Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach

Abstract

Background: SSIs (surgical site infections) are associated with increased rates of morbidity and mortality. The traditional quality improvement strategies focusing on individual performance did not achieve sustainable improvement. This study aimed to implement the Six Sigma DMAIC method to reduce SSIs and to sustain improvements in surgical quality. The surgical procedures, clinical data, and surgical site infections were collected among 42,233 hospitalized surgical patients from 1 January 2019 to 31 December 2020. Following strengthening leadership and empowering a multidisciplinary SSI prevention team, DMAIC (Define, Measure, Analyze, Improve, and Control) was used as the performance improvement model. An evidence-based prevention bundle for reduction of SSI was adopted as performance measures. Environmental monitoring and antimicrobial stewardship programs were strengthened to prevent the transmission of multi-drug resistant microorganisms. Process change was integrated into a clinical pathway information system. Improvement cycles by corrective actions for the risk events of SSIs were implemented to ensure sustaining improvements. We have reached the targets of the prevention bundle elements in the post-intervention period in 2020. The carbapenem resistance rates of Enterobacteriaceae and P. aeruginosa were lower than 10%. A significant 22.2% decline in SSI rates has been achieved, from 0.9% for the pre-intervention period in 2019 to 0.7% for the post-intervention period in 2020 (p = 0.004). Application of the Six Sigma DMAIC approach could significantly reduce the SSI rates. It also could help hospital administrators and quality management personnel to create a culture of patient safety.

A comprehensive study on the risk factors and pathogen analysis of postoperative wound infections following caesarean section procedures

“…Current data indicate a worrying increase in the prevalence of antibiotic‐resistant pathogens in SSIs. In the context of C‐section, the rise in antibiotic‐resistant bacteria such as methicillin‐resistant Staphylococcus aureus and vancomycin‐resistant Enterococci has been particularly concerning 18 . These resistant strains not only complicate treatment options but also lead to longer hospital stays, higher treatment costs and increased morbidity 19 .…”

“…In the context of C‐section, the rise in antibiotic‐resistant bacteria such as methicillin‐resistant Staphylococcus aureus and vancomycin‐resistant Enterococci has been particularly concerning. 18 These resistant strains not only complicate treatment options but also lead to longer hospital stays, higher treatment costs and increased morbidity. 19 This evolving landscape of antibiotic resistance underscores the need for ongoing surveillance, judicious use of antibiotics and the development of new antimicrobial strategies to combat these resistant pathogens in SSIs.…”