If you work in a hospital, chances are you have an extensive infection-tracking program that includes input from the biomed department, a staff infection control nurse and in-house risk manager. Not to mention the education department that formalizes any infection-tracking initiatives.

In the ASC, however, you probably won't find much, if any of this kind of staff infrastructure. Combine that with the perception that ASCs don't have problems with surgical site infections, and you might end up with far less thorough infection-tracking programs.

But regardless of the surgical setting, your goal is zero SSIs. With that in mind, here's a primer on what to track, how to track ' including recognizing an infection problem ' and the steps you should take to involve physicians and other providers in process reviews and implementation of change.

Get it on paper
Your first step is to create a spreadsheet that includes all the information needed about each case to spot a potential trend (see "Infection- tracking Chart"). Next, you should dedicate someone to reviewing the patients' charts and filling in the data. That means every patient's chart, not just a sample of your patient population. If all your infections aren't in the sample population, are you capturing all the data?

With all the data recorded, you're primed to follow up on each surgery for a post-op infection; most infection organizations call for the post-op period to be 30 days. Rely on the surgeon to make most of the initial diagnoses, but you might be able to spot a post-op infection while talking to a patient if you know the signs to look for and the right questions to ask.

• Have you experienced any redness around the incision?
• Has there been any purulent drainage?
• Have you been running a fever?
• Have you been experiencing any unusually severe pain or swelling at the site?

You might also be able to determine post-op infections by sending surveys to physicians on any infections or complications they saw in follow-up visits with patients. If an infection is identified, review physicians' records; examine office charts for notes on post-op care, referrals for specialty care, follow-up referrals and long-term outcomes.

Pay attention
If you learn of a few SSIs, with all the data you've recorded, you can easily watch for trends. The first step here is to review the infection log for trends ' consider all staff, instruments, equipment and medications. Were there any equipment problems during the period the infections arose? If so, have the equipment problems been resolved? When?

Another tack is to observe the clinical staff to determine if any processes have changed. Finally, you can observe technique ' in the OR and everywhere else along the patient's journey through your facility.

Start in pre-op. Look for a standardized admissions process ' and whether anything out of the ordinary occurs that causes the process to be altered. Are topical meds used? Is an IV or a heparin lock inserted? Is the patient's skin intact?

Next up is the OR. Observe the patient. Is he wearing street clothes or a gown? The surgical team should adhere to the OR dress code in all cases. What's the traffic pattern ' are people in and out constantly? The OR doors should, ideally, remain closed throughout the procedure; note how many times they're opened. Observe prepping and draping for adherence to proper technique protocols.

In PACU or step down (phase 2), record the time the patient spends in recovery, any patient complaints (such as pain, PONV or discomfort) and the staff present. Also note the time from the end of case to transfer and any complications or alteration from routine. Further, how is the patient prepared for discharge, and what is the condition of the surgical site at this time? Determine the patient's awareness and understanding of discharge instructions. Was a family member present? What was that person's awareness of post-op instructions?

You should also examine your processes. For example, the times between patient admission and transfer to the OR, and arrival in the OR and the start of the procedure. Record procedure lengths. How long does it take from the end of surgery to the patient's transfer to PACU? Watch for breaks in technique in the OR, how instruments and equipment are handled, and whether there are employee changes during the case. How many instruments are on trays? Were there any observers in the OR? Everyone present in the OR should be listed on the OR record. Identify any complications with the procedure.

Central sterile processing is another good place to spend time observing. Watch the handling of equipment and instruments, cleaning, disinfection and preparation for sterilization or high-level disinfection. Record the types of sterilization procedures and equipment and the products used.

Recruit help
If you do discover you have an infection problem, use all the options at your disposal, including your reprocessing equipment manufacturers, other surgical facilities, pharmaceutical representatives, AORN, equipment specialists, consultants and the Association for Professionals in Infection Control and Epidemiology. Keep staff involved throughout the process of fixing the problem. After all, you can't have an infection-free facility if you don't get everyone involved.

Use all infection prevention strategies systematically, educate staff constantly, and be scrupulous about tracking and reporting. If you stay vigilant, you can meet your goal of an infection rate at or near zero percent for outpatient surgery.