4 minute read
Best Practice for SSI Prevention
from OR Today April 2023
By Tiffany Thompson, DNPc, RN
Prevention of surgical site infections (SSI) is a key focus in health care. Two to four percent of the surgical procedures performed annually result in the adverse event of SSI or complication. That percentage may sound small, but based on more than 10 million surgeries, it represents 200,000 to 400,000 individuals. The Agency for Healthcare Research and Quality (AHRQ) estimates that those infections claim the lives of 6,000 to 12,000 people and are the leading cause of hospital readmissions.1 In an area of practice with high risk such as surgery and sterile processing, there is simply no room for error.
Because of the direct and significant impact on patient care, infection prevention practices are closely scrutinized during accreditation surveys. ACHC surveyors heighten focus on sterilization and decontamination processes as a component of overall infection prevention.
The onus is on leaders and governing bodies of health care organizations to approve and oversee implementation of policies and procedures designed to drive the best possible patient outcomes. They must ensure that their providers and staff have adequate and needed equipment, resources and space to provide safe, high-quality patient care. A robust infection prevention and control program and evidence-based practices are key components of this responsibility. Best practice steps to protect patients from harm related to SSIs can be categorized as policy-driven, proceduredriven and resource-driven.
1. EFFECTIVE POLICIES
• Conduct SSI risk assessments.
• The hospital should adopt nationally recognized guidelines and have a risk assessment tool to guide evaluation of every pre-operative patient for risk of SSI.
• Engage surgical services as a collaborative partner with the IPC program for input and approval of relevant policies.
• Establish written policies and procedures based on manufacturer’s instructions and nationally recognized standards for decontamination and sterilization techniques performed. Ensure all policies are written with input from relevant teams and coordinated through the IPC program.
• Establish written policies and procedures regarding reuse of singleuse devices that aligns the practice in accordance with FDA reuse of single-use devices guidelines.
• Establish written policies and detailed procedures for housekeeping and cleaning of surgical suites and the surgery department.
2. ROBUST PROCEDURES
• Engage surgical services as a collaborative partner with the IPC program for development and review of procedures for evidencebase, completeness and accuracy.
• Start the decontamination process as soon as possible after a surgical procedure is complete.
• Pre-clean instruments and spray with enzymatic cleaners to reduce formation of biofilm. Important: Instruments that contain a biofilm cannot be properly sterilized.
• Ensure instruments are sterilized appropriately.
• Hinged, ratcheted instruments such as hemostats, scissors and Kelly clamps must be open as wide as possible during decontamination and sterilization.
• Consider the use of decontamination stringers.
• When using peel packs for instruments, keep hinged instruments open and ensure there is enough space within the package for sterilant to touch all parts of the instruments.
• Conduct routine surveillance of staff practices.
• Observe and monitor staff to ensure staff are competent and the current practice adheres to approved policies and procedures.
• Conduct environmental surveillance within sterile processing areas and ORs. The organization is responsible for maintenance of a clean, sterile surgical environment with immediate correction of concerns.
• Survey for clean environment and appropriateness of temperature, humidity, airflow and air exchange rates.
• Survey for presence of rust on operating tables, oxygen tanks and other equipment.
• Inspect floors, counter tops, and walls for cracks, splitting seams, chips or divots.
• Inspect ceilings for stains, moisture or gaps greater than 1/8 inch.
• Maintain OR air supply vents and grilles to reduce potential of airborne particles and contaminants.
3. ADEQUATE RESOURCES
• Maintain sufficient quantities of instrumentation, supplies and equipment in the OR.
• Having the right supplies in the right quantities minimizes movement in and out of the operating room during surgical cases, reducing the risk of introducing airborne contaminants to the room.
• Adequate, appropriate supplies and instrumentation eliminate or greatly minimize the need for immediate use steam sterilization (IUSS). IUSS should be reserved for emergency use only.
• Ensure the physical environment within decontamination rooms allows plenty of space for required equipment, a double sink, correct airflow direction and exchange rates of at least six in the clean area to at least 10 in the dirty area.
Collect and use your data
Ultimately, data collection is your best resource for maintaining a successful infection prevention program to address surgical site infections. Too often, surveyors find that organizations dutifully collect data, but fail to analyze and take action on the results. Metrics to watch include sterilization data and SSI rate and prevalence.
For every sterilized load, there should be documentation of temperature and pressure readings. Maintain this documentation and perform regular quality control checks.
When monitoring SSI rate and prevalence, each SSI incident should be followed by a deep dive investigation into the “what” and “how” of the occurrence. In hospital settings, this should be correlated with readmission data. Findings should be communicated to leadership and frontline staff, and processes and procedures altered and trained as corrective actions are identified.
Infection control and prevention is the cornerstone of quality care and positive patient outcomes. While vital in all areas of a health care organization, effective infection prevention practices are paramount in the operating room. Surgical teams have an opportunity to elevate the importance of infection prevention and control throughout the organization because the rate of surgical site infections is such a frequent and visible quality metric.
For an ASC, the sustainability of your organization depends on achieving excellence in this area. For a hospital, your surgical department has the opportunity to set the benchmark for the whole organization by prioritizing excellence in infection prevention.
– Tiffany Thompson, DNPc, RN, is a standards interpretation specialist for ACHC’s Acute Care and Critical Access Hospital Accreditation Programs. She has served a large health system in Ohio as director of nursing for two hospitals. She also served as an ACHC surveyor and continues to conduct surveys in her current role.
1Agency for Healthcare Research and Quality. (2019, September 7). Surgical site infections. Patient Safety Network. Retrieved January 9, 2023, from http://psnet.ahrq.gov/primer/surgical-site-infections