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6 ways to achieve infection prevention with simulation

Publish Date: 5/29/2013

If you're not using simulation in your facility or it's not being used as part of your infection prevention (IP) efforts, start doing so as soon as you can. Simulation can serve as an extremely valuable tool for education and training, helping to improve in areas of deficiency, ensure proper practices and ultimately prevent healthcare-acquired and surgical site infections.

While preventing healthcare acquired infections (HAI) is critical for patient safety and high quality care, it's now tied directly to reimbursement; hospitals may lose out on opportunities to capture additional payments if patients contract certain HAIs after their admission. In addition, infection rates are becoming public information, so patients’ researching their options for care may lean toward choosing organizations with lower infection rates.

Here are six ways to leverage simulation to support IP and control efforts.

1. Commit to using simulation. Regardless of your facility size or budget, there is a place for using simulation to support IP efforts, says Sue Barnes, RN, CIC, national leader of IP and control for Kaiser Permanente. "Simulation can be hi-tech, or it can be low-tech. There's a wide variation of budgets that are applied to simulation programs, even within Kaiser Permanente. It's always a great idea to start simple and small, gain confidence with the process, figure out what you're doing, right and wrong, and then grow your simulation program."

2. Record your simulations. Not only is there tremendous value in running a simulation exercise, but recording the exercise and discussing it with participants afterward provides opportunities for education, says Maureen Houstle, RN, perioperative unit educator west campus and co-chair of the perioperative education council for Beth Israel Deaconess Medical Center. "We record the simulation and then everybody gathers in a separate room for a debriefing and watches the video of what took place. Everybody gets a chance to see the roles, responsibilities and performance of the other members of the team. It's a real eye-opener to people to observe how many different tasks — often performed simultaneously — each member of the team handles during a process. This builds a new level of respect between team members and helps people perform safer practices as viewing the simulation they clearly see the demands on each member of the team"

Recorded simulations can also be used as infection prevention teaching tools for members of the team who did not participate in the simulation itself, as long as proper steps are taken. If the participants sign releases agreeing to such use of a recorded simulation or if your hospital has the technology to blur out participants' faces (it's still a good practice to have signed release forms), the simulation can be watched and discussed by other OR teams.

"There are so many things that play into infection prevention in an OR environment — everything from the room cleaning to proper technique in terms of gowning, gloving and instrument sterilization — sometimes just viewing a simulated experience gives you awareness of where mistakes can happen or shortcuts are taken," Houstle says.

3. Use simulation when changing processes. Whenever you roll out new processes in your facility, including those that may increase the likelihood of an infection, use simulation to teach the proper way to perform that process, says Barbara DiTullio, RN, OR nurse manager for Beth Israel Deaconess Medical Center. "When you tell staff about a new process and what they need to do to perform that particular practice, you can get hundreds of variations of how that process is performed. But when you show a simulated video or video-taped script of the way it should be done, that's pretty concrete. It leaves nothing left to the imagination or to question."


4. Apply simulation to basic procedures. Barnes says she has seen simulation used effectively to teach what some people may consider basic procedures. "In one our regions where there are more than 20 hospitals, a simulation program was designed to teach the proper sequence of process of donning and removing personal protective equipment for contact precautions in order to reduce C. difficile transmission risk. The region theorized that incorrect removal of gowns and gloves and subsequent contamination of hands and clothing was possibly contributing to transmission of C. difficile. The simulation program was designed using a train-the-trainer approach. Representatives from each hospital traveled to a central location for training and then returned to their facilities to teach all of the staff."

Barnes continues, "The region saw a subsequent reduction in C. difficile, which was very exciting. That's an example of a really basic procedure where simulation can be useful for improving reliability."

Houstle agrees. "Whether you're teaching handwashing, scrubbing or how to perform a prep, having everybody learn the same information the same way leaves no question as to how the process needs to be followed," she says

5. Use simulation to address problem areas. "In another Kaiser Permanente region, the IP department conducted a number of observations of surgical cases where there was a spike in the infection rate," Barnes says. "What they observed was the surgical prep was not performed correctly every time."

The region created a simulation program where they made it mandatory for every OR nurse and tech go through the program and perform the application of the surgical prep and clipping of hair in the prescribed way on a mannequin. "Subsequent to that one intervention a significant reduction in surgical infection rate was observed," she says. "This program has been shared widely within Kaiser and with non-Kaiser medical centers as well"

6. Simulate high-stress scenarios. Firefighter training will often include extremely challenging scenarios where firefighters are tested to react quickly and without hesitation. Simulation can be used in a similar fashion for members of the OR team.

"We had a real-life code situation in the OR that could have had a horrendous outcome," DiTullio says. "But the OR nurse handled it extremely well because she had encountered the same exact scenario in simulation. When the code situation occurred, her training kicked in and she was able to respond in a way that made for a really good outcome because she was very familiar with the situation."

Include the infection preventionist on the OR team
To ensure efficient collaboration between the infection preventionist and surgical services, in all areas including simulation, requires the infection preventionist to become familiar with the OR environment and serve as a member of the OR committee, says Barnes. "Optimal surgical site IP programs require the infection preventionist to become familiar with the OR environment and actively partner with the perioperative services department. There needs to be an effort made by both departments to achieve this goal. And it is well worth the effort as it can result in the blending of the clinical expertise of those two disciplines, optimizing patient safety."

At Beth Israel Deaconess Medical Center in Boston, the infection preventionist sits on the OR practice council in addition to other specialty specific committees, according to Houstle. Similarly, there is perioperative representation on the hospitalwide IP steering committee.

Barnes says, "The OR staff — they are the subject matter experts in terms of what happens to the patient in the OR, the use of the complex equipment, aseptic technique, etc. The infection preventionist brings a special body of clinical expertise relative to how surgical infections can be prevented that often the OR staff and surgeons often aren't aware of as there it is so dynamic and rapidly evolving. It's really exciting when there is a close partnership between those two clinically expert groups. Simulation is a tool that can be used to create the bridge between the two departments."

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