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Volume 10
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10.3390/healthcare10112291
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Article

Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach

by
Zhi-Yuan Shi
1,2,3,
Pei-Hsuan Huang
1,
Ying-Chun Chen
1,
Hui-Mei Huang
4,
Yuh-Feng Chen
1,
I-Chen Chen
5,
Yi-Jing Sheen
6,
Ching-Hui Shen
2,7,8,
Jau-Shin Hon
3 and
Chin-Yin Huang
3,*
1
Infection Control Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan
2
College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
3
Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407224, Taiwan
4
Nursing Department, Taichung Veterans General Hospital, Taichung 407219, Taiwan
5
Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan
6
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
7
Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
8
School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
*
Author to whom correspondence should be addressed.
Healthcare 2022, 10(11), 2291; https://doi.org/10.3390/healthcare10112291
Submission received: 30 September 2022 / Revised: 11 November 2022 / Accepted: 12 November 2022 / Published: 15 November 2022
(This article belongs to the Special Issue Antimicrobial Resistance, Healthcare-Associated Infections, and Environmental Microbial Contamination)
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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.
Keywords: surgical site infections; Six Sigma; DMAIC; improvement; antibiotic surgical site infections; Six Sigma; DMAIC; improvement; antibiotic

Share and Cite

MDPI and ACS Style

Shi, Z.-Y.; Huang, P.-H.; Chen, Y.-C.; Huang, H.-M.; Chen, Y.-F.; Chen, I.-C.; Sheen, Y.-J.; Shen, C.-H.; Hon, J.-S.; Huang, C.-Y. Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach. Healthcare 2022, 10, 2291. https://doi.org/10.3390/healthcare10112291

AMA Style

Shi Z-Y, Huang P-H, Chen Y-C, Huang H-M, Chen Y-F, Chen I-C, Sheen Y-J, Shen C-H, Hon J-S, Huang C-Y. Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach. Healthcare. 2022; 10(11):2291. https://doi.org/10.3390/healthcare10112291

Chicago/Turabian Style

Shi, Zhi-Yuan, Pei-Hsuan Huang, Ying-Chun Chen, Hui-Mei Huang, Yuh-Feng Chen, I-Chen Chen, Yi-Jing Sheen, Ching-Hui Shen, Jau-Shin Hon, and Chin-Yin Huang. 2022. "Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach" Healthcare 10, no. 11: 2291. https://doi.org/10.3390/healthcare10112291

APA Style

Shi, Z.-Y., Huang, P.-H., Chen, Y.-C., Huang, H.-M., Chen, Y.-F., Chen, I.-C., Sheen, Y.-J., Shen, C.-H., Hon, J.-S., & Huang, C.-Y. (2022). Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach. Healthcare, 10(11), 2291. https://doi.org/10.3390/healthcare10112291

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