Infection Control

ALL HANDS ON DECK The mandatory morning scrub sets the infection control tone for the day.

The surgical team at Tri-State Memorial Hospital in Clarkston, Wash., is proud that their post-op infection rate has sat below 1% for years. How they make it happen might not sound much different from what you do on a daily basis:

• ensure patients bathe with chlorhexidine gluconate the night before surgery;
• administer antibiotics an hour before procedures start; and
• employ a standardized approach to applying skin preps.

What really separates their efforts at curbing SSIs — and makes them worthy of winning this year’s OR Excellence Award for Infection Control — is the passion behind their actions. Infection control is ingrained in the hospital’s culture. Look no further than the mandatory morning scrub-in for anyone performing surgery. If you’re planning on stepping into an OR that day, you’d better be in front of a sink with brush in hand for 3 minutes. Sure, it’s a great time to catch up with colleagues and see how weekends went but, more importantly, it sets the tone for the rest of the day.

“Preventing infections demands a huge collaborative effort,” says Lori Benton, RN, the hospital’s infection prevention and employee health manager. Everyone’s on board at Tri-State Memorial, from the orthopedic surgeons who are “fanatical” about keeping infection rates low to the central sterile team, which takes as much ownership in safe patient care as the OR nurses.

No caving on no-flashing rule
The hospital’s efforts reach far beyond the morning scrub. Patients scheduled for total joint procedures attend an educational sit-down, where they’re schooled on all aspects of their perioperative care, including proper infection control practices. Immediate-use sterilization is performed only in emergent cases. Otherwise, surgeons must wait until instruments are run through full sterilization cycles. “We do not cave,” laughs Molly Wright, RN, the OR clinical care coordinator, in such a way that you know she isn’t joking.

ALL BASES COVERED Tri-State Memorial’s standardized prepping practices reduce post-op infection risks.

The hospital staffs a pre-op nurse dedicated to ensuring the Surgical Care Improvement Project’s measures are followed, including the on-time delivery of pre-op antibiotics. “Our peak performance on that front is not because of only her efforts, but having a single person responsible for it at all times — having that continuity — really helps,” says Ms. Benton.

Surgeons and staff work in concert to limit SSIs, sharing new practices they’ve read about in journals or heard at conferences. For example, they now perform nasal swabs with povidone-iodine on each patient within an hour of surgery as precautionary checks for staph infections.

They also rely heavily on the expertise and diligence of the hospital’s anesthesia providers, who have a knack for probing pre-op interviews that uncover red flags such as preexisting lung infections.

The department reports its monthly and quarterly infection rates to the head of performance improvement, shares them at infection control meetings and posts them outside the ORs. If an infection does occur, they drill deep into the potential causes to find out why. Did it have to do with patient non-compliance at home or something that occurred during in-hospital care?

Enlisting patients
The answers might lead to changes in practices that ensure the same thing won’t happen again. For example, after an undetected finger infection in a total joint patient resulted in an SSI, the hospital updated its EMR template to ensure the pre-op staff asks questions that confirm patients are truly ready for surgery: Have you had any previous infection? Do you have any wound that’s non-healing? Have you had dental work done recently? Ms. Wright says it’s more important than ever to curb infection rates, which are on the Internet for all to see — especially the patients who are deciding where to go for their surgeries. “Our low infection rate is a huge sense of pride,” she says. “We’re good at reducing SSI risks, and it feels great knowing our patients are safe.”

— Daniel Cook