Prevent SSIs With This Big Picture Approach

Melding multiple protocols into a seamless bundle is the name of the game.

Michelle King, MT(ASCP), MPH, CIC, LTC-CIP, underwent a major surgical event after the birth of her second child. There were two procedures performed by two different surgeons, so the coordination and communication needed to ensure that all surgical site infection (SSI) prevention protocols were followed to the letter was a significant challenge.

In spite of clear obstacles the dual surgeries presented, Ms. King, corporate director of infection prevention and control for McLeod Health in Florence, S.C., and an APIC Corporate Communications Committee member, says everyone involved in her care rose to the occasion with aplomb. “I was very fortunate that the team was extremely well versed in infection prevention,” says Ms. King. “What they did, the way they communicated, it was everything to me at the time.”

Staff explained everything — from what they were doing to why it was necessary — on a level that anybody would understand, and they followed up on everything consistently and appropriately. “When staff puts in the extra effort to explain everything, it makes the patient feel that you care about them and about what you’re doing to their body,” says Ms. King.

Patient over procedure

Ms. King’s experience highlights one of the most important truths about surgery. “You need to take care of the whole patient and not just the procedure,” she says. “It’s all about preparing your team for the patient, having your patient prepared for the procedure and using the items in your SSI-prevention bundle to ensure the patient can lead a better, healthier and fuller life after surgery.”

Sum of multiple infection-prevention practices

Each step in the SSI-prevention bundle plays a vital role, but it’s the sum of these multifaceted protocols and policies that ultimately protects the patient throughout the entire perioperative journey. From proper preoperative patient education and prophylaxis administration to consistent skin prep and wound irrigation and closure practices, best-in-class facilities understand the importance of approaching the SSI-prevention challenge from multiple fronts.

Ms. King offers these simple, practical tips to maximize the effectiveness of the following elements in many SSI-prevention bundles.

• Patient education. Collaboration with physician offices is critical — especially for smaller ASCs. “Everyone needs to be on the same page at all times,” she says. The education must also clearly lay out every part of the perioperative process from pre-op through recovery.”

It’s one thing to explain the surgery to patients — many of whom feel overwhelmed and overstressed. It’s another thing altogether to get them to retain that info. One tactic Ms. King finds helpful is repetition. “Have your patients repeat what you told them,” she says. “And always send home education materials with a contact number patients can reach out to with their questions.”

“You need to take care of the whole patient and not just the procedure.”
Michelle King, MT (ASCP), MPH, CIC, LTC-CIP

• Skin prep. It’s difficult to overstate the importance of performing this core infection prevention practice properly. Unfortunately, the right way isn’t always the way it’s done.

“Sometimes there’s this faulty assumption that only one area needs to be cleaned in skin prep prior to the procedure, but the reality is the patient needs to be cleaned from head to toe,” says Ms. King. “We have seen patients with limited resources come in for a procedure needing a bath.”

Adequate skin prep also requires staff to use the correct amount of a product, such as CHG swabs. “Higher-BMI patients require more than one CHG swap, and that’s something that can be overlooked,” says Ms. King.

There’s also the time element to consider. Ms. King notes that even with intense pressure to turn over cases quickly, OR teams must adhere to proper dry times with the skin prep agents they use.

Ms. King urges facilities to enforce proper clipping and shaving practices. “You never want to use clippers on the patient in the OR because you don’t want hair to contaminate the sterile field,” she says. “If it’s an absolute emergency, the clippers should have a vacuum attached to avoid contaminating the surgical site.”

• Prophylaxis administration and redosing. This element of infection prevention requires strong collaboration with your formulary to regularly review dosage timing. “Surgical prophylactics change over time, and you also need to factor in BMI when you’re looking at dosage and re-dosage,” says Ms. King. “The administration needs to be timely enough for the prophylactic antibiotic to perfuse the tissue before the incision or cut time.”

• Wound irrigation, closure and care. Comprehensive wound care is a central part of infection control, so it’s important to regularly audit your protocols in this area. Ms. King points out that a major fluid shortage caused by a convergence of factors related to Hurricanes Helene and Milton highlighted what not to do on the irrigation side. “During the fluid supply shortage, we realized we could prevent mixing errors by using premixed irrigation solutions for the procedure,” she says. “Premixed irrigation solutions take those errors out of the equation.”

Lean on expert help

If you’re a facility leader at a busy ASC whose multiple hats include infection prevention, the prospect of creating or enhancing a comprehensive SSI-prevention bundle, properly training staff on its multiple parts and regularly auditing processes for compliance can seem overwhelming. But there’s absolutely no reason to reinvent the wheel.

Yes, surgery centers need the person overseeing their infection control efforts to be trained in infection prevention, but plenty of options are available. Given the focus on ASC-specific infection prevention in recent years, available resources will almost certainly increase in the near future.

“There are a lot of resources out there. APIC offers training geared toward ASCs, AORN has a program,” says Ms. King. “It’s important for leaders to get some type of expert training because it will help them understand how they can better prevent SSIs.” OSM

Note: This three-part article series is supported by Ansell.