Mohammad Arabmotlagh ◽  
Tamin Rahim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Wound Infection ◽  
Spinal Fusion ◽  
Negative Pressure Wound Therapy ◽  
Wound Infections ◽  
Wound Therapy ◽  
Postoperative Wound ◽  
Deep Wound ◽  
The Impact

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

scholarly journals Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Alfred Kwesi Manyeh ◽  
Tobias Chirwa ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

Abstract Background Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana. Method A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area. Results The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment. Conclusion The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.

A quality improvement project to reduce restrictive interventions in a mental health service

2021 ◽  
pp. 1-12
Author(s):  
Darren Savarimuthu ◽  
Katja Jung
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Positive Impact ◽  
Essential Elements ◽  
Quality Improvement Project ◽  
Psychiatric Ward ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Evidence Based ◽  
Improvement Project

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

scholarly journals Evidence-based development of a nephrotoxic medication list to screen for acute kidney injury risk in hospitalized children

2019 ◽  
Vol 76 (22) ◽  
pp. 1869-1874 ◽  
Author(s):  
Elizabeth Goswami ◽  
Richard K Ogden ◽  
William E Bennett ◽  
Stuart L Goldstein ◽  
Richard Hackbarth ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Quality Improvement ◽  
Injury Risk ◽  
Kidney Injury ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Hospitalized Children ◽  
Consensus Definition ◽  
Medication Exposure ◽  
Definition Of

Abstract Purpose Medications are commonly associated with acute kidney injury (AKI). However, in both clinical practice and research, consideration of specific medications as nephrotoxic varies widely. The Nephrotoxic Injury Negated by Just-in-time Action quality improvement collaborative was formed to focus on prevention or reduction of nephrotoxic medication-associated AKI in noncritically ill hospitalized children. However, there were discrepancies among institutions as to which medications should be considered nephrotoxic. The collaborative convened a Nephrotoxic Medication (NTMx) Subcommittee to develop a consensus for the classification of nephrotoxic medications. Summary The NTMx Subcommittee initially included pediatric nephrologists, a pharmacist, and a pediatric intensivist. The committee reviewed NTMx lists from the collaborative and identified changes from the initial NTMx list. The NTMx Subcommittee conducted a literature review of the disputed medications and assigned an evidence grade based on the reported association with nephrotoxicity and the quality of the data. The association between medication exposure and AKI was also determined using administrative data from the Pediatric Health Information Systems database. The NTMx Subcommittee then came to a majority consensus regarding which medications should be included on the list. The subcommittee’s recommendations were presented to the larger collaborative for approval, and consensus was achieved. The list continues to be reviewed and updated annually. Conclusion Formation of a multicenter quality-improvement initiative exposed current limitations as to which medications are considered nephrotoxic in clinical and research settings and presented an opportunity to approach this problem using an evidence-based process. A consensus definition of nephrotoxic-medication exposure was achieved.

Breast imaging boot camp: A mammography quality improvement initiative.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 138-138
Author(s):  
Danielle Dupuy ◽  
Louise Miller ◽  
Christine B. Weldon ◽  
Jennifer M. Orsi ◽  
Terry Macarol ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Breast Imaging ◽  
Evaluation Process ◽  
Boot Camp ◽  
Quality Improvement Intervention ◽  
Breast Size ◽  
Quality Improvement Initiative ◽  
Quality Factors ◽  
Structured Interviews ◽  
Hands On

138 Background: In mammography, compression, and positioning are key quality factors. ACR standards suggest that compression should ensure that a breast is taut (drawn tight with no slack). In environmental scans, semi-structured interviews with cross discipline providers from Chicago mammography facilities, we found wide variation in radiology technologist’s understanding of standard compression and views. Optimal compression was reported from 12-45 lbs and some sites reported that four views are taken regardless of breast size. This discovery led to a mammography technologist training program as a quality improvement intervention. Methods: The Chicago Breast Cancer Quality Consortium contracted with Louise Miller, AART, CRT, and RTRM to lead a Breast Imaging Boot Camp and partnered with 4 hospitals to carry out the training. There were three components of the boot camp: a 1-day seminar for all mammography technologists, 1 day of hands on training for a limited number of techs and a train the trainer component where selected techs went through a 3-day intensive program with the goal of preparing them to provide ongoing education to the Chicago mam-tech community. A preliminary tool was developed and used randomly by radiologists during the training to examine the amount of tissue in the image from one year to the next, the presence or absence of an Inter-mammary fold and cleavage. Results: More than 120 radiology technologists attended a day-long seminar, 10 received hands on training, 4 of the 10 were trained to be future trainers. Participants rated their overall impression of the day-long seminar between 4 and 5 on a 5-point scale. During the hands-on training, radiologists assessing the images commented on significant improvements in image quality from the previous year’s mammogram. A quantitative evaluation process has been developed to examine the efficacy of the training and measure impact on mammography quality. This evaluation involves a 3 month and 1-year assessment that will take place in September of 2012 and again in May of 2013. Results of first evaluation will be available for presentation. Conclusions: Results from the evaluation will help review effectiveness of technologists post-training techniques and identify areas to improve.

Deep Wound Infections After Spinal Fusion in Children With Cerebral Palsy

Spine ◽  
2013 ◽  
Vol 38 (23) ◽  
pp. 2023-2027 ◽  
Author(s):  
Paul D. Sponseller ◽  
Amit Jain ◽  
Suken A. Shah ◽  
Amer Samdani ◽  
Burt Yaszay ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Spinal Fusion ◽  
Wound Infections ◽  
Deep Wound ◽  
Children With Cerebral Palsy

Implementation of a checklist before colonoscopy: a quality improvement initiative

Endoscopy ◽  
2017 ◽  
Vol 50 (03) ◽  
pp. 203-210 ◽  
Author(s):  
Omar Kherad ◽  
Sophie Restellini ◽  
Charles Ménard ◽  
Myriam Martel ◽  
Alan Barkun
Keyword(s):  
Quality Improvement ◽  
Positive Impact ◽  
Quality Improvement Intervention ◽  
Quality Improvement Initiative ◽  
Team Communication ◽  
Intervention Period ◽  
Retrospective Audit ◽  
Safety Outcomes ◽  
Checklist Implementation ◽  
Improvement Intervention

Abstract Background and study aims Checklists can prevent errors and have a positive impact on patient morbidity and mortality in different surgical settings, and possibly also in gastrointestinal endoscopy. The aims of this study were to reinforce commitment in safety culture and better communication among team members in endoscopy, and to prove the feasibility of successful checklist adoption before colonoscopy. Patients and methods The study involved a pre – post quality improvement intervention involving all consecutive patients undergoing a colonoscopy at a single academic endoscopy unit. The first part of the study was a retrospective audit, carried out over a 3-month period (July to September 2016). A checklist developed through a formal validation process was implemented during the intervention period (October to December 2016). Primary outcomes were changes in patient and team satisfaction after the quality improvement intervention, using validated 5-point scale questionnaires. Secondary outcomes included successful procedure completion rates and safety outcomes. Results During the baseline and comparative intervention period, 1317 and 1141 colonoscopies, respectively, were performed. Overall, checklists were fully completed by nurses and physicians for 791 patients (69.3 %). Mean overall patient satisfaction was high at baseline and did not differ following the quality improvement intervention (4.66 vs. 4.63; P  = 0.5). Perception of team communication and teamwork was improved after checklist implementation. Comparative analyses of per-procedure and safety outcomes did not differ between the pre- and post-checklist implementation. Conclusion Adoption of an endoscopy checklist before colonoscopy is feasible, and significantly increases perception of team communication and teamwork. Additional studies are needed to assess the generalizability of these results to complex endoscopic procedures and to characterize any improvement in patient safety outcomes.

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