Karen Lombard, RN, is contract manager, medical/surgical for Amerinet, a national healthcare group purchasing organization. She previously ran a 21-OR ambulatory surgery center and helped to achieve an infection rate of just 0.3 percent.
Q: How do you think your ASC was able to attain such a low infection rate?
Karen Lombard: We focused on five areas:
1. Universal precautions.
2. Treating every one the same.
3. Following the rules and regulations set forth.
4. Following proper handwashing guidelines.
5. Following proper cleaning of instruments and sterilization.
We were Joint Commission-accredited and we followed those rules. That was it. We did our due diligence when it came to implants. Implants have to be sterilized a different way. We practiced good handwashing technique. Our prepping technique was by the book. That's really the key to it. If you begin to slack, begin to fall off from [the rules], that's when you run into problems.
Q: Can you identify an approach you took as a leader that played a significant role in keeping the rate so low?
KL: One of the interesting things that I learned many years ago when I first started out in the OR was when in doubt, throw it out. Don't be afraid to admit you maybe contaminated something on the way down to the table. If you think you did, don't be afraid to admit that you did that. Toss it. It's better for the patient if you do that. If you contaminate your back table, your whole case is contaminated and you need to start over. You have to treat every patient like they are a family member. You would not want a questionable contaminated product on your table if it were one of them.
This was one thing I was big on — I didn't want those folks in the field that made this mistake and we had to throw it all out to feel like there was going to be negative recourse for that if they admitted it.
The biggest thing really is admitting you contaminated something. If you're throwing out suction tubing, that is very hard to toss out on the sterile field. If part of that thing flies off the side, you have contaminated the entire sterile field. Some people will just pull it up and hope nobody saw it [fall off the side]. Anything beneath the table level is considered contaminated and if it falls beneath that table level, it's contaminated and you have to throw it out. You have to be cognizant of that. It may seem like it's not that bad but it is that bad.
Think about the cost of treating an infection. As an ASC, we didn't usually treat that but as a healthcare entity and provider, we don't want to contribute to increasing the cost to the patient. That will come back to us. The last thing you want to hear is "I came to your ASC and I got this infection and it cost me this much money." Or in some cases, they get an infection and they have to come back to you and you have to address it for free. Spending $50 saves you thousands of dollars later.
That was our culture and we had that kind of attitude. And we had that kind of regard for our physicians. If your physicians are dealing with infections in your facility, they're not going to come.
Q: How did you get buy-in from your team?
KL: We posted our results, we posted our satisfaction surveys. When I ran this ASC, we ran this ASC. We were a for-profit organization. We ran this as if it was our business because we wanted to be in business. An ASC gets reimbursed less than a hospital. We had to do it better for less. We depended on those patients to come to our ASC. They have choices. We ran it together as a team as if it were our own. I talked about it every month in monthly staff meetings: This is where we are, this is where we need to be, this is how we're going to get there.
Q: How did you address any spikes in the infection rate?
KL: If we saw maybe one month trended up a bit, we did root cause analysis to negative outcomes. We researched what our infection was, what type of patients we were seeing. You always look to see who is involved. Is there a trend with one person?
We analyzed all of the infections. Then we just reiterated our policies and procedures on sterilization, handwashing, sterile technique.
We always had annual training. Everyone had to go through the process, be checked off, and return demonstrations. We just followed the rules.
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