An Infection Prevention Game All Can Play
The winner is the one who spies the most chemical indicators among sets.
A sterilization process failure demands an immediate response. The sooner you can take corrective action, the better. The speed of your response, however, depends largely on how soon your employees are alerted to such an incident. That's why it's important to train not just your reprocessing technicians, but also your OR nurses and techs, to recognize the signs of a sterilizer breach.

Surgical staff should always take note of the chemical indicators wrapped into packages or trays of sterilized instruments before the items are unpacked in the OR, and make sure they've changed in accordance with the directions. At our facility, we turned this into a fun and effective competition.

To play, OR staff members had to save all the chemical indicators they found among the instruments they unpacked for a case. The one who had collected the most by a specified deadline won a prize, a gift card or the like. Admit-tedly, there was a complication at first — orthopedics cases consistently use the most trays, so the staff assigned to those kept winning. But after we scaled the results to the percentage of indicators collected per number of packages used, we'd found a fun way to train staff, especially new staff, to check for the indicators every time.

Dawn M. Yost, RDH, RN, BSN, CNOR
Manager, Nursing Operations
and Sterile Processing Department
West Virginia University Hospitals
Morgantown, W.Va.
[email protected]

Prepare a Linen Bag for Each Bay
To save time at our busy GI center, we create linen bags filled with the bedding and gown that we'll need for each patient and stock them in a nearby cabinet where the pre-op nurses can easily grab them. We then use the same plastic bags to store patients' belongings.

Elizabeth Ann Buckley, BSN, RN
Director of Nursing
South Hills Endoscopy Center
Upper Saint Clair, Pa.
[email protected]

Everybody Wins When Staff Compete With Each Other
Friendly competition is an often overlooked way to influence staff behavior. When we wanted our staff to improve their customer service — telephone etiquette, escorting visitors, displaying name identification tags, things like that — we came up with a contest and a coveted prize: Oscar, a life-sized skeleton that stays for 2 months with the highest-scoring unit.

Oscar is a big deal. He's handed over to each unit as bare bones, but it doesn't take long for the winners to dress him up in a fun theme of their choice. The 2-year-old competition has gotten staff more interested in finding out how they're performing. They often want to see their scores if they didn't win so they can make improvements and win Oscar the next time around. Oscar not only creates a friendly competition among the staff, but also gives us a way to track which units could benefit from a few extra pointers in customer service. Even the physicians have gotten involved and often congratulate the unit that is proudly displaying Oscar.

Stacie Vance, RN
Vice President of Clinical Services
Indiana Orthopaedic Hospital
Indianapolis, Ind.
[email protected]

Keep Close Tabs on Your ENT Implants
Implants used in ENT procedures are as tiny as a comma and as expensive as gold. We pay between $222 and $600 per implant. A sure way to lose money is to let these implants outdate. Not long ago, that's what was happening at our campus, where our hospital and ASC are separated by a parking lot that takes 10 minutes to walk across. The problem was that both facilities were stocking the same implants for the same doctors who do cases at each place. Our solution: a big plastic box filled with 2 of each size of ENT implant that travels back and forth between the 2 facilities. All ENT implants that our surgeons use come from this box, which you can see pictured. When the hospital uses one, I bill the hospital and order another implant. Guess what? No more outdated implants.

Lynda Dowman-Simon, RN
St John's Clinic, Director of Clinic Nursing
St John's Clinic: Head & Neck Surgery, OR Manager
Springfield, Mo.
[email protected]

Surgeon-Led Seminars Help Recruit Patients
Working with your surgeons to host educational seminars is an effective way to market your facility to potential patients, especially if you focus on procedures that differentiate your facility from others in the community. Our surgeons tout the benefits of partial knee replacement, including the same-day discharge that the community hospital doesn't offer. The seminars also set patients' expectations about the potential for quicker recoveries, which is a key factor in being able to discharge them quickly and safely after surgery.

About 15 to 20 people attended each of the 3 "Outpatient Outlook" seminars we've hosted. One of our surgeons says he scheduled 4 cases from the first 2 seminars. That's a solid return on a minimal and enjoyable investment. Keys to successful seminars include:

• Getting the word out. Post flyers throughout your facility to capture current patients, ask surgeons to post notices in their offices and pin invites on public bulletin boards (in grocery stores and libraries, for example) throughout your town. Consider advertising in church bulletins and in your community's free newspaper. Overall, we spend about $125 to advertise each event.
• Keeping presentations brief. Ours are scheduled for 1 hour and typically begin at 1 p.m. The presenting surgeon speaks for about 30 minutes before opening the floor to questions.
• Feeding the masses. Buy lunch from a local restaurant or warehouse retail chain. The amount of food and drinks you'll need obviously depends on the number of people scheduled to attend. We typically spend between $40 and $175 for the dozen or so attendees we've hosted. Share the leftovers with your surgeons and staff — that's always a real crowd-pleaser.

Rebecca Klein, RN
Director of Clinical Operations
Brookside Surgery Center
Battle Creek, Mich.
[email protected]

A Fresh Addition To Skin Prepping
For foot and ankle procedures, we do what we can to keep bacteria counts as low as possible. So in addition to the skin preps we apply before making the incision, and in addition to the chlorhexidine gluconate soap or wipe we prescribe the patient to use the night before and the morning of surgery, we also put aerosol deodorant to antiseptic use.

We ask our patients to spray the foot we'll be operating on with a deodorant — but not an antiperspirant deodorant — that includes triclosan among its active ingredients before presenting for surgery. We instruct them to apply a liberal coat in order to saturate the spaces between their toes and under their toenails.

The idea came from recreational athletes who spray their shoes to keep the odoriferous bacteria down. We haven't done clinical studies to test microbial kill quantities, but there's really no downside to the precaution. Spray deodorant is easy and inexpensive for patients to obtain, and it's an added layer of perioperative protection.

William A. Newcomb, MD
Chief Executive Officer
First State Surgery Center
Newark, Del.
[email protected]

Make Having Fun a Job Requirement
Even though your staff's noses are often pressed firmly against the grindstone, don't forget to blow off some steam every now and then. Assign a representative from each department in your facility to serve on a Fun Team. Ask the ringleaders to organize activities or plan outings designed to lighten your moods, develop camaraderie and raise staff morale.

Our team has arranged after-work happy hours, hung a Nerf dartboard in the staff lounge and bought hula hoops and Frisbees for an upcoming outdoor employee lunch. They recently hosted a "Blast From the Past" party during which staff brought in old pictures of themselves so their colleagues could look past the funky clothes and crazy hairstyles to guess who was who in a prior life.

Perhaps their best idea occurs every Wednesday when the Fun Team turns off the TV in the staff lounge. The winner of a weekly drawing can choose the music that's played instead. Switching off the boob tube has been a big hit and a surprising teambuilding exercise. Instead of watching the (often bad) news of the day in silence, the staff chats and laughs together.

Alisa Fischer, RN, MHSA, CASC
Administrator
St. Augustine Surgery Center
St. Augustine, Fla.
[email protected]

Take a Time Out Before You Administer a Regional Block
You take a time out in the OR before you cut, so why not pause in the block room before you inject a regional anesthetic? As an additional safety procedure, some of our readers tell us that they're pausing briefly before they administer regional blocks. "It's not as detailed as the time out in the OR," says an ASC manager, "but we decided it was best to stop and take a deep breath in the block room to make sure we had the right patient and procedure." A pre-op nurse and the anesthesia provider placing the block confirm the patient's ID and the procedure along with side modifier. They also make sure that consents are signed, and sign and date the time the pause occurred on pre-printed stickers that they affix to the anesthesia consent form.