Infection Prevention: Mistakes ASC Infection Preventionists Must Avoid

Here’s help for navigating conflicting priorities and endless critical tasks.

As the frontline defenders against pathogens, infection preventionists (IPs) play a significant role in safeguarding patients and staff. However, navigating the complexities of infection control can be challenging, and even the most experienced IPs may stumble into these six pitfalls.

1. Inadequate staff training. Insufficient education leaves staff susceptible to unknowingly engaging in behaviors that heighten patient infection risk. IPs should coordinate ongoing training sessions to ensure all staff members are well-informed about infection prevention measures. Go beyond the minimum requirements of training staff only upon hire and annually. Prioritize time for training that occurs at established intervals, but also when problems are identified, processes are changed or guidelines are updated.

2. Neglecting environmental cleaning. “Inattentional blindness” refers to individuals overlooking objects or events despite them being within their field of vision. Both the IP and other staff members may become less attentive to the cleanliness of their environment due to inattentional blindness that develops over time. It’s a lot like the gradual growth of hair, which we may not notice day by day but becomes apparent when comparing “before” and “after” photos taken weeks apart. To combat inattentional blindness, IPs should establish cleaning schedules and checklists, and conduct regular assessments of environmental cleaning practices to ensure adherence to established policies and procedures. This is done through audits, staff feedback, survey results and swab testing of surfaces.

3. Insufficient sterilization and disinfection. An IP must ensure their ASC strictly adheres to manufacturer Instructions For Use (IFU) when cleaning, disinfecting and sterilizing reusable medical devices and instruments. Deviation from these instructions can lead to the transmission of pathogenic organisms and create risk for patient exposure.

It’s easy to overlook loaned and vendor instrument sets in this regard. Recognizing this challenge, AORN recommends that a successful loaned instrument management program begin with clear and detailed policies and procedures that, among other things, do the following:

• Provide the manufacturers’ IFU to personnel responsible for processing instruments and reusable medical devices in a format they can read and understand.
• Establish standard operating procedures for managing loaned reusable surgical instruments.
• Consider all loaned reusable instruments contaminated and deliver them directly to the decontamination area for decontamination, inspection and packaging before sterilization for patient use.

4. Poor hand hygiene compliance. The World Health Organization highlights the significance of proper hand hygiene, attributing it to the prevention of up to 50% of avoidable infections acquired during healthcare delivery, including those impacting healthcare workers. IPs must stress the importance of thorough handwashing and the use of alcohol-based hand rubs. Visual aids like posters can help reinforce this important practice, alongside consistent monitoring of hand hygiene practices. Changes in practices and workflows may impact staff access to alcohol-based hand rubs. If noncompliance is noticed during hand hygiene audits, review the area with staff members to ensure they have easy access to hand rubs or washing stations.

5. Overlooking patient education. This creates misunderstandings, noncompliance with infection control protocols and can ultimately contribute to surgical site infections. Patient education should begin in the physician’s clinic and be reinforced by ASC staff. Provide instructions to the patient that include any tasks they must complete leading up to the day of surgery, with postoperative instructions highlighted so patients can anticipate and plan for any restrictions in their daily routines.

Preoperative infection prevention strategies to decrease the risk of an SSI can be simple with a high compliance rate if they are properly explained to patients. Prior to surgery, patients can take the following steps: laundering bedding and towels, not shaving the surgical site, showering with special soaps one to two days prior to and the morning of surgery, and wearing clean clothes to the procedure.

Post-op instructions should be written and provided to the patient in a format they can understand.

Discharge instructions should include proper hand hygiene, dressing care, wound care, personal hygiene, signs and symptoms of surgical site infections and when to notify their provider. Consider potential gaps in patient education when reviewing SSIs or complications. Enhance comprehension by incorporating visual aids such as images, drawings or video links that can simplify complex tasks for patients.

6. Lack of continuing education. IPs must stay on top of the latest developments in infection control by regularly attending educational seminars and trainings, participating in professional organizations and keeping up with relevant research. Federal agencies that govern infection prevention practices offer resources including definitions, updates to regulations, implementation tool kits and educational materials. Failure to stay updated can result in outdated practices and missed improvement opportunities.

A big job

Infection preventionists play a key role in the leadership team. Conflicting priorities, evolving trends and the amount of work required to properly oversee an infection prevention and control program can be daunting. Although ultimate responsibility falls to the IP, other team members can serve as valuable resources. Collaborate with leaders and staff to communicate concerns, divide responsibilities, champion projects, audit practices, document activities, implement improvements and, most of all, celebrate success and positive outcomes. OSM