1. Institute a full infection prevention program with staff buy-in. Staff buy-in is undoubtedly the most important step any hospital department or surgery center can take toward building a robust infection control and infection prevention program. In order to achieve 100 percent staff buy-in, Linda Ruterbories, director of surgical services and program development at OA Surgery Center, says staff members at the OA Surgery Center are encouraged to take ownership and identify infection control concerns and make suggestions to improve infection prevention. Staff members are also reassured that there will not be any punitive action, such as terminations, if any mishaps with infection control occur. A culture of fear is counter-productive to the goal of identifying and fixing problems, says John Wipfler, CEO of OA – Centers for Orthopaedics.
“An ASC can have all the tips and tricks [to having excellent infection control], but those tips and tricks won’t be particularly helpful without a culture of process, protocols and accountability,” Mr. Wipfler says. “Those three things have to be on the top of every employee’s list. Without any accountability or a sense of ownership, it’s just a bag of tricks.”
2. Use hand sanitizers often, and encourage patients to do so as well. Installing hand sanitizers throughout a hospital department or an ASC gives the facility an added reinforcement to fighting off infection. Denise Kesler, director of Athens (Ga.) Orthopedic Ambulatory Surgery Center, says the ASC installed hand sanitizer pumps and motion-sensor hand sanitizers on the walls of the surgery center. More recently, in the midst of ongoing construction, Athens has installed a motion-sensor hand sanitizer at the reception desk for patients and their family members to use as well.
“We’ve strategically placed hand sanitizers in multiple areas, so no one has the excuse of not having ready access to washing their hands,” Ms. Kesler says. “Also, it’s not only accessible to the staff and physicians but also the patients and their families. This way, patients are able to sanitize their hands in the patient area prior to surgery.”
3. Test for bacterial colonization before surgery. Many orthopedic surgeons are beginning to test patients for methicilling sensitive staphycolococcus aureus (MSSA) and methicillin resistant staphylococcus aureus (MRSA) colonization before surgery. These bacteria are found the nose of about 30 percent of patients, which makes these individuals 200-900 percent more likely to develop an infection. “The studies have shown that patients undergoing elective surgery may benefit from being tested for bacteria in their noses,” says Calin Moucha, MD, associate chief of joint replacement and assistant professor at Mount Sinai Medical Center in New York City. If the patient does have MSSA or MRSA, surgeons can recommend mupirocin ointment to their nares as well as chlorhexidine baths for five baths prior to surgery.
4. Make sure pre-operative showers or skin cleansing are done correctly. Patients can decrease the risk of infection by taking a chlorhexidine shower preoperatively. Chlorhexidine reduces the number of microorganisms on the skin and keeps that number down for a certain length of time, so the patient can shower at home before the surgery. However, taking these showers could be difficult for elderly patients or patients with spinal conditions because they may not be able to reach the surgical site.
“Despite the practices’ efforts to prevent an infection, execution of these efforts is equally important,” says Linda Greene, RN, MPS, CIC, a member of the Association for Professionals in Infection Control and Epidemiology’s board and lead author of APIC’s Guide to the Elimination of Orthopedic Surgical Site Infections. “Patients may need to have a family member or nurse apply the chlorohexidine shower or skin wash the night the morning of surgery because we want to make sure we are able to execute these measures in a way that gets the best results.”
5. Time antibiotic administration carefully. It is absolutely critical that physicians are accountable for the administration of antibiotics, ensuring that administration falls within the one-hour time window of incisions. Ralph Gambardella, MD, an orthopedic surgeon and president of Kerlan-Jobe Surgery Center in Los Angeles, says it is common knowledge that falling outside the one-hour time window may put patients at risk of being administered less effective antibiotics. Additionally, a new program has been introduced to physicians at Kerlan-Jobe. Now physicians must make sure patient are not cold before administering antibiotics, as hypothermia has been linked to decreased immune system, he says.
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