Dianne Rawson, RN, is the senior director of Minneapolis-based MHealth Clinics and Surgery Center at the University of Minnesota. She has over 40 years of experience in the perioperative environment, critical care nursing and healthcare industry.
Q. What are some efforts being taken in the ASC and outpatient surgery 'world' to reduce SSI?
Dianne Rawson: Ambulatory surgery centers have the same responsibilities and are accountable to the same guidelines and professional standards as any inpatient surgical setting. However, we typically have patients onsite in our facilities for just a fraction of the time, making it crucial that our protocols are in line with best practices and executed flawlessly and efficiently.
The purpose of protocols is to control processes and minimize variation in practice, because variation introduces risk. For instance, surgical skin preps have varying application methods, requiring specific techniques, dry times, etc., as specified in manufacturers' instructions for use. If perioperative personnel deviate from the process, the prep's effectiveness can be compromised. Regular training and annual competency checks can help ensure that staff are fully trained and remain in compliance with established protocols.
Patients have a role in reducing SSI risk as well. During a preoperative visit, patients receive instructions to help them prepare for surgery, including preoperative bathing with a CHG soap or an antiseptic. Smoking cessation, weight control or reduction if necessary are also preoperative patient concerns. Some facilities prescribe a five-day regimen of Mupirocin for nasal decolonization, primarily targeting S. aureus. Unfortunately, poor patient compliance can lead to unnecessary risk. In our facility, we have standardized on a povidone-iodine nasal antiseptic from 3M, administered onsite by staff one hour prior to a surgical procedure. In this way, we can control compliance and provide persistent antiseptic activity, even against MRSA.
Q. What are the key challenges of responding to SSI in ambulatory care?
DR: As an ASC, our mission is to deliver quality care in a cost-efficient manner. First and foremost, an SSI can create unnecessary suffering for a patient and their family, which counters all our efforts in the field of healthcare. An SSI will also drive additional operational and financial burden within the healthcare system. As we envision a path towards spending control combined with a focus on prevention, we need to aggressively seek improvements in quality measures, including SSI.
Despite the best efforts, sometimes an SSI occurs. When an SSI is identified in the ambulatory care setting, the surgeon begins by communicating with the infection prevention department. We then follow a regimented surveillance program to determine the root cause of the SSI. Patient history, patient compliance, aseptic practices, sterile processing quality assurance and others are considered as potential contributing factors. If warranted, we may provide education to staff and/or patients on topics such as the importance of good hand hygiene to help prevent the spread of staph aureus, a main contributor to SSI.
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