Date of Graduation

Fall 12-15-2017

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Diane Torkelson

Abstract

Surgical site infections (SSIs) are the most common and expensive healthcare-acquired infection. The objective of this nurse-driven process improvement project was to implement a cost-effective and practical decolonization protocol to improve outcomes for high-risk veteran populations undergoing surgery at a large veteran’s hospital in the Pacific Northwest. Prior to the implementation, a decolonization protocol was used for cardiac and orthopedic preoperative patients. The process involved screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization via nasal swab preoperatively and treating positive patients with mupirocin ointment to nares BID and chlorhexidine showers for five days prior to surgery. Adherence to the protocol was problematic and SSI rates increased in these populations. New evidence-based practice recommendations published in 2105 described a 50% reduction of SSI with screening for MRSA in the pre-operative clinic, followed by treating each preoperative patient with chlorhexidine washcloths, oral chlorhexidine rinse, and intranasal povidone-iodine. Starting May 15, 2017, all surgical patients now receive intranasal povidone-iodine treatment before surgery with the aim of reducing MRSA SSIs by 10% in one fiscal year (FY). For the past three years, the hospital has averaged 11 SSIs per year, and 5 SSIs for the current FY, all prior to initiation of the new evidence-based protocol.

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