Reducing infection rates
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By Joan Blanchard, RN, MSS, CNOR, CIC Perioperative Nursing Specialist AORN Center for Nursing Practice |
Infection control has always been a concern in the perioperative area, but recent moves toward pay-for-performance reimbursement and mandatory reporting of infection rates have brought new urgency to the implementation of quality improvement processes. The Centers for Medicare and Medicaid Services (CMS) will be implementing pay-for-performance measures, in which CMS will not reimburse healthcare facilities for the charges related to treating healthcare issues that could be prevented, such as surgical site infections (SSIs) and retained foreign objects.
In addition, many states already have legislation mandating the reporting of infection rates for hospitals. Different states have different requirements, and each state may define exactly what measures hospitals must report on; for example, some states may require reporting of surgical site infection (SSI) rates, others may also require reporting of bloodstream infection rates, and still other states may have additional requirements. Right now, not every state has such legislation, but it is likely that eventually such legislation will be nationwide.
In states that do not yet have such legislation, perioperative managers and infection control practitioners should work with state legislators to educate them and walk them through the process of surveillance and tracking infections in healthcare facilities. This will help legislators understand that legislation should not mandate that hospitals report data that ultimately end up comparing apples and oranges; for example, infection reporting should be limited to populations that make sense, such as reporting central line infection rates only for patients who are at risk for a central line infection.
The state of Pennsylvania originally mandated that hospitals report on rates for all types of infections without considering the populations that were actually at risk for these infections, which resulted in skewed data. Healthcare practitioners need to work with legislators to assist them in understanding infection control surveillance so that any legislation requires hospitals to measure appropriately.
Perioperative managers also should collaborate with infection control and prevention practitioners in their facilities to develop interactive processes in the event of a heightened infection risk. For example, if a break in technique occurs and a patient is at elevated risk for an SSI, the necessary individuals can be alerted to monitor that patient in particular for signs of an SSI.
For healthcare facilities that have significant infection rates, there are several tools that perioperative managers can use to help lower their rates. One such tool is bundling, which gives healthcare practitioners protocols to follow in various situations so nurses or other practitioners are reminded of all the steps they need to take. Bundling also makes training easier because it provides a guideline for what steps to take in each situation rather than the trainer or the trainee simply having to remember each individual step.
In addition, perioperative managers should make certain that their facilities follow the guidelines of the Surgical Care Improvement Project (SCIP) that are applicable to the OR. These guidelines include appropriate hair removal of surgical patients using clippers rather than razors; providing appropriate antibiotic prophylaxis for patients undergoing the appropriate procedures; monitoring a patient's temperature and maintaining normothermia; and performing glucose monitoring, particularly for cardiac patients. Managers can obtain more information on SCIP measures by visiting the Web site, www.medqic.org/scip.
Another important resource for perioperative managers are AORN's recommended practices. Managers who are trying to reduce their infection rates in particular should consult the recommended practices on skin preparation, hand hygiene, high-level disinfection, surgical attire, and environmental cleaning in the surgical setting, as well as the sterilization guideline. AORN's recommended practices and guidelines are updated periodically and are available in Perioperative Standards and Recommended Practices, 2008 Edition.
The OR is a complex environment with new technology being introduced constantly, which increases the complexity of surgical procedures. Consequently the opportunities for errors and breaks in technique could lead to infections. Perioperative managers should be aware of the future trends in healthcare, such as those outlined in the December 2007 AORN Journal article "Emerging technologies in the OR and their effect on perioperative professionals," that could lead to new areas of risk for patients. Perioperative managers should work with infection control and prevention practitioners in their facilities to proactively develop strategies to minimize infection rates and anticipate possible areas for problems as new technologies change the work processes for perioperative nurses.
Reimbursement through pay-for-performance and legislated mandatory reporting are becoming realities in the healthcare field. Perioperative managers must stay ahead of the curve and proactively implement measures to lower infection control rates, not only to maintain the financial health of their institutions but also to protect their patients.
Blanchard is a perioperative nursing specialist in the AORN Center for Nursing Practice in Denver. She is the AORN liaison to the CDC Healthcare Infection Control Practices Committee, The Joint Commission Hospital Professional Technical Advisory Committee, The Surgical Care Improvement Project Technical Expert Panel on Infections, the Association for Infection Control Practitioners Scientific Research Council and the Association for Infection Control Practitioners Practice Council. At the APIC 2007 Annual Education Conference in San Jose, Calif., she presented on the topic of decreasing healthcare-acquired infections by using AORN's Recommended Practices.