One of the greatest challenges that face managers of ambulatory surgery centers is keeping the rate of infection low.
Although any surgery requiring anesthesia poses the risk of infection, many steps can be taken to decrease the amount of infections that proceed through an ASC. As in hospitals, nosocomial infections are possible, but not as likely since the patient has limited exposure to the facility environment.
Focus should begin with the three phases of the surgical process. Improving infection control in the preoperative phase is the first step toward protecting the patient from infection. This includes proper hand washing between patients, universal precautions, and the proper handling of infectious waste. In the intraoperative phase, staff need to focus on maintaining the sterile field, proper application of antibacterial mixtures, and personal protective equipment for all staff. Finally, in the postoperative stage, the training should focus again on good hand hygiene, protection of the operative sites, and instructions regarding antibiotics. In preventing infection during these phases, managers can implement a number of different strategies.
Identification of High Risk Patients
One of the best ways to prevent infections is to identify those at high risk. You may want to consider implementing a screening tool that will allow your staff to quickly and easily distinguish who needs to be considered high risk. The tool can screen for patients with diabetes, MRSA infection, or immune suppressing drugs. In addition, patients who have artificial heart valves should also be singled out because of the risk of infection they can experience.
The form does not need to be long, but it does need to be comprehensive. It may help to form a task force that decides which patients are at high risk for getting infections. Those who are frequently in hospitals are another community of patients that may need special attention. You need to get the information on patients at high risk for infection from the doctors in your facility or possibly consulting with a doctor of immunology. From this research, a tool can be constructed and put in place.
Ensured Removal of Personal Belongings
Although patients are often told to leave jewelry and such at home, it can be a problem once they get to your ASC. Watches, jewelry, and rings can pose a large risk to infection control. Staff should know to check the patient thoroughly for objects that could potentially break the sterile field. This includes such items as nose rings, belly rings, and anklets. Many of the items are easy enough to see, but some are hidden.
You should also instruct your staff to check for dentures. Not only do these pose an airway risk during the surgery, they can also pose an infection risk. Some patients may be reluctant to remove their dentures due to embarrassment, but it is important to have staff explain the reasons why they can potentially cause infection and difficulty breathing. Not all dentures are full plates, either. Partial plates should be removed as well, and this may mean that the staff needs to do a mouth check to ensure that no hardware is left in the oral cavity.
Double Gloving and Torn Glove Procedure
Gloves are the most important part of a surgeon’s protection against the patient’s bodily fluids, but they are also the protection for the patient against the bacteria on the surgeon’s hands. It should be standard operating procedures that the surgeon double glove when performing a surgery on a patient. In addition, assistants may want to double glove, as well, because the risk of tearing glove when using needles and sharp equipment is high. Double gloves can provide the extra protection that will protect the sterile field and the patient.
Torn gloves are another problem that surgeons face, and there should be rules in place to inform staff how to handle this occurrence. It may be necessary for the worker with the torn glove to leave the sterile field, resterilize, and then return to the procedure. The circulating nurse should be on hand to help the staff member who has a torn glove and ensure the maintenance of the sterile field. A section of the policies and procedures manual should be dedicated to this task.
Skin Preparation
Skin preparation and the protection of the sterile field is one of the most important aspects in decreasing infections among the ASC patients. The skin should be prepped with an antibacterial solution and properly draped with sterile sheets to expose on the area to be operated on. All of the prep can be performed using simple, clean procedures, but the area must be properly sterilized before the surgeon begins to make an incision.
Asepsis and the protection of the patient against bacteria in the environment are important to preventing the eventuality of infection. All OR staff should be tested on asepsis and maintenance of the sterile field on a regular basis. For instance, they should all pass tests on sterility at least once per year to ensure that the necessary skills are in place to avoid breaking the field and contaminating the patient. With proper attention to this part of the operating room procedure, the incidence of infection can decrease dramatically.
Proper Use of Antibacterial Solutions
Finally, the proper use of antibiotics can help to decrease infections in the ASC patient. Patients should be told to cleanse the operative site with antibacterial soap the night before the surgery. When the patient enters the intraoperative phase, the use of antibiotic solutions increases to prep the skin and then to establish a sterile field. Antibiotic skin washes for staff should also be available. It is important for the manager to ensure that the solutions are not only present for staff usage on themselves and the patients, but are being use properly.
Prophylactic antibiotics are another consideration. While the patient has an IV, a dose of antibiotics may help to decrease the rate of infections. If this isn’t indicated or necessary, then a short run of oral antibiotics may also help to reduce the infection rate. Although the risk of antibiotic resistant bacteria makes all healthcare providers wary of prescribing these medications, those who have had invasive surgery will benefit from the use of them. It is part of responsible antibiotic usage, and patients are less likely to contract infections from the use of low dose antibiotics.
This article was provided by Sports and Spine Orthopaedics, a fully staffed sports medicine facility and ASC with board certified surgeons. They have been helping patients with minimally invasive surgery procedures in the Los Angeles area for nearly 10 years and can also be found on twitter and facebook.
