Infection Prevention: Stepping Up to Prevent SSIs

Infection Prevention

By: Joe Paone

Published: 9/11/2019

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Staff at Saint Francis Health System has worked hard to significantly lower infection risks - and they're not done yet.


Last fall, Saint Francis Health System in Tulsa, Okla., made a big push to improve point-of-use instrument cleaning by posting a new regimen for staff to follow in every OR. "We're keeping our instruments soaking and wiped down during cases," says Tamra Luna, MSN, RN, CNOR, the OR manager of surgery services at Saint Francis. "As soon as the case is done and the patient's out of the room, we make sure we get all the "chunks and hunks' off the instruments."

Doing away with the "chunks and hunks" — along with the significant strides the staff has made over the past year toward eliminating SSIs — has earned Saint Francis the OR Excellence Award for Infection Prevention.

The changes staff made to infection prevention protocols over the past year are comprehensive, and have nearly eliminated infection rates among total joint and colorectal surgery patients.

  • Pre-screening. When patients arrive at the pre-admission testing clinic, numerous actions are taken with SSI prevention in mind. Clinicians note the patient's A1C levels and comorbidities, and institute enhanced recovery protocols by giving patients nutritional supplement drinks 5 days before surgery. On the day of surgery, patients are pre-warmed with a focus on maintaining core body temperatures.
  • Instrument care. Ms. Luna and her team trialed multiple products for maintaining the wetness of surgical instruments and to eliminate bioburden buildup. They ultimately decided on a pre-cleanse wetting solution rather than an enzymatic soak because they found it best maintained wetness until delivery to sterile processing.

NO NEED TO LEAVE Infrequently used materials that a given surgeon might need on a case are conveniently stored in cabinetry in Saint Francis' newly renovated ORs.   |  Saint Francis Health System

After thorough pre-cleaning in the OR, instruments are transported to sterile processing in a closed case cart, with a wet towel placed over the instruments to keep them moist.

Most surgical staffers were aware of pre-cleaning but didn't grasp its importance. The hospital now audits for point-of-care cleaning in the OR. "Any instruments that are sent to sterile processing without maintaining wetness are reported, and we go back to the individuals [who worked the case] and talk about it," says Ms. Luna.

  • Decreased foot traffic. "Evidence-based research shows the importance of decreasing movement in the OR — and not necessarily just opening and shutting of the doors, people coming in and out — but also the traffic in the room itself," says Ms. Luna. "Extra movement in the rooms during the surgery stirs the air and any bacteria in the room."

To minimize movement, renovated ORs at Saint Francis feature more built-in cabinetry that can house rarely used or emergency instruments, so if a surgeon needs such an item, it'll be in the room.

Another movement-reduction technique: All of the equipment in ORs is hung on built-in booms, meaning the equipment doesn't need to be rolled into and around the room as it's needed.

As a result of all of these changes, Ms. Luna says the ORs are "more contained," and St. Francis now exceeds the national standard in terms of limiting traffic movement in the OR.

  • Antibiotic management. "We always make sure there's an antibiotic that matches appropriately to the evidence-based practice for which kind of antibiotic to use for certain kinds of cases," says Ms. Luna. The correct antibiotic is predetermined in the pre-admission testing clinic unless the surgeon chooses a different one for a specific case.

Ms. Luna and her team will formally roll out a comprehensive colorectal SSI bundling program on Oct. 1, but continue to improve their infection prevention program — a total joint SSI bundle is next, with bundles for additional procedures to follow. "Over the past year we have decreased our total joint infection rates as well as our colorectal infection rates and continue to constantly improve on our processes to decrease any potentials that could lead to SSIs," says Ms. Luna. OSM

HONORABLE MENTIONS
Always Improving Infection Control
LIGHT THE WAY Johanna Pratts, RN, uses a UV disinfection robot in a GI suite.   |  Lakeland Surgical and Diagnostic Center
  • Cleaning every surface. Lakeland (Fla.) Surgical & Diagnostic Center invested in and uses a UV disinfecting robot regularly, all over its facility. OR Director Nikki Williams, RN, CNOR, explains that after manual cleaning, each OR is subjected to 2 10-minute cycles from the robot, ensuring all surface areas are disinfected. OR staffers make sure the UV light shines on hard-to-access places like the undersides of mattresses and the insides of the drawers on anesthesia machines — "every nook and cranny we can," says Ms. Williams. The robot is not just used in the ORs, however; it's used on a regular basis in patient bathrooms, the lobby, SPD and materials management.
  • Technology and technique. A rise in SSIs in the cardiac surgery unit at Temple University Hospital in Philadelphia, Pa., led to close collaboration between 2 groups that often don't speak each other's language: clinical staff and the IT department. Together, they created a comprehensive real-time reporting document — the OR Surgical Site Infection Report — to monitor compliance with SSI prevention protocols. "It was difficult to identify if deficits in care existed," says Mary Mahabee-Betts, MSN, RN, CNOR, perioperative quality and patient safety nurse manager. While reviewing the prevention strategies being employed, data collection proved time consuming, because the data had to be manually extracted from every phase of the patient's care. Another problem was the siloing of cardiac patients' pre-op, perioperative and post-op phases of care. The new electronic report allowed the team to determine if "we were really doing what we said we were doing" with SSI prevention, says Ms. Mahabee-Betts. "We discovered a lot of gaps in nursing practices." In real time, the document captures all the essential components and data points needed for an SSI bundle. As a result, the total number of SSIs in the cardiac unit at Temple decreased from 11 in 2017 to 5 in 2018 to 2 in 2019, and the cardiac unit's program has become a model for the rest of the hospital.
  • Team-wide approach. UPMC Pinnacle in Harrisburg, Pa., has an ambitious goal — zero SSIs — and bolstered it with a variety of changes. Hand hygiene is now audited monthly. "If someone is caught not washing their hands, we sometimes give the person who caught them a $20 gift card," says Sandra Winston, MHA, MSN, RN, vice president of surgical services.
KEEP OUT\!
UPMC Pinnacle
KEEP OUT! UPMC Pinnacle uses signs on its OR doors to discourage staffers from entering unnecessarily during surgeries.

Other SSI prevention initiatives at UPMC Pinnacle: A Surgical Optimization Clinic for high-risk patients screens them for smoking, obesity, diabetes and COPD; if there are risky conditions, letters are sent to both the surgeon and PCP, asking them to consider sending the patient to the clinic for optimization. To limit foot traffic in the ORs, "do not enter" signs are placed on doors during surgeries. "Every single person has a responsibility to prevent SSIs," says Ms. Winston. "Even one infection is too many."

— Joe Paone

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