AJIC Volume 27, Number 2 Abstracts 21 1 inappropriate use of vancomycin (no documented penicillin allergy) among the cardiothoracic (CT) patients prophy- laxed in 1995. This rate decreased by 65.6% in 1996 and 79.8% in 1997. The selection of the appropriate prophylactic agent increased from 63.1% in 1995 to 82.9% in 1996, and 83.1% in 1997. Adequate timing of the prophylactic agents (_<2 hrs. prior to surgical incision) on the CT service was excellent during the 3 years of surveillance ranging from 90%-100% compliance. On the vascular service (VS) the inappropriate use of vancomycin decreased from 3.5% in 1995 to 2.7% in 1996, and was 0% in 1997. The adequate timing of prophylactic agents was excellent during the three years, ranging from 90%-95%. Compliance with the selec- tion of the appropriate agent increased each year--76.7%, 78%, and 88.7%, respectively. Adequate timing of prophy- lactic agents ranged from 93% to 99.5% during the three years. A trend toward ideal timing (<30 minutes prior to incision) for each year was noted with those prophylaxed <I hour prior to incision at 84%, 90.3%, and 96.4%, respective- ly. We also monitored post-op dosing patterns for CT, VS, and ortho for one year and found that 2 days of post-op dos- ing was noted for 61%, 16%, and 79% of the patients on these services, respectively. Eliminating post-op dosing is a new quality improvement initiative. Surgical site infections on all three services have been consistently low. Our experi- ence demonstrates that prophylactic antibiotic monitoring can contribute to improved compliance with recommended prophylaxis guidelines, decreased cost and use of inappro- priate antibiotics, and may influence SSI rates. IMPROVING CLINICAL PATIENT OUTCOME IN A HIGH RISK PATIENT POPULATION UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY. V.R. Gonzalez, BS, CIC,* S. Houston, RN, PhD, P.W. Hougland, MD. St. Luke's Episcopal Hosptial, Houston, TX. BACKGROUND: St. Luke's Episcopal Health System (SLEHS) is a 954-bed, private, not for profit hospital that performs over 1,200 coronary artery graft (CABG) surg- eries annually. Significant morbidity and mortality rates, as well as increased length of stay and cost are associated with CABG surgical site infection (SSI). Review and analysis of SSI surveillance data revealed an increasing trend in sternal SSIs. METHOD: Multivariate regression analysis with data collected from 1995-1997 identified three risk factors con- tributing to sternal SSIs. Diabetes, obesity (>120% ideal weight) and chronic obstructive pulmonary disease (COPD) were independent factors SSI. A collaborative team includ- ing representatives from infection control, nursing, periop- erative services, medical staff, and outcomes management was formed to identify process changes that would reduce the SSI rate. The team used SLEHS's Performance Enhancement Plan which provided direction to the group's effort. This plan identified 5 components which are Select- Examine-Act-Evaluate-Decide. Adhering to each step with- in the plan allows for a comprehensive approach to quality and improving outcome. Using this quality model the fol- lowing processes were selected for intervention: preopera- tive skin care, operative site preparation (ongoing study evaluating 4 different protocols), sternal wound protocol (early and accurate identification of SSI and its treatment in high risk patients) and postoperative incision care. RESULT: Overall the sternal SSI rate decreased signifi- cantly with the introduction of the sternal wound protocol. Additionally, preliminary analysis of the operative site study suggests that one skin prep regimen decreases the incidence of sternal SSI. CONCLUSION: Implementation of action plan is in dif- ferent phases and still in progress. However, collaborative teamwork has successfully impacted our patient care prac- tice. The team will continue to evaluate care and outcome for this population of patients. RECENT ADVANCES IN CARDIAC CATHERIZATION MAY INCREASE INFECTION RISK. M. Jones, BSN, CIC,* E Hixson, BSN, CIC, E Apprill, MD, M. Gardner, MD. St. Louis, MO. Two new Cardiac catheter puncture closure techniques were recently implemented at St. Mary's Health Center-St. Louis (SMHC), a 400-bed teaching community hospital located in St. Louis, Missouri. Both techniques provide rapid hemostatis as well as leaving a foreign body at the site. A collagen plug (CP) was introduced in 8/97 and a per- cutaneous stitching procedure (PSP) began in 1/98. Routine surveillance methods detected 2 groin infections; I in 8/97, and 1 in 4/98, thereby prompting an investigation. During the investigation and intervention phase, a third infection was discovered. Review of the 1996, 1997, and Jan-May 1998 data indicated only one post-procedure infection out of 2,673 "regular" cardiac catherization procedures (rate 0.04%). Rates for CP and PSP were 0.5% and 1.0% respec- tively (p=0.007). Case reviews, and environmental and pro- cedural observations were done. The following interven- tions were implemented: I) discontinue pre-procedure shaving and convert to clipper hair removal; 2) the RNs who perform site prep will assess groin skin integrity, and report any abnormalities to the cardiologist who will not utilize the rapid hemostatis techniques; 3) the cardiologist will change gloves prior to tying knots in the percutaneous stitching procedure. Since intervention implementation in 7/98, there has been 1 post-PSP procedure infection. These advances in hemostatis may increase the risk for infection and may call for additional infection control interventions. Devices INFECTIONS IN ADULT PATIENTS UNDERGOING INTRACRANIAL PRESSURE MONITORING (ICPM) AND/OR EXTERNAL CEREBROSPINAL FLUID DRAIN- AGE (ECFD). M. O~rien, RN, BS,* O. Obasanjo, MBBS, MPH, R. Chotani, MD, MPH, M. Williams, MD, T. Perl, MD, MSc. The Johns Hopkins Hospital, Baltimore, MD.