ORX Awards 2021 - Infection Prevention - Confronting the Pandemic Head On

Staff Safety Patient Safety OR Excellence Infection Prevention COVID-19

By: Adam Taylor | Senior Editor

Published: 8/30/2021

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New policies and aggressive COVID-19 testing kept OMNI Surgery Center open during the nationwide surgery shutdown.


While many facilities were shuttered during the pandemic’s first wave, OMNI Surgery Center’s quick action allowed surgeons to use the facility’s four operating rooms for urgent cases when former New York Gov. Andrew Cuomo suspended elective procedures statewide. The extraordinary steps the center in Utica, N.Y., took to remain open and operating earned it this year’s OR Excellence Award for Infection Prevention.

“Our center has always had a zero percent surgical site infection rate, but we also wanted to make sure staff remained healthy throughout the pandemic so they could continue to perform necessary surgeries,” says Amy Porter, the center’s director. “I think we did well.”

The staff’s first order of business was to sanitize and purify the air within the facility. OMNI already had HVAC filters and fresh air circulators that were installed when the center was constructed six years ago. The center purchased industrial-grade negative-pressure air purifiers at the pandemic’s onset. While mobile in theory, the refrigerator-sized units will likely take up permanent residence in the center’s pre- and post-op areas. The devices have a five-stage filtration system that filters 100% of the air in the spaces every four minutes.

“They provide outstanding defense against Sars-CoV-2 particles as well as other contaminants, chemicals, viruses and bacteria,” says Ms. Porter.

OMNI also enhanced its cleaning protocols. Curtains between pre-op and PACU bays that were once sent out to be laundered quarterly now get steam cleaned twice daily, after each shift. Chairs with soft surfaces are also steam cleaned. (Research shows that steam 212°F or hotter kills the COVID-19 virus.)

The facility’s new electrostatic sprayer disinfects high-touch surfaces such as doorknobs and high-traffic common areas, including restrooms, patient registration desks and nurses’ stations. The sprayer uses a cleaner that Ms. Porter says kills 99.9% of germs, including SARS-CoV-2.

Perhaps most importantly, OMNI mandated weekly polymerase chain reaction (PCR) coronavirus testing for all staff, surgeons and other providers. New York required patients to have a negative COVID-19 test result prior to elective surgery, but there were no such mandates for healthcare personnel.

High-Level Disinfection Done Right
HONORABLE MENTION
NO SHORTCUTS Doi Pham, a senior endoscopy technician, cleans a flexible endoscope at the bedside immediately after a procedure.  |  National Ambulatory Surgery Center

Staff at National Ambulatory Surgery Center, a two-OR facility in Los Gatos, Calif., take endoscope reprocessing very seriously. “Our culture is such that we’re willing to stop a procedure if there’s any reason to believe that a step was missed in our infection control processes,” says Marisa Ynchausti, RN, BSN, the facility’s clinical nurse manager. “We’d even close the center if need be.”

Employees meticulously follow manufacturers’ instructions for use when cleaning endoscopes and refer to high-level disinfection guidelines issued by AORN and the Society of Gastroenterology Nurses and Associates. The facility’s infection control coordinator audits 10% of the endoscope’s fleet on a daily basis to ensure the devices were correctly reprocessed. If a scope is found to be contaminated, the employee who was involved in its reprocessing must complete an in-service on proper endoscope care before working again. The center also requires its per-diem employees to complete the in-service education.

Ms. Ynchausti views the center’s 100 five-star Google reviews as an infection prevention report cards of sorts. “Our patients trust that we know what we’re doing, and that we’re keeping them safe when they come here,” she says. “To read what grateful patients write is more than a professional reward for us. It’s a signal that our infection prevention efforts work.” 

— Adam Taylor 

“To prevent potential transmission from staff to patients, we required employees to undergo PCR testing at least weekly,” says Ms. Porter. The PCR test used by OMNI is different from rapid testing. It’s considered the gold standard test for COVID-19, as it detects the genetic material of the virus rather than detecting only antigens of the coronavirus, as is the case with rapid tests. OMNI Medical Director Nameer Haider, MD, created and implemented a protocol that returned results within four hours of the collection of PCR nasal swabs.

If a staff member tested positive or was exposed to the virus, they immediately were quarantined and restricted from work for 14 days with pay, says Ms. Porter. All other staff members still reporting to work were mandated to undergo daily PCR testing, since results could be obtained within four hours.

“This strict protocol wasn’t mandatory in New York or nationally, but it allowed us to operate as safely as possible during such a vulnerable time,” says Ms. Porter. “While hospitals had suspended all elective surgeries, we’re proud to have been able to provide the community with a site where patients could receive needed care and surgeons could perform urgent and emergent procedures.” 

The changes OMNI implemented facilitated its approval by CMS to participate in the Hospitals Without Walls program. 

All of the facility’s pandemic-specific guidelines remain in place. Masks are mandatory for all staff and patients, even for those who have been vaccinated. Visitors and non-medically essential support persons are prohibited access.

“Our staff and patients are encouraged to help reduce the spread of the virus by vaccinating, but we understand this is personal preference and therefore continue to maintain social distancing and the use of proper PPE,” says Ms. Porter. “As always, our focus is on the safety of our patients and staff members. We hope to do our part in putting the pandemic behind us.” OSM

Adding Cases, Not Infections
HONORABLE MENTION
PRE-OP PREP Missoula’s spine and total joints patients apply a 2% chlorhexidine gluconate antiseptic solution before surgery.  |  Missoula Bone & Joint Surgery Center Pamela Bevelhymer, RN, BSN, CNOR

Last year, Missoula (Mont.) Bone & Joint Surgery Center doubled its case volume and maintained its already low surgical site infection rate by upping their game with evidence-based practices in four essential areas:

• Protocols for high-risk patients. Patients scheduled for spine procedures or total joint replacements shower using a 4% chlorhexidine soap the night before and the morning of surgery. Staff also screen patients for methicillin-resistant and methicillin-susceptible Staphylococcus aureus. “Patients who test positive are treated with an antibiotic nasal decolonization protocol and IV vancomycin before surgery,” says Kelly O’Brien, MSN, RN, CPAN, the facility’s clinical director. “All total joint and spine patients administer a rinse-free, head-to-toe prep with 2% chlorhexidine gluconate preoperatively using a disposable cloth for long-lasting antimicrobial protection.”

• Fewer flash sterilizations. An internal analysis in 2019 showed the center was using immediate use steam sterilization (IUSS) too frequently. “We educated ourselves on why a reduction in the practice was needed, then added more instrument sets and hired an additional sterile processing technician to increase our workload capacity,” says Ms. O’Brien. “We reduced our IUSS rate to 3% and have kept it there.”

• More environmental cleaning. The facility purchased a cleaning verification system that allows staff to collect and analyze data to prove that their cleaning and disinfecting practices meet cleanliness standards for operating rooms, says Ms. O’Brien. The wireless system has a 5-inch touchscreen that monitors the results and effectiveness of cleaning devices and detects the presence of adenosine triphosphate (ATP), an indicator of the presence of live bacteria. High-touch surfaces such as keyboards are swabbed to test for ATP as well. The results have created opportunities for more thorough cleansing by the OR and housekeeping staffs.

• Hand hygiene audits. The facility’s leadership conducts secret monthly inspections using an observation method to verify compliance and share results. The audits include observations of surgeons, anesthesiologists and all staff who provide direct patient care. 

— Adam Taylor

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