Implementing a preoperative bundle to reduce Staphylococcus aureus surgical site infections in eight New Zealand hospitals using quality improvement and collaborative methodology

Ms Nikki Grae1, Mr Arthur Morris1, Ms Sally Roberts1, Ms Gillian Bohm1

1Health Quality & Safety Commission, Wellington, New Zealand


Introduction: Staphylococcus aureus (S. aureus) causes the majority of cardiac and orthopaedic surgical site infections (SSIs) in New Zealand (NZ). A preoperative bundle to reduce S. aureus SSIs has been implemented in numerous hospitals internationally however there was not a consistent practice in NZ. A quality improvement collaborative to develop and implement an anti-staph bundle was established.

Methods: Public and private hospitals were recruited to participate in a collaborative to design and implement the bundle. The collaborative included three one-day learning sessions, monthly webinars, one-to-one teleconferences, and site visits. Quality improvement (QI) methodology was used to design and implement the bundle so individual hospitals could customise a proposed bundle to fit their local circumstances.

Results: Eight hospitals fully implemented a bundle to reduce S. aureus related SSIs. Education, auditing, and documentation tools were developed and shared across all teams. The bundles aligned with a proposed set of interventions with customisation at the local level based on clinical pathway, product availability, and documentation systems. Compliance rates for bundle implementation reached 95-100 percent across all hospitals.

Conclusion: This was the first multi-centre collaborative designed to implement an anti-staph bundle in private and public hospitals to reduce S. aureus related SSI in New Zealand. Participation increased the level of networking and QI skill set among multi-disciplinary teams so the bundle could be applied with local customisation. The success of this collaborative has led to a set of protocols, tools, and practices that can be shared and used widely across NZ hospitals.


Nikki Grae is a senior advisor for the infection prevention and control programme at the Health Quality & Safety Commission. She has 10 years of infection prevention, quality, and patient safety experience in the healthcare sector. Prior to working at the Commission, she managed and led the infection prevention and patient safety programmes for a health system in Idaho, USA. Nikki has also worked as a research scientist in cancer biology and microbiology. She relocated to New Zealand in 2016 to enjoy the diverse culture and spectacular scenery while continuing her career in infection prevention and control.

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