The New Zealand Surgical Site Infection Improvement Programme: A Quality Improvement Programme Supporting Systems-based Practice Change

Nikki Grae 1, Sally Roberts 1, Arthur Morris 1, Gabrielle Nicholson 2, Andrea Flynn 2

Health Quality & Safety Commission, Auckland, New Zealand

Health Quality & Safety Commission, Wellington, New Zealand


Introduction: The Surgical Site Infection Improvement Programme (SIIIP) started in 2013. The aims are to improve the standard of care by measuring compliance with, and shifting practice to interventions known to reduce surgical site infections (SSI) and to use high quality data to inform quality improvement / harm reduction initiatives.

Method: Data is collected on all hip and knee arthroplasty procedures funded by District Health Boards (DHB); approximately 10,000 procedures annually. Quality and Safety Markers (QSM) were established to set the expected levels of performance. The QSM focus on surgical antimicrobial prophylaxis (SAP) and skin antisepsis. The outcome measure is the SSI rate. Reporting is public and quarterly. There is a focus on improving quality improvement capability.

Results: 26,233 hip and knee arthroplasty procedures have been performed. There has been a significant aggregated improvement in the QSM performance for the timing, choice and dose of SAP between July 2013 and December 2015. However, the QSM target for timing (100% of primary arthroplasty procedures receive SAP 0-60 minutes before knife to skin), has not yet been consistently achieved by most DHB. The QSM target for dose of SAP (≥ 95%) has been met nationally and by ≥ 14 DHB. All 20 DHB achieved ≥ 98% compliance for skin preparation but only 13 DHB achieved 100%. The overall SSI rate is 1.2% (95% CI 1.1-1.3).

Conclusions: The SSIIP has resulted in significant improvement in QSM performance. Most procedures now comply with best practice guidance. Measurement with timely reporting has supported this change.

Recent Comments