A Reference Guide to the Essentials of Nursing Leadership and Management
In the tiny town of Scottsboro, Alabama, there’s an unlikely megastore: the Unclaimed Baggage Center. It’s where the airlines sell property travelers leave behind but never claim. For the millions of miles airline passengers travel annually, the amount of lost luggage is surprisingly low: less than 1 percent (.309) of bags are mishandled, according to a US Department of Transportation study. The same can’t be said for Surgical Site Infection rates in surgery centers. ASCs, as one study found, have lower SSI rates than their Hospital Outpatient Department (HOPD) counterparts. But, there’s plenty of work ahead if ASCs are going to consistently match the airline industry’s lost luggage statistic. To prioritize infection control, here are some standard — and not so standard — considerations to keep in mind.
Today’s ASC Infection Control Environment
SSI rates, according to the Journal of the American Medical Association (JAMA), range from 3.09 post-surgical care visits per 1,000 at 14 days post-op, to 33.62 “all-cause” visits per 1,000 at 30 days. Closing this gap requires standard metrics to track infection rates over time, and to enable comparison of infection rates between facilities.
The Centers for Disease Control have developed a series of SSI measurements, which are used by its own National Healthcare Safety Network (NHSN) and the National Surgical Quality Improvement Program (NSQIP). But, setting the measurements is just the beginning.
The Comprehensive Unit-Based Safety Program (CUSP), used by the Agency for Healthcare Research and Quality (AHRQ), is a proven method for reducing SSI. The AHRQ used the CUSP model in one pilot program at 197 hospitals. Using either the NHSN or NSQIP measurements, participating hospitals reported significant reductions in SSIs.
In addition to measurements, the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage (CfC) detail their mandated ASC infection prevention and control program. Most ASCs are familiar with the CMS interpretive guidelines and the later updates, but they can be found summarized here.
Surgical safety checklists are another important tool in SSI prevention. The high profile publication of Atul Gawande’s The Checklist Manifesto in 2009 made the case for documented processes in surgery and other areas of medicine. The two-minute checklist he developed for a pilot program in eight hospitals produced pioneering results, and has been adopted widely. “We caught basic mistakes and some of the stupid stuff,” said Gawande in an interview with National Public Radio. "We also found that good teamwork required certain things that we missed very frequently.”
These are Not Your Hospital’s Infection Control Measures
While Gawande’s checklist has gained wide acceptance in surgical suites, including ASCs, other measures don’t always translate to the ASC environment. The results of a four-year interventional study, aimed at reducing infections and other surgical complications in an ASC setting, found significant barriers to study implementation and data collection.
In one instance, scheduling in-person collaborative meetings was difficult because staff did not have “the dedicated time or resources set aside for this project.” In addition, it was difficult to secure high levels of engagement from surgeons. Low participation in some of the earlier cohorts demonstrated how difficult it is to track interventions in ASCs.
If healthcare is going to match the safety record of the airline industry, more tailored approaches are needed. Surgery centers need ASC-specific digital tools to assist with data collection and monitoring, as well as targeted areas such as anesthesia quality reporting.
Maintain Consistency
“Do it again and again. Consistency makes the rain drops to create holes in the rock. Whatever is difficult can be done easily with regular attendance, attention and action,” says Israelmore Ayivor. Staff education and training must center on standardizing as many processes and behaviors that mitigate surgical risk factors. Monitoring compliance by both recording them digitally, and deploying clinicians and consultants to observe the measures are consistently applied, reduces infection risk and improves patient care quality.
Unprofessional Behaviors Cause More Surgical Complications
Both the AHRQ study, and the many checklist-driven studies that have followed since Gawande’s pilot program, touch on the often overlooked importance of a cohesive, supportive work environment. In addition to procedural efforts, motivating and inspiring surgical team members goes a long way toward infection control, as research from Vanderbilt University Medical Center recently discovered. It found that surgeons who are rude and unprofessional with their fellow surgical team members are more likely to have complications, including infections, during and after operations. Some facilities are combatting the anonymity behind the mask and enhancing the team dynamic with surgical caps with title and name. This is especially helpful when there are new team members. Saying, “Bob or Jayne, we seem to have missed step X” might be a little easier when JAYNE, Surgeon or BOB, CRNA is emblazoned on their cap. (See #TheaterCapChallenge)
Start Infection Control Measures Early in Training and Don’t Stop
It helps to ingrain SSI prevention measures early in medical careers. One peer teaching module showed that undergraduate, inter-professional teaching among Operating Room technician trainees and medical students via interactive, simulation training is most effective at prioritizing infection control and building a teamwork approach to the issue. All new employees and contract employees should be well versed on the facility infection control plan, their role in decreasing the risk of infection, and the importance of sterile fields. A drill that checks every phase, from patient arrival to discharge with handwashing, as well as terminal clean checks, can pinpoint gaps. Validating the efficacy of all cleaning is vital. A bioluminescence marker can make quite the impression after shaking hands with people post-meeting (checking for handwashing) or to test areas post-terminal cleaning.
Don’t Forget Soft Surface Contamination
Soft surfaces — privacy curtains, furniture, even neckties — are a potential, but often overlooked source of contamination that can heighten the chance of infection. The CDC has a detailed soft surface contamination prevention checklist for outpatient settings. The CMS surveyor’s worksheet is another guideline.
Not surprisingly, overall cleanliness is a factor in patient satisfaction. Patients may not fully understand anatomy or surgical precision, but they do recognize a dirty bathroom or privacy curtain. Their experience is positively influenced when they see staff washing hands, providing masks to patients and others who request them, and infection control signage posted frequently around the center.
Streamline Infection Control Efforts
By 2020, 60% of all surgeries are projected to take place in an ASC. This increase in volume, together with the growing complexity of approved ASC procedures, intensifies the need for flawless infection control. It requires tracking a vast array of checklists, guidelines and regulations, and fostering a positive culture among surgical team members.
Instead of focusing all your infection control efforts on gathering and measuring data, why not let Simplify ASC lend a (very clean) hand? Our platform gives you access to the critical data you need to manage all your infection control policies and procedures. Reporting is ready to go for everything from state-specific compliance data submission to building site-specific reports, to monitoring hand washing adherence protocols.
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