5 Steps to Fewer SSIs

Simple solutions are almost always best. No one will accuse your facility of providing groundbreaking surgical care if you make sure patients clean their skin before they arrive for surgery, your staff follow proper skin prepping and hand hygiene protocols, and nasal decolonization is part of your pre-op routine. Still, it's always a good idea to brush up on infection prevention's basic protocols and make sure they're being followed in your facility for a very practical reason: They work.

Instruct patients to use chlorhexidine gluconate (CHG) wipes or bathing solution on the days leading up to surgery, and make sure they understand the solution and the importance of doing so, says Luci Perri, RN, BSN, MSN, CIC, FAPIC, founder and president of Infection Control Results, a North Carolina-based consulting firm.

Patients can be educated on how to use CHG wipes or bathing solution during a pre-op clinic appointment. You can also distribute the wipes or solution in kits that include directives on how and when to apply the CHG and bottles containing the specific amount of solution that should be used during each application. Some facilities even use engagement apps to send patients text message reminders when it's time to apply the CHG.

Ms. Perri says you can't always be certain of how well — or if —patients prep their skin before they arrive for surgery, so she suggests applying CHG in pre-op on and around the intended surgical site to ensure the bacterial count on the area is decreased.

Providing patients with clear wound care directives in discharge instructions is just as important as the efforts you make before surgery to reduce infection risks, notes Ms. Perri, recalling a case where a patient, due to inadequate discharge information, didn't bathe for a week after his procedure.

Also be sure to properly apply skin prepping solutions in the OR. "It's important to follow the manufacturer's instructions," says Ms. Perri. For example, studies suggest it's best to apply a chlorhexidine gluconate-isopropyl solution using a back-and-forth technique as opposed to the circular application techniques suggested by most povidone-iodine prep manufacturers.

Ms. Perri reminds her clients to clean their hands before and after each patient contact, after gloves are removed and after contacting high-touch surfaces such as computer keyboards.

Temple doubled the number of sanitizing gel dispensers throughout the surgical unit to make sure staff members had convenient access to the solution. There are numerous waterless hand rubs available, and each recommends a different application process, "so it's important to follow the instructions for the ones you're using," says Ms. Perri.

This issue is becoming more important than ever, with lengthier and more complex procedures such as total joints becoming commonplace in outpatient facilities. Temple's cardiac team created a large "Do Not Enter" sign that hangs above the main OR entrance. The hospital also had to educate staff to not enter rooms during procedures to ask the surgical team questions that weren't pertinent to the surgery that was taking place. Temple also continues to enforce a policy that prohibits staff from wearing surgical scrubs outside of the facility and then into the OR.

Temple's cardiac unit experienced a spike in surgical site infections in the summer of 2016. The creation of the unit's OR Surgical Site Infection Report to monitor SSI prevention protocols led to better adherence to good practices, which led to a gradual decrease in SSIs: 11 from June 2016 to July 2017, 5 in 2017-2018 and 2 in 2018-2019.

The OR Surgical Site Infection Report is a comprehensive electronic reporting tool that lets surgical team members capture and track key aspects of the hospital's SSI bundle, including antimicrobial prophylaxis (timing, selection and duration of therapy); chlorhexidine bathing, both pre- and post-operatively; nasal decolonization; tight glycemic control; and surgical wound care.

Lyndelyn Javier, RN, BSN, RNFA, service line manager of Temple's cardiac, vascular and abdominal organ transplant units, suggests creating a clinical pathway involving a step-by-step guide that doesn't allow patients to move forward along the perioperative pathway until each infection prevention step along the way has been completed.

That wasn't always the case at Temple, where various members of the patient care team documented that infection prevention steps had been completed in various fields within the OR Surgical Site Infection Report — and sometimes even on slip sheets. As a result, the results of the hospital's infection control practices were hard to measure.

That's all changed now that the hospital implemented its electronic reporting system, which captures defined data points for each patient in the same places each time, so completed steps in the SSI-prevention bundle and other key information are now seen in a timely fashion.

"We found out we weren't as good as we thought we were," says Ms. Mahabee-Betts.

Now, they have a clear way of making sure that what's supposed to be getting done really is accomplished as they continue to move toward zero post-op infections. OSM