Establish General Aims — Surgical Site Infections

By Sabitha Rajan, MD , Danielle Scheuer, MD, MSc, FHM, and Chayan Chakraborti, MD

Establishing appropriate goals is essential for maintaining focus and engaging the team.
Your aims should be specific, measurable, and time defined and should specify the population or populations for whom you want to improve care. A "stretch" goal should be established that should be aggressive enough to mandate a change in the design of your current process in order to achieve it. Until you have reliable metrics and a baseline evaluation, however, team-supported general aims or goals can be important for galvanizing action and establishing clarity of purpose.

Consider drafting a team charter for review and approval by the group. The charter should state the members requested, responsibilities involved, and goals of the team.

One important task is to define the scope of your efforts. Although SSIs may be a considerable issue within your institution, it may be reasonable to start small with a manageable test site and spread your learned improvements across other areas. This gives you an opportunity to evaluate what worked within your pilot area, analyze your results, and then develop the necessary tools to apply your interventions for a larger impact.

Examples of general aims:

1. Control serum blood sugar pre-, peri, and postoperatively; specifically, reduce blood sugar to < 200 for the first 48 hours.
2. Encourage smoking cessation pre- and postoperatively.
3. Identify and treat infections before the procedure. Elective surgery should be postponed until infection is cleared..
4. Increase appropriate postoperative wound care and ensure the covering of wounds with sterile dressings for 24—48 hours and wash hands before and after each contact.
5. Increase compliance with pre- and postoperative delivery of antibiotics.

As your team develops, your challenge will be to define many of the terms in your general aim, which will entail developing defined metrics and more mature, specific, time-defined aims. For example, what aspects of surgical site infection care do you want to improve first? What are the factors that lead to a failure of conservative management? How do we educate caregivers about the care of surgical site infections?

Task: Establish general aims.

Task Assignment: The Improvement Team

Due Date: First Team meeting