THIS WEEK'S ARTICLES
Going Beyond Barrier Protection During the COVID-19 Pandemic - Sponsored Content
Striking Quickly to Prevent SSIs
Real-time feedback from the front lines drives change that reduces infection risks.
When post-op infections occur at University of Wisconsin Health in Madison, a Strike Team assembles to drill down to their root causes and then takes immediate action to prevent them from happening again. The multidisciplinary group of surgical professionals investigates gaps in care and reinforces best practices to the perioperative staff.
The Strike Team created a standardized form on which perioperative providers check off each element of the health system's infection control bundle and note any concerns they had about how the case progressed. The information on the forms is entered into a spreadsheet on a weekly basis, giving surgical leaders a current snapshot of the staff's performance and feedback. When an infection is reported, the Strike Team reviews the information collected during the case in question to determine if best practices were followed and then addresses members of the surgical team if oversights occurred.
"We have immediate access to real-time data that shows what our providers are doing on a daily basis," says Ahmed Al-Niaimi, MD, FACOG, FACS, chair of the Quality Improvement and Review Committee at the University of Wisconsin School of Medicine and Public Health. "That allows us to identify gaps in care and respond more frequently and urgently, which is key to lowering infection rates."
Even when infections don't occur, the Strike Team meets on a regular basis to review the forms and brainstorm ways to improve the health system's infection prevention practices. Its members have full authority to recommend changes to surgical protocols and final say in what must be done to enhance patient care.
"When the Strike Team decides to implement a new policy, it gets done, no questions asked," says Dr. Al-Niaimi. "The health system's administration made it clear from the beginning that reducing SSI rates was mission critical and empowered the team to make it happen."
3 Keys to Safe and Speedy Room Turnovers
Keep these cornerstone principles in mind as you prep for the next case.
Safety and speed aren't mutually exclusive when it comes to turning over ORs between cases. Both are essential components of quality outpatient care. Manage the following three variables to empower your surgical teams to achieve safe and professional room turnovers in a hurry, says Romel Jimera, MSN, RN, CNOR, perioperative nurse educator at UCSF Health in San Francisco.
Teamwork. Designate a room turnover role to every member of the surgical team. For example, place one person in charge of ensuring computer keyboards, video monitors and the whiteboard are wiped down. Assign other team members to clean the surgical lights, table surface, countertops and so on. "The assignments will vary from facility to facility, but the important aspect is to have a system in place to ensure all areas are covered and staff members don't reclean spots that have already been treated," says Mr. Jimera.
Communication. Remind team members to communicate during the turnover process to ensure the room is in order and fully supplied. If issues arise such as inadequate staffing, loop in your infection preventionist or perioperative management, who can help you formulate a process improvement plan to present to your leadership team. In Mr. Jimera's experience, outside consultants were occasionally hired to help OR teams create efficient processes and protocols to improve the quality of room turnovers.
Collaboration. Conduct periodic audits of the cleaning process to see if anything is being missed or to identify areas for improvement. Taking an active role in enhancing the turnover process avoids placing the entire responsibility on surgical team members and infection preventionists. Involve representatives from various departments, such as nursing, anesthesia and infection prevention, in creating a cleaning protocol, because each discipline has its own distinct perspective based on roles and experiences. By giving everyone a say in the process, the challenges and needs are clearer to everyone.
Don't forget to include surgeons in this process, especially when major changes occur. Surgeons are usually in and out of the OR, so they often don't see what really happens between cases. Nevertheless, they need to understand the effort your OR team expends in ensuring efficient room turnovers, as well as how they can contribute themselves. "For instance, their willingness to remove waste from the sterile field after procedures will expedite the cleaning process," says Mr. Jimera. "The next case will start sooner and their next patient won't be kept waiting."
Following these three principles will not only ensure that your turnover teams jump into action as soon as patients are wheeled out of ORs, but also that they'll do so as safely and as quickly as possible.
Going Beyond Barrier Protection During the COVID-19 Pandemic
Can your table sheet do THIS?
Now, more than ever, critical infection prevention efforts are being implemented into the high-risk hospital environment. To prevent the transmission of infectious agents in the healthcare setting, the CDC recommends the use of disposable patient-care equipment in acute care areas.1
Environmental surfaces continue to harbor viruses and act as a reservoir for bacterial proliferation. Organisms have the unique ability to survive and multiply in the cracks, crevices and microscopic holes of table mattresses, gurneys and beds. Inadequate disinfection or cleaning have the potential to lead to harboring harmful pathogens which put both the patient and healthcare worker at risk for acquiring infections.
In one study, the FDA received 700 reports that mattress covers failed to prevent blood and body fluids from leaking into the mattress, exposing patients to harmful pathogens and bacteria.2
The risks of reusable linens
Reusable cotton linens do not maintain acceptable barrier properties. Reusable textiles show serious faults, impairing functionality and exposing patients to pathogens and bacteria, being harbored in the O.R. mattress.
A recent study showed insufficient removal of bacterial contaminates after laundering, with 93% of towels containing E. coli and Klebsiella.3
Many facilities have now transitioned to disposable, impervious table sheets however even with this barrier protection, significant bacterial transfer still occurs from a contaminated operating room table to the patient contact surface.
Ansell is the only provider of disposable, antimicrobial linens that offer COMPLETE PROTECTION against bacterial migration and strike-through contamination. STAT-BLOC™ Linens are 99.9% effective against E.coli, MRSA and CRE. In a time when the fight against cross-contamination is critical, these disposable, antimicrobial linens are an infection prevention tool that every hospital should have on hand.
1. "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings." CDC. Last accessed 20 April 2020; https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf.
2. "An undercover hazard: Beware of ‘clean’ mattress." OR Manager. February 2019; 25-26.
3. Gerba, C. "Microbial contamination of hospital reusable towels." American Journal of Infection Control. October 2013 41(10). 912-5
Note: Visit Ansell.com/STAT-BLOC to request a sample or contact Customer Service at 866-764-3327 to place your order today.
Data on file. Ansell® and ™ are owned by Ansell Limited or one of its affiliates. US Patented and US and non-US Patents Pending: www.ansell.com/patentmarketing.© 2022 Ansell Limited. All rights reserved.
ATP Marks the Spot
This simple test can expose manual cleaning errors to help keep your surfaces cleaner than ever.
If you are having difficulty finding a gap in your facility's cleaning process, take a closer look at the amount of elbow grease your staff is applying while wiping down surfaces. Thanks to adenosine triphosphate (ATP) testing, it's relatively easy to do.
Victoria Hornbeck, RN, BSN, CNOR, quality improvement and nurse clinician of surgical services at Northside Hospital Forsyth in Cumming, Ga., employed ATP testing on high-touch surfaces in the facility's ORs. "It revealed that staff needed to go over some areas two or three times to get them clean," she says. "They don't often think about how much friction they're applying during cleaning, and that's certainly not something we would have considered without the testing."
ATP testing involves zigzagging a swab over a four-inch by four-inch surface area and then placing it into a luminometer that tests for the presence of ATP. The results are provided in relative light units (RLUs). Ms. Hornbeck used the evidence-based threshold of 100 RLUs to determine the cleanliness of OR surfaces. Areas that exceeded the 100-RLU limit were recleaned and retested until a "clean" reading was achieved.
It's easy to track and monitor ATP test results because the luminometer automatically inputs them into an electronic database. Surgical leaders can then analyze this empirical data and present the results to staff.
When should these tests be performed? Ms. Hornbeck notes that trace amounts of bioburden often accumulate on surfaces throughout successive room turnovers, even when staff closely adhere to a facility's surface cleaning protocols. As a result, instead of testing her staff's cleaning performance between every case and slowing down the room turnover process, she asks staff to swab surfaces after the last procedure of the day to test the cumulative results of their cleaning efforts.
Monitoring of Cleaning Compliance Keeps Patients and Staff Safer
No amount of manual effort can overcome the misunderstanding of protocols and instructions for use.
The COVID-19 pandemic has placed a sharper focus on the importance of cleaning ORs thoroughly between cases, and facilities have largely been able to maintain safe spaces for surgery. With the pandemic and recent supply chain issues, however, OR teams sometimes find themselves working without a net, using unfamiliar disinfectants on the fly and not always adhering to the varied dry times in their instructions for use.
Ann Marie Pettis, RN, BSN, CIC, FAPIC, director of infection prevention at University of Rochester (N.Y.) Medicine and immediate past president of the Association for Professionals in Infection Control and Epidemiology (APIC), says her facility has at times had to use whatever type of cleaning product was available, including bleach, quaternary ammonium compounds and alcohol-based solutions. Keeping them straight, including how they should be applied, is a challenge.
"Contact times can vary from one to 10 minutes," says Ms. Pettis. "If you're using an agent that's long-acting, and it dries before the required time, you need to reapply it, which means you actually need to time the application and drying process." Ms. Pettis and her team came up with a low-tech timing solution by having staff use a Sharpie to mark each disinfectant's contact time in large lettering on the front of the package. "Now staff doesn't need to look at the tiny print on the container to see what it is," she says. She also has hung posters that remind workers to check contact times.
While dry times are an important variable to be addressed, so is the thoroughness of the manual cleaning for which those disinfectants are used. "When you're in a rush, it's easy to miss areas," says Ms. Pettis. Fortunately, technology such as ultraviolet (UV) light can help administrators monitor just how effectively staff are following cleaning protocols. Areas they missed will glow brightly when the UV light is shined upon them.
Then there are soft surfaces like privacy curtains around pre- and post-op bays and upholstered waiting room furniture, which require special disinfectants. Ms. Pettis notes that many outpatient facilities typically launder their privacy curtains only twice a year. "Now we've all had to step up our game," she says. "Don't worry about cleaning the entire curtain every time a patient is moved from a bay, but disinfect the curtain's grab area."
It can sometimes feel overwhelming, but Ms. Pettis suggests that viewing your entire facility from the patient's perspective will provide the clarity and focus for your surface disinfection and the compliance monitoring that comes with it. "The most important point I've shared with staff, particularly at our ASCs, is that perception is reality," she says. "We've had to rethink our cleaning protocols and make sure every surface looks spick-and-span, down to the carpeting in the waiting room. We need to continue looking at our practices with a new eye."