Patients who develop surgical site infections are 60 percent more likely to spend time in an ICU. Preventing surgical site infections is an important quality measure in ambulatory surgery centers, says Scott J. Trimas, MD, FACS, a Florida facial plastic surgeon and otolaryngologist who serves as a surveyor for AAAHC and as a consultant for its subsidiary, Healthcare Consultants International.
Dr. Trimas has seen infection rates — which already tend to be lower in ASCs than in hospital settings — decrease in his work as an AAAHC surveyor, but he says there's always room for improvement.
"Rarely do you see improper technique at a surgery center," he says. "It's more the simple things that people forget to do."
He discusses five simple ways ASCs can decrease their surgical site infection rate.
1. Stick to hand hygiene protocol. Dr. Trimas says this is the single most effective way to prevent surgical site infections. Centers need to make sure they are following Center for Disease Control or World Health Organization guidelines for hand hygiene. He says this is also one of the biggest areas of non-compliance for centers he visits as an AAAHC surveyor.
"If you go and look in surgery centers, there's a 60-70 percent compliance," he says.
Hands need to be washed between every patient contact, he says. If hands have not been grossly contaminated (coming in contact with bodily fluids), an alcohol-based disinfectant is fine, but if they have been grossly contaminated, staff needs to use soap and water before an alcohol-based disinfectant. Dr. Trimas says nurses tend to be more compliant, and it's usually the surgeons and anesthesiologists who are not following protocol.
While most providers recognize hand hygiene is important, they may have more difficulty reaching 100 percent compliance. Dr. Trimas has seen some centers install cameras over the scrub sink or in the operating room so someone can watch in real time to check if staff is washing their hands. He has also heard of centers keeping track of how much alcohol-based disinfectant they go through in one day. They will look at how much disinfectant is in the dispenser at the beginning of the day and calculate — according to the number of staff and procedures — how much should be left at the end of the day.
2. Wipe off equipment between cases. Like hand-washing, wiping off equipment between cases is another area of non-compliance that Dr. Trimas sees in his work as a surveyor. Staff should wipe off equipment and surfaces, such as countertops, between each and every procedure. This can also be improved through simple surveillance techniques.
3. Administer the antibiotic at the right time. In addition to making sure the correct antibiotic is administered, the timing of the antibiotic is key, Dr. Trimas says. Antibiotics should be administered within one hour before surgery. If the antibiotics are given too early, they will not be effective. This oversight can be caught in a timeout before the surgery begins and corrected, he says.
4. Prevent hypothermia. Hypothermia can occur in up to 90 percent of all surgeries, and even mild hypothermia can increase the risk of infection. Keeping patients warm after surgery has been shown to reduce the incidence of surgical site infections, he says. Common methods include warming blankets and forced-air warming, a method that uses a machine to pump heated air into a single-use blanket.
5. Track surgical site infection data. Because a surgical site infection will occur after a patient leaves the surgery center, it's essential for centers to collect accurate data from their surgeons' offices. Dr. Trimas says that on the whole, surgery centers do a good job of tracking infection, but they do have limitations because of the timing.
"You're at the mercy of the surgeon," he says. "If they don't provide the data, you aren't going to have the accurate numbers."
Dr. Trimas says that most surgeons understand the value of having accurate infection data and are likely to report correct data. However, if a surgeon is skeptical about reporting infection data to quality staff members, he says to assure them that it's about education rather than penalty.
"Show them that there is no penalty for being honest," he says. "Emphasize that it's going to be used more as a teaching tool if you have a rate that's higher than expected."
Related Articles on Quality and Infection Control:
4 Strategies for Discouraging Shortcuts in Infection Control
6 Oversights That Can Cause Trouble for an ASC
How to Clean a Surgery Center's OR According to AAAASF Standards
Dr. Trimas has seen infection rates — which already tend to be lower in ASCs than in hospital settings — decrease in his work as an AAAHC surveyor, but he says there's always room for improvement.
"Rarely do you see improper technique at a surgery center," he says. "It's more the simple things that people forget to do."
He discusses five simple ways ASCs can decrease their surgical site infection rate.
1. Stick to hand hygiene protocol. Dr. Trimas says this is the single most effective way to prevent surgical site infections. Centers need to make sure they are following Center for Disease Control or World Health Organization guidelines for hand hygiene. He says this is also one of the biggest areas of non-compliance for centers he visits as an AAAHC surveyor.
"If you go and look in surgery centers, there's a 60-70 percent compliance," he says.
Hands need to be washed between every patient contact, he says. If hands have not been grossly contaminated (coming in contact with bodily fluids), an alcohol-based disinfectant is fine, but if they have been grossly contaminated, staff needs to use soap and water before an alcohol-based disinfectant. Dr. Trimas says nurses tend to be more compliant, and it's usually the surgeons and anesthesiologists who are not following protocol.
While most providers recognize hand hygiene is important, they may have more difficulty reaching 100 percent compliance. Dr. Trimas has seen some centers install cameras over the scrub sink or in the operating room so someone can watch in real time to check if staff is washing their hands. He has also heard of centers keeping track of how much alcohol-based disinfectant they go through in one day. They will look at how much disinfectant is in the dispenser at the beginning of the day and calculate — according to the number of staff and procedures — how much should be left at the end of the day.
2. Wipe off equipment between cases. Like hand-washing, wiping off equipment between cases is another area of non-compliance that Dr. Trimas sees in his work as a surveyor. Staff should wipe off equipment and surfaces, such as countertops, between each and every procedure. This can also be improved through simple surveillance techniques.
3. Administer the antibiotic at the right time. In addition to making sure the correct antibiotic is administered, the timing of the antibiotic is key, Dr. Trimas says. Antibiotics should be administered within one hour before surgery. If the antibiotics are given too early, they will not be effective. This oversight can be caught in a timeout before the surgery begins and corrected, he says.
4. Prevent hypothermia. Hypothermia can occur in up to 90 percent of all surgeries, and even mild hypothermia can increase the risk of infection. Keeping patients warm after surgery has been shown to reduce the incidence of surgical site infections, he says. Common methods include warming blankets and forced-air warming, a method that uses a machine to pump heated air into a single-use blanket.
5. Track surgical site infection data. Because a surgical site infection will occur after a patient leaves the surgery center, it's essential for centers to collect accurate data from their surgeons' offices. Dr. Trimas says that on the whole, surgery centers do a good job of tracking infection, but they do have limitations because of the timing.
"You're at the mercy of the surgeon," he says. "If they don't provide the data, you aren't going to have the accurate numbers."
Dr. Trimas says that most surgeons understand the value of having accurate infection data and are likely to report correct data. However, if a surgeon is skeptical about reporting infection data to quality staff members, he says to assure them that it's about education rather than penalty.
"Show them that there is no penalty for being honest," he says. "Emphasize that it's going to be used more as a teaching tool if you have a rate that's higher than expected."
Related Articles on Quality and Infection Control:
4 Strategies for Discouraging Shortcuts in Infection Control
6 Oversights That Can Cause Trouble for an ASC
How to Clean a Surgery Center's OR According to AAAASF Standards
