2011 Infection Prevention Leadership Summit Preventing HAI in the OR Preventing HAI in the OR Presented by: Charlotte Guglielmi, MA, BSN, RN, CNOR 2 Speaker Disclosures Patient Safety/ Risk Consultant: Sedgwick CMS This presentation was sponsored by 3M. 3 1
The strength of an organization is measured not by counting the number of successes, but by its response to failure Learn all that we can Apply those lessons as broadly as possible 4 Topics for Consideration Surgical preps Traffic patterns Surgical attire Sterilization 5 AORN Standards & Recommended Practices Based on Principles of nursing science Microbiology Research Review of literature Opinions of knowledgeable experts Collaborators Expert perioperative nurses American Association of Nurse Anesthetists American College of Surgeons American Society of Anesthesiologists Association for Professionals in Infection Control & Epidemiology Centers for Disease Control & Prevention International Association of Healthcare Central Service Materiel Management McNamara, S. The Normalization of Deviance: What are the Perioperative Risks, AORN Journal. 2011:93(6):798. 6 2
Surgical Skin Preps 7 Elements of Skin Prep Audit Evidence-based metrics Based on AORN RP Direct observations by dedicated auditors Assessment of practice Standardization of prep within service lines Back to Basics education all disciplines Correct prep solution as per evidence Technique as outlined in RP or by manufacturer Dry Time 8 How to Start Identify a champion for the project Most frequently done surgeries per service line Service lines and surgeons within those services Surgeons skin prep preferences within each service Target outliers based on institutional SSI data available 9 3
Audit Tool DuraPrep BIDMC 2009. Used with permission. 10 Traffic Patterns & Surgical Attire 11 Surgical Attire Wearing of freshly hospital laundered surgical attire intended for use within the surgical suite Fabrics used in scrub attire Laundering of surgical attire Clean surgical attire: shoes, head coverings, masks, jackets and ID badges Wearing of jewelry Fingernails and nail polish Wearing of protective barriers such as gloves and eye shields Recommend Practices for Surgical Attire, 2011 Perioperative Standards and Recommended Practices (2011) AORN, Denver CO, p. 57 71. 12 4
Traffic Patterns Purpose of traffic patterns in the surgical suite Definition of environmental controls and security Movement of personnel and supplies while procedures are in progress Adaption of traffic patterns during construction and renovation Recommend Practices for Traffic Patterns in the Perioperative Practice Setting, 2011 Perioperative Standards and Recommended Practices (2011) AORN, Denver CO, p. 95-98. 13 How Big is the Problem? 14 What We Saw People are opening cases while wearing scrub jackets and paper gowns Unsterile people are reaching over sterile tables/equipment People are opening cases while wearing scrub jackets and paper gowns People reach over a sterile field with bare hands usually to get a towel to dry their hands or a gown to gown and glove People are gowning and gloving off sterile tables 15 5
Teach All Disciplines to the Standards Unscrubbed personnel should face sterile fields on approach should not walk between two sterile fields should be aware of the need for distance from the sterile field All items should be delivered to the surgical field in a manner that prevents non-sterile objects or people from extending over the sterile field Scrubbed personnel should don sterile gowns and gloves from a sterile area away from the main instrument table 16 What About the Gowns? Gowns are considered sterile: From chest to level of the sterile field Gown back is considered non-sterile Sleeves from 2 inches above elbow to the cuff The neckline, shoulders, underarms, sleeve cuffs, and gown back are areas of friction and not considered effective barriers When changing levels, exposure of the non-sterile portion of gown is likely 17 Sterilization 18 6
Sterilization Issue to Consider Immediate use steam sterilization formerly referred to as flashing Use of internal integrators Biological monitoring of sterilization ti Kit integrity following sterilization Care and handling of internal integrators Management of loaner instrumentation Investing in your physical plant 19 Invest in CPD Make sure that you: Have the capacity to manage your growing volume Have the technology to meet the current standards Have a workforce that is valued by the entire team 20 Make Vigilance Around the Basics Part of the Bundle 21 7
Thank You 22 8