Six experts share points on improving infection control processes in gastroenterological-driven ambulatory surgery centers.
1. Use daily documentation, checklists and reminders. Use daily checklists that contain information on infection control-related responsibilities, such as the procedures for terminally cleaning, along with dates, times and concentrations of solutions for scope reprocessing. The checklists should be laminated and posted in view in the scope reprocessing room, said Susan Rahn, clinical manager of Endoscopy Center of St. Louis. Using check lists not only ensures standards are being followed, but also provides the manager with accountability of the staff.
In conjunction with daily checklists, scope reprocessing logs can be used to record scope numbers, times of day, dates and concentrations for reprocessing solutions. This process is repeated for every scope. "This is also a means for measuring accountability," Ms. Rahn said. "These logs can be used as a tracking mechanism should problems arise."
2. Revise instrument cleaning guidelines. No matter what type of enzymatic detergent an ASC uses to soak scopes into, Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, stresses the importance of changing — not reusing — detergents after each use for optimal effectiveness. Just as a household member would refill a sink with new water and new detergent to clean dirty dishes, ASCs should also be mindful of changing water and enzymatic detergent because detergent will break down, Mr. Sweeney said.
"This may be a case of someone not paying attention to the manufacturer's recommendations or trying to save money, but ASCs must not reuse enzymatic detergent with multiple scopes. Detergents absolutely break down and lose integrity after each use," he said. "ASCs will sometimes reuse a brush to clean a scope too, but they have to remember that there are disposable kinds and reusable kinds. If you use a single-use item, you're supposed to use that item just one time."
3. Be proactive about G-code reporting. Since October, ASCs have been required to report five quality measures on Medicare claims forms using G-codes, part of Medicare's Quality Reporting Program. The Centers for Medicare and Medicaid Services is interested in knowing if ASCs are administering intravenous antibiotics in a timely fashion to avoid infections, said Sandra Jones, MBA, CEO and COO of ASD Management.
Ms. Jones suggested ASCs run reports to know the frequency of G-codes used to report the specific care provided and review it against set goals and external benchmarks. "Assessment findings can lead to quality improvement opportunity," she said. She encouraged ASCs to set up a system to report data and then send it as soon as possible.
4. Create processes to avoid using out-dated supplies. Staff members can use stickers marked with dates to show when certain supplies have been opened, which helps others avoid the potential of using supplies that have been open for too long and compromising patient safety.
"At the end of every day, we make sure everything's thrown away properly and cleaned up," said Karen Smith, interim executive director at Central Illinois Endoscopy Center in Peoria. "Also, to make double sure someone hasn't forgotten to dispose of something that's old, there are stickers on everything. So every time a staff member has to open a supply, there are pre-printed stickers with the staff member's name, time and date. Putting that on the object ensures they aren't using something that's been out for too long, like sterile water."
5. Builds a strong network of peers working in infection control. Membership or affiliation with local chapters of national professional groups, such as APIC or the Association of periOperative Registered Nurses, not only opens doors for learning opportunities but also gives infection preventionists a way to network with other professionals. Failure to network can stunt an infection preventionist's growth, particularly those who work in smaller facilities, said Karen Mackie, RN, MA, CIC, infection control manager at Greater Baltimore Medical Center in Towson, Md. For her part, Ms. Mackie found joining the Baltimore chapter of APIC has dramatically expanded her learning opportunities.
"While I have two wonderful colleagues who work with me on infection prevention at GBMC, I realize that infection control professionals can't do it alone. You need to develop that network," she said. "I have developed relationships with other practitioners in the area, and now they're an email or phone call away."
6. Empower patients. "Empowering patients to say 'Have you washed your hands?' before the doctor examines them is very powerful," said Amesh A. Adalja, MD, infectious disease physician and clinical assistant professor in the department of critical care medicine at the University of Pittsburgh. "No doctor would not do that if a patient specifically asked [him or her] to do that." Some hospitals have even put signs in the exam room encouraging patients to ask physicians if they washed their hands, he said.
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1. Use daily documentation, checklists and reminders. Use daily checklists that contain information on infection control-related responsibilities, such as the procedures for terminally cleaning, along with dates, times and concentrations of solutions for scope reprocessing. The checklists should be laminated and posted in view in the scope reprocessing room, said Susan Rahn, clinical manager of Endoscopy Center of St. Louis. Using check lists not only ensures standards are being followed, but also provides the manager with accountability of the staff.
In conjunction with daily checklists, scope reprocessing logs can be used to record scope numbers, times of day, dates and concentrations for reprocessing solutions. This process is repeated for every scope. "This is also a means for measuring accountability," Ms. Rahn said. "These logs can be used as a tracking mechanism should problems arise."
2. Revise instrument cleaning guidelines. No matter what type of enzymatic detergent an ASC uses to soak scopes into, Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, stresses the importance of changing — not reusing — detergents after each use for optimal effectiveness. Just as a household member would refill a sink with new water and new detergent to clean dirty dishes, ASCs should also be mindful of changing water and enzymatic detergent because detergent will break down, Mr. Sweeney said.
"This may be a case of someone not paying attention to the manufacturer's recommendations or trying to save money, but ASCs must not reuse enzymatic detergent with multiple scopes. Detergents absolutely break down and lose integrity after each use," he said. "ASCs will sometimes reuse a brush to clean a scope too, but they have to remember that there are disposable kinds and reusable kinds. If you use a single-use item, you're supposed to use that item just one time."
3. Be proactive about G-code reporting. Since October, ASCs have been required to report five quality measures on Medicare claims forms using G-codes, part of Medicare's Quality Reporting Program. The Centers for Medicare and Medicaid Services is interested in knowing if ASCs are administering intravenous antibiotics in a timely fashion to avoid infections, said Sandra Jones, MBA, CEO and COO of ASD Management.
Ms. Jones suggested ASCs run reports to know the frequency of G-codes used to report the specific care provided and review it against set goals and external benchmarks. "Assessment findings can lead to quality improvement opportunity," she said. She encouraged ASCs to set up a system to report data and then send it as soon as possible.
4. Create processes to avoid using out-dated supplies. Staff members can use stickers marked with dates to show when certain supplies have been opened, which helps others avoid the potential of using supplies that have been open for too long and compromising patient safety.
"At the end of every day, we make sure everything's thrown away properly and cleaned up," said Karen Smith, interim executive director at Central Illinois Endoscopy Center in Peoria. "Also, to make double sure someone hasn't forgotten to dispose of something that's old, there are stickers on everything. So every time a staff member has to open a supply, there are pre-printed stickers with the staff member's name, time and date. Putting that on the object ensures they aren't using something that's been out for too long, like sterile water."
5. Builds a strong network of peers working in infection control. Membership or affiliation with local chapters of national professional groups, such as APIC or the Association of periOperative Registered Nurses, not only opens doors for learning opportunities but also gives infection preventionists a way to network with other professionals. Failure to network can stunt an infection preventionist's growth, particularly those who work in smaller facilities, said Karen Mackie, RN, MA, CIC, infection control manager at Greater Baltimore Medical Center in Towson, Md. For her part, Ms. Mackie found joining the Baltimore chapter of APIC has dramatically expanded her learning opportunities.
"While I have two wonderful colleagues who work with me on infection prevention at GBMC, I realize that infection control professionals can't do it alone. You need to develop that network," she said. "I have developed relationships with other practitioners in the area, and now they're an email or phone call away."
6. Empower patients. "Empowering patients to say 'Have you washed your hands?' before the doctor examines them is very powerful," said Amesh A. Adalja, MD, infectious disease physician and clinical assistant professor in the department of critical care medicine at the University of Pittsburgh. "No doctor would not do that if a patient specifically asked [him or her] to do that." Some hospitals have even put signs in the exam room encouraging patients to ask physicians if they washed their hands, he said.
More Articles on Infection Control:
Why is Hand Hygiene Still a Problem in Healthcare? 4 Common Culprits
13 Latest Findings on Infection Control
4 Preventive Health Strategies to Improve Care, Cut Costs