Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach

Author:

Shi Zhi-YuanORCID,Huang Pei-Hsuan,Chen Ying-Chun,Huang Hui-Mei,Chen Yuh-Feng,Chen I-Chen,Sheen Yi-Jing,Shen Ching-Hui,Hon Jau-Shin,Huang Chin-Yin

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.

Publisher

MDPI AG

Subject

Health Information Management,Health Informatics,Health Policy,Leadership and Management

Reference41 articles.

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3. World Health Organization (2018). Global Guidelines for the Prevention of Surgical Site Infection, World Health Organization. [2nd ed.]. Available online: https://www.who.int/publications/i/item/global-guidelines-for-the-prevention-of-surgical-site-infection-2nd-ed.

4. Algado-Sellés, N., Mira-Bernabeu, J., Gras-Valentí, P., Chico-Sánchez, P., Jiménez-Sepúlveda, N.J., Fuster-Pérez, M., Sánchez-Payá, J., and Ronda-Pérez, E.M. (2022). Estimated Costs Associated with Surgical Site Infections in Patients Undergoing Cholecystectomy. Int. J. Environ. Res. Public Health, 19.

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