Improving Compliance with Preoperative Nasal Povidone-Iodine to Prevent Surgical Site Infections: A Pilot Quality Improvement Project in Vascular and Neurosurgery Units in a Community Teaching Hospital

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The nasal mucosa is the main site of Staphylococcus aureus colonization, and S. aureus colonization increases the risk of surgical site infection. Transition from preoperative treatment of nasal MRSA colonized patients with mupirocin to treatment with povidone-iodine nasal swabs added value to the treatment of nasal colonization modality. It is more effective in the prevention of SSIs and less expensive. However, suboptimal adoption of the povidone-iodine nasal swab minimized its benefits. This pilot QI project aimed to increase the compliance of clinicians with the use of the preoperative povidone-iodine nasal swab to decrease surgical site infection rates. Baseline data analysis that included the use of pareto chart systematically identified vascular surgery and neurosurgery units at Kettering Hospital Main Campus as having the biggest opportunity for improvement. Using the fishbone diagram and the 5 Why’s, the barriers to compliance and the interventions for improvement were identified by a project team. Over a period of four months (Jan – April 2021), intensive education, an awareness campaign and introduction of cognitive aids for physicians (Best Practice Advisory, BPA) and for nurses (administration verification reminder) in the work process were applied using PDSA. A pre- and post-intervention data analysis were done. The project significantly improved the order compliance rate in vascular and neurosurgery from a historical mean of 79.6% to a monthly average of 95.7%, over 3SD on the control chart. The administration compliance rate of the nasal swab was also increased from a baseline mean of 72.29% to monthly average of over 80%, over 2SD on the control chart. At the end of the pilot project, the increased compliance resulted in decline in SSIs rate by 70%. Improving the order and administration compliance of preoperative povidone-iodine nasal swab by clinicians led to improved prevention of SSIs.



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