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Improving Compliance to a Standardized Protocol to Reduce Head and Neck Surgical Site Infections

Luosang, Nancy (2023) Improving Compliance to a Standardized Protocol to Reduce Head and Neck Surgical Site Infections. Master Essay, University of Pittsburgh.

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Patients undergoing head and neck reconstructive surgeries are at high risk for surgical site infections (SSI). Due to open-wound exposure to bacteria in the environment and inevitable contamination to the site, adherence to interventions to address wound contamination should reduce SSI risk. This project analyzed the effectiveness of the implementation of a four-component standardized operative wound care protocol in reducing the incidence of National Healthcare Safety Network (NSHN) defined neck SSIs.
The intervention comprises nursing education and feedback of compliance with SSI reduction process measures, which included emollient (Aquaphor) application twice daily, oral antiseptic (Peridex) use at least twice daily, and metronidazole and cefazolin (antimicrobials) intravenous infusion pre-operatively. Phase 1 of the intervention assessed SSI trends following standardized surgeon ordering of the wound care bundle only, whereas phase 2 of intervention is assessing SSI trends following the full implementation of the nursing education intervention.
Between the baseline and phase 1 period, compliance improved for emollient (59% vs 83%, p<0.0001); did not significantly change for oral antiseptic (45% vs 48%, p=0.3), cefazolin (85% vs 94%, p=0.1), and metronidazole (36% vs 29%, p=0.3). Between the baseline and phase 2 period, there were no differences in compliance for emollient (59% vs 60%, p=0.8), cefazolin (85% vs 81%, p=0.1), and metronidazole (36% vs 34%, p=0.5), but compliance worsened for oral antiseptic (45% vs 30%, p<0.001). SSI rate was 13.7% and 5.8% per procedure in baseline and phase 1, respectively, (p=0.1); SSI rate was 16% per procedure in phase 2 and there is no difference between SSI rate in baseline and phase 2 (p=0.7).
Nursing implementation of wound care SSI prevention measures improved with education and compliance feedback; however, antibiotic prophylaxis prescribing did not show improvement. Results from phase 1 show promise and for phase 2, we will continue the intervention over a longer time-period to understand impact and durability. Understanding and implementing evidence-based SSI prevention strategies is of public health importance as it can help in reducing healthcare costs, AR pathogen infections, and overall incidence of SSIs.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Luosang, Nancynancylosang@gmail.comdal227
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairGlynn, Nancy W.epidnwg@pitt.eduepidnwgUNSPECIFIED
Committee MemberSnyder, Grahamsnydergm3@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberAyres, Ashleyayresam@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberCrall, Victoriacrallv@upmc.eduUNSPECIFIEDUNSPECIFIED
Date: 5 January 2023
Date Type: Completion
Number of Pages: 39
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 05 Jan 2023 15:55
Last Modified: 05 Jan 2023 15:55


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