In December, 2007, Emory replaced soap-and-water bathing with baths using CHG wipes for pre-operative skin care in their cardiac surgical population. During a Medical Intensive Care Unit (MICU) summit held in January, 2008, after further review of research and best practice results using these wipes, the decision was made to expand the use of CHG wipes for all daily bathing of MICU patients, both pre- and post-op, regardless of admission diagnosis.

Renee and her team of clinical staff leaders went to work on developing a program designed to make all 7,000 employees of CHOA—and the hospitals’ patients—aware of the importance of proper hand hygiene and to keep compliance top-of-mind in every area of the facilities. “Good Health Is In Your Hands – A Hand Hygiene Improvement Initiative” was launched in November, 2006 with a goal of 100% hand hygiene compliance. A Rapid Action Taskforce was charged with development and implementation of Performance Improvement processes, which included:

Children’s Healthcare of Atlanta cares for more than half a million patients annually and operates three hospitals in metro Atlanta, Georgia:

During the Plan phase, several key initiatives for improvement were identified, including education of clinicians on the SCIP evidence-based guidelines; communicating areas for improvement such as wrong site/wrong procedure surgery, surgical infections, and the dangers of hypothermia; and redesigning routines to promote a safer surgical environment.
In the Do phase, a targeted educational program was created for surgical and medical staff using SCIP methodology, and enhanced safety practices in the OR were implemented over a 24-month period. Some of these included use of an antimicrobial prophylaxis within one hour of surgical cut time; using a clipper instead of a shaver for pre-op patient hair removal, to reduce the risk of skin nicks through which bacteria could enter; use of hot air blankets and monitoring of patient temperatures throughout surgery to help maintain normothermia; and having the surgeon mark the area of the patient’s body to be operated on and the type of procedure, before the patient is anesthetized.

The Check phase revealed that the overall average mean for the SCIP data increased by 46% compared to the previous year, and staff reporting of adverse events almost tripled. Sentinel events decreased to one per year, compared to 1.6 the previous year. (A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. Such events are called "sentinel" because they signal the need for immediate investigation and response.)

During the Act phase, the team decided to adopt all changes in the care of surgical patients permanently.

Since the project was implemented, North Fulton has experienced compliance with SCIP indicators in the 90-100% range. The overall surgical wound infection rate declined from 1.02% in 2006 to 0.54% at the end of the first quarter of 2008. There were no Sentinel events reported in surgical services for the year.

According to Kathy Young, “There were several important elements in our success. One was the involvement of all departments within the hospital, to reduce the risk of cross-contamination before patients enter and after they leave the OR. Another was the establishment of a JUST Culture, which encourages employees to report adverse events through the use of a non-punitive reporting process. And reinforcement of the new protocol with Time Out posters in the surgical suites, reminding clinical staff to do one final check before surgery, was also helpful.”