THIS WEEK'S ARTICLES
A Team Approach Can Reduce Immediate Use Steam Sterilization Rates
This Virginia hospital’s solution addressed the issue by encouraging teamwork and communication between different departments.
High rates of immediate use steam sterilization (IUSS) at facilities are associated with increases in surgical site infections and complications. When Bon Secours Mary Immaculate Hospital in Newport News, Va., realized its rates of IUSS were the highest among other facilities in its network, its first order of business was to recruit a team of staff members who possessed a broad variety of professional experiences in different roles.
“The multidisciplinary team members took turns explaining portions of the IUSS process from their unique viewpoint,” says Elaine Hudgens, RN, CDCES, surgical services quality specialist at the facility. When the surgical techs took their turn, they said a common reason for utilizing IUSS was the unavailability of necessary instruments at a given time. OR teams, under pressure to start cases on time, often resorted to IUSS in those situations.
That was the key that unlocked a solution to the problem. “We were able to open lines of communication with the sterile processing department (SPD) team members, who were able to quickly determine if other instrument trays that had the needed item in them were available to use instead of performing IUSS,” says Ms. Hudgens.
Another new process was implemented as a result. “All IUSS loads have to be cleared by the SPD manager if it is determined that an alternative instrument tray is not available,” she says. “This coordination allows for replacement items to be obtained and delivered to the OR without having to utilize the IUSS process.”
By encouraging teamwork and communication between different departments, each team member’s contributions added to the overall success of reducing IUSS rates within the facility. Effective communication and teamwork made it all happen.
Keeping Wounds Infection-Free
The challenge goes beyond the method of closure employed.
A surgery is not 100% successful until a surgical incision is properly closed to prevent post-op infection. Depending on the type of incision, surgeons often opt for a few tried-and-true closing methods, such as sutures, staples, skin adhesives, hybrid devices and Steri-Strips. But it’s not just about what methods surgeons use. It’s also about how well they apply these methods.
Experts say surgeons should tightly layer the wound closure and make sure there are no open areas below the skin surface that can turn into abscesses and, eventually, infections. Matthew Regulski, DPM, a foot and ankle surgeon and medical director at the Wound Care Institute of Ocean County in Toms River, N.J., says surgeons often use nonabsorbable sutures when securing structures they want to hold together for a long time, such as tendons. “Absorbable sutures that can take up to six months to dissolve are also available,” he says.
Proper irrigation is another key element of superior wound care. “The classic statement is, ‘the solution to pollution is dilution,’” says Jon Minter, DO, an orthopedic surgeon in Alpharetta, Ga., who specializes in advanced surgical management of hip and knee arthritis. “In most surgical cases, foreign debris or planktonic bacteria can be removed using irrigating solutions.”
Dr. Minter says this is a huge upgrade over the old practice of using saline, which has no effect on bacteria or biofilm, or a diluted betadine solution, which is toxic to healing cells and bone tissue. “Newer irrigating options destroy biofilm, which is resistant to so many things, without harming good tissue,” he says. “You can irrigate the wound as you’re completing a layered closure to prevent infections in high-risk patients.”
Of course, in an outpatient setting, daily postoperative care for wounds is in the hands of patients and their in-home caregivers. During clinic appointments prior to surgery, providers should educate patients on what they should expect as their wound heals and deliver important information on how to care for their wound.
Dr. Regulski makes it a point not to leave anything out during these consultations. He gives his patients the long version of every conceivable problem that could occur. “My list of complications has about 40 on it, so patients know exactly what might happen,” he says.
Covid Lessons Learned and What to Expect as the “New Normal” for OR Teams
Frontline workers were amazingly adaptable as they kept patients safe with infection prevention practices and effective surface disinfection.
As ASCs and hospital outpatient departments plan for a “new normal,” infection prevention experts contemplate the need for resources and strategies for the next pandemic. We spoke to Sharon Ward-Fore, MS, MT(ASCP), CIC, FAPIC, Infection Prevention Advisor for Metrex, and asked her about the company’s vision for the future.
Do you think that COVID-19 spurred different thinking among the healthcare profession about protocols for surface disinfection?
A protocol defines a set of procedures or steps to be followed for the accomplishment of a given task. In the case of surface disinfection, the protocol is driven by the manufacturer instructions for use (MIFU) for that particular product. With surface disinfection, most protocols are similar, with the possible exception of the contact or “dwell time.” So, I don’t think the protocols have changed, but I do think there is a renewed awareness of the many different surface disinfection products available on the market.
What would you say are the “lessons learned” from COVID-19?
Yes, there are many lessons learned from the pandemic. First and foremost is the need for “preparedness.” No one could have anticipated the scope of this pandemic, but knowing what we know now, stockpiling certain supplies, like PPE and disinfectants, for future use is a good idea. Also stockpiling critical medications, medical equipment and other supplies should also be considered. Secondly, the importance of training and auditing practices often – especially when you run out of what you typically use and have to introduce something new.
What can front-line healthcare workers expect for the “new normal” going forward?
Healthcare workers are amazingly adaptable to change, and the pandemic demonstrated their ability to adapt. They were already used to wearing PPE, performing hand hygiene, and cleaning patient care equipment, but not on a pandemic scale. The pandemic brought home the importance of following these best infection prevention practices to keep everyone safe. What really changed was the VOLUME of patients they cared for. The “new normal” is the return to their normal patient workload.
Can the current products available fight against another pandemic or new virus that may emerge?
I think it’s important to consider surface disinfectant products that have the “Emerging Viral Pathogens” claim. This gives these products the EPA claim for use against future, unknown viruses. This way you will already have a product sanctioned for use against the next viral pandemic organism.
Why is the Metrex Research, LLC partnership with the Association for Professionals in Infection Prevention Control and Epidemiology (APIC) important?
When important stakeholders, like APIC and disinfectant companies like Metrex, work together it benefits the user. Metrex provides more than products. It is positioning itself as a resource IPs can use for things like continuing education, white papers and expert speakers sanctioned by APIC.
Can you give an overview of the Emerging pathogen program at Metrex and what it hopes to accomplish?
Metrex is a company helping healthcare facilities provide a safer environment for the patient by providing disinfectant products that clean and disinfect, reducing the possibility of pathogenic organism transmission to patients and healthcare providers. A cleaner, safer environment means better outcomes for patients. The Emerging Viral Pathogens Program (EVPP) provides an extra level of “protection” against the next unknown viral threat. Disinfectant products registered for use against viral pathogens in one category of the Spaulding Classification model are presumed effective against viral pathogens in less resistant categories, and the EVPP is intended to serve as a conservative approach to identifying disinfectant products likely to be effective against emerging pathogens. Metrex has taken the steps to achieve this claim with CaviWipes 2.0 to help healthcare prepare for the future.
After a tough year-and-half of keeping patients safe with proper disinfection protocols, what do you see as future positive trends in infection prevention?
The pandemic has brought more attention to the profession of Infection Prevention. Hopefully more resources will be allocated to building robust Infection Prevention programs in healthcare because now their importance and value has been highlighted.
Note: For more information, please go to www.metrex.com.
Tech Can Help With Whole-Room Disinfection
UV-C light and hydrogen peroxide mist provide extra peace of mind that your ORs are ultra-clean.
Supplementing operating room manual cleaning protocols with high-tech systems such as UV lights and hydrogen peroxide misting machines can take your whole-room disinfection to another level of safety and cleanliness. Experts laud these high-tech systems not only because they work, but also because they help staff and patients feel safer when they know they're in use.
Short-wavelength ultraviolet C (UV-C) light, deployed with portable robots or designed into operating rooms lighting units, kills or inactivates microorganisms by destroying nucleic acids and disrupting their DNA, leaving them unable to perform vital cellular functions. Matthew Patterson, system director of environmental services at St. Elizabeth Healthcare in Edgewood, Ky., employs the technology on all isolations and terminal and cycle cleaning. Mr. Patterson's team utilizes small UV light wands to validate manual cleaning of surfaces, as well as a large UV light kit to sanitize entire rooms, which takes about 15 minutes for a standard OR. "You have to calculate through dose verification cards or UV light meters to determine the run time for a certain area," he says.
Hydrogen peroxide systems, which produce airborne hydrogen peroxide as a vapor or mist, cover every surface of the sealed room in which they are positioned. "The unit will produce a dry mist of disinfectant that is only microns in size, which allows for full coverage of the room without causing damaging saturation," says Mr. Patterson.
While acknowledging the relative pros and cons of these two adjunct technologies, Mr. Patterson says he is a fan of both. "They're portable, and training is minimal," he says. "We're still using microfibers to wipe down surfaces, but with the help of current technology, we’re able to produce a better product that's safe for our providers and patients."
Mr. Patterson says the main disadvantage when deploying these technologies is time. Your staff must stay out of the room when they are in use and, with hydrogen peroxide systems, he adds, "you also have to close HVAC vents and monitor the OR being treated to ensure the vapor or mist isn't escaping the room, because it's toxic to humans."
The Soft Side of Surface Disinfection
Maintaining an effective cleaning strategy goes far beyond elbow grease and wipes.
Sterilization and sanitation have always been important to ASCs and hospitals, but the COVID-19 pandemic intensified the need to do it properly and effectively. As a result, manual cleaning methods have come under unprecedented scrutiny.
Ann Marie Pettis, RN, BSN, CIC, FAPIC, director of infection prevention at University of Rochester (N.Y.) Medicine and president of the Association for Professionals in Infection Control and Epidemiology (APIC), says it’s important to make sure your staff is using disinfectant wipes correctly. "When you're in a rush, it's easy to miss areas," she notes. Fortunately, she says, powerful tools to confirm compliance exist, such as ultraviolet light, which you can shine on surfaces staff just cleaned. Areas a staffer missed will glow brightly.
Ms. Pettis also makes sure her staff has upped its game when it comes to soft surfaces such as privacy curtains around pre- and post-op bays and upholstered waiting room furniture. While most outpatient facilities would launder their privacy curtains twice a year, "Now we've all had to step up our game," she says, noting that special disinfectants for soft surfaces should always be used, with their instructions for use followed to the letter.
Ms. Pettis suggests to her staff to view the entire facility from a patient’s perspective. "The most important point I’ve shared with staff 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."