OBJECTIVE: Surgical site infections (SSIs) negatively affect patients and the health care system. National standards for SSI prevention do not exist in pediatric settings. We sought to reduce SSI-related harm by implementing a prevention bundle through the Solutions for Patient Safety (SPS) national hospital engagement network.METHODS: Our study period was January 2011 to December 2013. We formed a national workgroup of content and quality improvement experts. We focused on 3 procedure types at high risk for SSIs: cardiothoracic, neurosurgical shunt, and spinal fusion surgeries. We used the Model for Improvement methodology and the Centers for Disease Control and Prevention SSI definition. After literature review and consultation with experts, we distributed a recommended bundle among network partners. Institutions were permitted to adopt all or part of the bundle and reported local bundle adherence and SSI rates monthly. Our learning network used webinars, discussion boards, targeted leader messaging, and in-person learning sessions.RESULTS: Recommended bundle elements encompassed proper preoperative bathing, intraoperative skin antisepsis, and antibiotic delivery. Within 6 months, the network achieved 96.7% reliability among institutions reporting adherence data. A 21% reduction in SSI rate was reported across network hospitals, from a mean baseline rate of 2.5 SSIs per 100 procedures to a mean rate of 1.8 SSIs per 100 procedures. The reduced rate was sustained for 15 months.CONCLUSIONS: Adoption of a SSI prevention bundle with concomitant reliability measurement reduced the network SSI rate. Linking reliability measurement to standardization at an institutional level may lead to safer care.Surgical site infections (SSIs) are common, accounting for nearly one-third of all health care-associated infections among hospitalized adults. 1,2 These infections increase patient morbidity and mortality and pose a high cost burden to the US health care system. [3][4][5] In 1 study, the national SSI rate in children was reported to be 1.8%. 6 Procedures that have been associated with higher SSI rates in children include cardiothoracic, neurosurgical ventricular shunt, and spinal fusion surgeries. Reported rates of infection have large institutional variability: 2.3% to 5% for cardiothoracic, 7-9 5.7% to 10.4% for neurosurgical ventricular shunt, [10][11][12] and 4.4% to 10.2% for spinal fusion surgeries. [13][14][15][16] For this reason, these 3 types of procedures are commonly monitored for SSIs and targeted for SSI reduction.

There is no universally accepted definition of quality improvement (QI). However, the American Board of Radiology (ABR) defines "QI"as "a systematic approach to the study of healthcare and/or a commitment to efforts to continuously improve performance and outcomes in healthcare". According to Kruskal et al., [1] QI in radiation oncology includes "(a) quality assurance programs for continuous improvements in quality, (b) processes to improve staff and patient safety, and (c) procedures to improve the clinical,technical,and therapy performance of all staff ". [1] Fundamentally, QI techniques are, well founded methods to drive change and improve efficiency. The goal of QI is therefore to create practical processes and structures that will introduce positive change into a work environment in a reproducible and sustainable way that is non-disruptive and at an acceptable cost. There are many forces that can drive the creation of QI programs in radiation oncology. The first is the desire to provide high-quality patient care, which is defined by the Institute of Medicine as "safe, effective, patient-centered, timely, efficient, and equitable care". [2] The second is the mandate of accrediting bodies such as the Joint Commission and the American College of Radiology (ACR), whose accrediting standards further support this goal. The third is the economic incentives to provide high-quality care at an affordable cost. [3] Clinical medical physicists (MPs) are often viewed as the custodians of quality in radiation therapy department. Radiation therapy is a long-complicated process and therefore has numerous avenues for potential QI endeavors. [4,5] These QI initiatives demand time and resources to be successful. More often, when time is not reserved, these initiatives become administrative burdens on the staff adding to their already established workflow. To make QI relevant, feasible and sustainable, it is necessary to embed it into MP workflow. This act transforms QI from a burden, which places anThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.