Environmental control, education cut infections
(Editor's note: This is the second part of a two-part series that looks at effective strategies to reduce surgical site infection rates. This month, experts talk about glucose management, environmental control, and new products. Last month, we looked at the importance of reducing the use of razors, using prophylactic antibiotics, and keeping the patient warm.)
While a key component of preventing surgical site infections is to educate staff members and physicians, don't forget that your patients and their family members need to understand the basics of infection control and infection identification.
Education about surgical site infection is critical, says Cynthia Spry, RN, MA, MSN, CNOR, clinical consultant with Advance Sterilization Products in Irvine, CA. Make sure family members know how critical hand washing is to the prevention of infection, she recommends. "Also, let them know what to look for as they change bandages or check the wound," she says. "Explain what a normal, healing wound looks like and talk about what potential signs of infection are, and when to call the physician's office."
Although outpatient surgery staff members want to prevent infections, it is just as important that an infection be treated early to prevent more problems, Spry adds.
Remember that monitoring staff actions is also important to ensure that staff members practice what they learn, she suggests. "It's one thing to know the basics of infection control and quite another thing to practice it all of the time," she points out. "Staff members in the operating room areas know to wear gloves, but then they pick up the telephone, or open doors and cabinets with the gloves on their hands, then go back to patient care." It's necessary to offer continuous education to ensure staff stay aware of actions they take might put a patient at risk, Spry says.
You can also make surgical site infection reduction a standing agenda item to keep the topic at the top of the mind for everyone, suggests Ann Beauregard, RN, RN, performance improvement manager at Porter Hospital in Middlebury, VT. "We talked about the changes we were implementing at all staff meetings and physician meetings," she says. "We took small steps, changing one thing at a time."
For example, one of the first changes was a change of clippers to a product that seemed to be easier to use and less likely to cause abrasions that might become infected, she says. "We explained how we tested different clippers and why we made the choice we did," Beauregard says. Throughout all of the changes, all staff members and physicians had a chance to offer input, she adds.
Beauregard says when reviewing research that supported the changes proposed, members of the performance improvement committee noticed that a number of studies discussed the importance of glucose management for improved wound healing for cardiac patients. "While we don't handle cardiac procedures in our outpatient program, we did see a relationship between glucose management and improved wound healing," she says.
Beauregard's staff members always have known to monitor patients who were identified as diabetic, but they are starting to screen for abnormal glucose levels in all patients, she says. "We are purchasing glucose screening monitors for our post anesthesia care unit so that we are able to monitor all patients," Beauregard adds. "A policy that calls for glucose monitoring of all patients won't work if you don't get the enough equipment for staff members to perform the monitoring."
Evaluate surroundings and supplies
Don't forget to review the entire environment of the surgery area when you are looking for potential causes of infections, says Melinda Rogers, RN, CNOR, clinical development specialist for the surgical services department at Northside Hospital in Atlanta.
"We control traffic in the operating room areas carefully," she points out. "We restrict who comes into the area and if people not directly involved in patient care must come into the area, we keep them away from patient care areas." For example, when a maintenance engineer had to come into the operating room to fix a leaky pipe behind one of the operating room walls, the first step was to have an infection control nurse survey the area and decide how to keep the people and equipment needed during the repair isolated from other areas in the surgery department, Rogers says.
Don't forget that there are employees from departments other than surgery that can affect your patients' environment, says Beauregard. Even if your operating room staff knows to keep patients warm, let other employees know as well, she suggests. "We monitor the temperature in our operating rooms and we noticed that the rooms were always cold for the first procedures."
After checking with operating room staff to see why thermostats were turned down, Beauregard discovered that the housekeeping staff would turn the thermostats down after they finished cleaning the area at night. "While their intentions to save on energy costs were good and were appropriate for other areas of the hospital in which no one works at night, we had to ask them to change their procedure in the OR," she says. This was a good example of why all different areas should be included in any performance improvement project, she adds.
There are also new products that are designed to reduce infection and outpatient surgery managers should take a look at them, suggests Spry. "Antimicrobial sutures are relatively new products that surgery managers are evaluating," she points out. "There are so many different ways that we can reduce infections that it is hard to point to one product or one technique that will have the best effect."
Rogers agrees that changing supplies is not the first step in an infection control program. "We are in the process of evaluating the antimicrobial sutures, but first we want to evaluate our procedures to make sure the way we care for our patients doesn't increase their risk of infection," she says.
Spry's last tip is to avoid flash sterilization whenever possible. "I believe this practice may be more prevalent than anyone realizes," she says. Staff members in a surgery area who are responsible for sterilization must be thoroughly educated in the instrument sterilization process and must take no shortcuts, or a patient's risk of infection rises, Spry explains. "Flash sterilization should not be used for convenience to the surgery program but should only be used in the case of a critical instrument for which there is no replacement," she says.
While a key component of preventing surgical site infections is to educate staff members and physicians, don't forget that your patients and their family members need to understand the basics of infection control and infection identification.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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