4 minute read
Project Tracks, Improves Hospital-wide Infection Control Procedures
By MARCUS A. BANKS
Operating room staff are likely to get prompt feedback from sterile processing colleagues if they do not properly preclean or spray a medical instrument before sterilization, but such feedback is less likely to occur for employees in units farther from the OR, such as the women’s health or endoscopy units, according to infection preventionist Jill Holdsworth, CIC, CRCST, of Emory Hospital Midtown, in Atlanta.
At the 2021 virtual meeting of the Association for Professionals in Infection Control and Epidemiology, Ms. Holdsworth described Emory’s ongoing strategy for standardizing infection control procedures throughout her facility.
“We had so many inconsistencies throughout the hospital with transportation of soiled instruments,” Ms. Holdsworth said, noting that sometimes these instruments are carried in Tupperwaretype storage containers. “I see that in a lot of facilities right now, so we set out just to standardize everything.”
When Ms. Holdsworth began this effort in 2018, she and her colleagues noticed that OR employees had a consistent process for managing soiled instruments that involved spraying them with surfactant gel and transporting them in closed carts that reduce the risk for contamination. OR employees also received regular training on how to avoid contaminating surgical equipment.
In contrast, within procedural or clinical areas outside of the OR, practices were much more inconsistent. Infection control training by sterile processing staff occurred less frequently or not at all in these areas, and proper equipment was not always on hand. Unlike within the OR, which used an electronic system to audit compliance with infection control procedures, there was no consistent way to document whether staff in other units followed proper protocols.
Ms. Holdsworth’s first step was to develop a documentation form to track other units’ compliance with best practices for infection control, using a biohazard container for transport of soiled instruments to the sterile processing unit and precleaning and spraying instruments before taking them away.
With the available data, Ms. Holdsworth determined that units outside the OR were compliant with best infection control practices less than 20% of the time when the project began. This intake stage also revealed that staff in many units were not
aware of which infection control supplies they had on hand or which supplies could be disposed of and which needed to go to sterile processing. In a joint effort involving nursing, infection prevention and sterile processing leaders encompassing every unit of the hospital, Ms. Holdsworth said, “we figured out what was there, what needed to be there and what maybe didn’t need to be stocked anymore.” After taking this inventory, Ms. Holdsworth and her colleagues proactively listed exactly which infection control supplies a given unit needed, so there would be no waste when ordering. “We didn’t want them to buy a bunch of biohazard bins that didn’t fit their instruments,” Ms. Holdsworth said, noting that this inventory support effort was one major achievement of the initiative. In addition to the inventory support, in April 2018, Ms. Holdsworth’s team launched an intensive education campaign about infection prevention best ‘We had so many inconsistencies practices throughout the hospital. One throughout the hospital aspect of this effort was simple, engaging flyers, including one that highlighted the with transportation of soiled “three easy steps” involved in precleaning instruments. I see that in a lot of medical instruments (box). As of February 2019, audits of the facilities right now, so we set out units outside the OR showed an increase just to standardize everything.’ in compliance from 20% to 91%. In June 2019, compliance reached 100%. —Jill Holdsworth, CIC, CRCST Commenting on the Emory project, Casey Czarnowski, CIC, CRCST, the sterile processing educator at Stanford Health Care, in the San Francisco Bay Area, said the initiative points to the fact that infection control will always be crucial. “There’s no time constraint when it comes to patient safety,” Mr. Czarnowski said. He said he promotes the idea that any member of a hospital staff, regardless of their role or the unit they work in, should feel empowered to speak up if they think any medical instrument might be contaminated. Mr. Czarnowski likens this to the “stop the line” philosophy of automobile manufacturing, in which any employee can request a production halt if they think something dangerous happened somewhere along the line. For her part, Ms. Holdsworth is not resting on the laurels of hitting 100% compliance in managing soiled instruments, saying that the work of optimizing infection control at Emory Midtown will always be ongoing. ■
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