Meeting the Challenge: Riverside County Reduces SSI, Increases Patient Safety

April is National County Government Month. During the month, CSAC is producing a series of videos and blog postings highlighting California Counties’ best practices. The programs we are spotlighting are recipients of our annual Challenge Awards, which recognize the innovative and creative spirit of California county governments as they find new and effective ways of providing programs and services to their citizens.  The Challenge Awards provide California’s 58 counties an opportunity to share their best practices with counties around the state and nation. The programs being highlighted are recipients of the 2013 awards. The Call for Entries for the 2014 CSAC Challenge Awards has been distributed; the entry deadline is June 27, 2014. 

To review a video about this Riverside County program, click here.

When Riverside County Medical Center staff compared its rate of surgical site infections (SSI) to other hospitals around the country, they realized they had an issue. The hospital’s ratio of infections was more than 200 percent above the recognized baseline. Something had to be done; something was done. And the result has been an amazing turnaround for the Medical Center that has resulted in improved patient care, heightened patient safety and a reduction in medical care costs.

To combat this high infection rate, the hospital formed a team consisting of surgeons, anesthesiologists, OR nurses, infection preventionists, housekeeping personnel and researchers. The team developed protocol for staff and education plan for patients to follow. Beyond following new protocols, staff found themselves participating in a cultural change.

For example, since the Medical Center is a teaching hospital, there was constant traffic in and out of the operating room. “We started counting how many times we open that door and we were surprised to learn that during some operations, those operating room doors were being opened and closed 70 times,” explains Dr. Arnold Tabuenca, the hospital’s chief medical officer. “And every time you open that door, you create turbulent air flow.”  Extraneous foot traffic during surgery is now limited, helping to reduce the potential for infection.

Regular audits are performed by an infection preventionist; staff looks out for each other, ensuring protocols are followed.

Dr. Silvia Gnass serves as the Medical Center’s chief infection control officer. She is quick to run down the numerous new protocols that are followed that go above and beyond national standards.

Between 2010 and 2012, the infection ration at the Medical Center plummeted by more than 75 percent. From at one point having a surgical site infection rate more than two times the standardized rate set by the Center for Disease Control, the hospital now has a rate nearly half the expected rate.

The SSI Reduction Program was developed and implemented within the existing hospital budget. The program, in fact, actually saves the hospital money. Treating a patient for SSI adds another $25,000 on average to the cost of care; hospital staff estimates its aggressive campaign is saving the county more than $1 million annually  since many of those patients do not have health insurance.

Dr. Tabuenca summed it up best in an interview with the Riverside Press-Enterprise: “AT RCRMC we have developed a culture of transparency and accountability about healthcare-associated infections,” he said. “By confronting this problem head on and not sweeping it under the carpet, we have enhanced the quality of our healthcare, improved our patients’ experiences and reduced costs.”

About: David Liebler:
David Liebler is the Deputy Director of Public Affairs and Member Services for the California State Association of Counties. He can be reached at

Comments are closed.