Issue link: https://beckershealthcare.uberflip.com/i/1122871
84 Executive Briefing Q: What are you and your hospital doing to decrease SSI rates for high-risk surgeries? Kim: The first step my hospital took was to make doctors aware of SSIs by assigning surgeon and physician leaders to talk about it. The next thing was to adopt the national Enhanced Recovery After Surgery protocols. These protocols focus on ensuring patients recover quickly. ERAS protocols include practices to minimize ileus, such as having patients chew gum shortly after surgery. Protocols also include identification of specific antibiotics to prevent an SSI. ERAS is not done by individual surgeons; it has to be driven by the institution. Bastidas: There are many things we try to decrease the infection rate. One is to adopt bundles to address risk factors preoperatively, perioperatively and postoperatively. Q: What new technologies are emerging to fight SSIs? What are your experiences with them? Kim: There are two types of technologies: "system" and "device" technologies. System technology means using protocols and taking more of a team approach. In terms of device technology, there are vacuum-assisted wound closure technologies that capture drainage from a wound and filter it through a sponge. These technologies help a wound heal faster and are used after surgery. A new device used during surgery that can prevent infections is CleanCision. It uses the idea introducing a wound protractor into the abdominal cavity, but CleanCision is also expandable. This technology also allows a wound to be irrigated during surgery with an IV fluid containing antibiotics. It prevents infections through these two mechanisms: protecting the wound with a plastic guard and providing constant irrigation during surgery. Bastidas: There is a new device (CleanCision) that not only provides a physical barrier in the wound to protect the exposed incision from contamination, but it is also constructed to irrigate and maintain the subcutaneous tissues and skin. There are good data showing that this significantly decreases bacterial contamination. I'm very happy with the results. The effect of the irrigation system is evident. Most of my operations are four, five or even six hours. When you take the device off and look at the wound, you can tell that the tissues are healthier and cleaner than without the technology. We are early in our experience, but we expect to see a lower wound infection rate. One technology will not eliminate SSIs, but this is the best I have seen. Chan: This new device from Prescient Surgical is very promising. It seems like a potentially low-cost measure to continuously irrigate the wound throughout the operation. It seems like a no brainer that could improve surgical site infections. It's one of the best things that have come along in the 15 years that I've been in practice. Q: What have been your experiences evaluating, adopting and advocating for emerging technologies? Chan: Ideally, it is beneficial to do a prospective trial. But that's not always possible. Every surgeon has to use their judgment and determine, "Does this make sense? Is it going to hurt the patient?" Hospital leaders also need to look at the costs of a new technology. For CleanCision, it's an easy decision. It doesn't add time to the surgery. There is no downside for the patient. It's not super expensive and if you can eliminate even one or two infections, you make your money back. Kim: Fortunately, my hospital is open minded. They think about how technology decisions will benefit both patients and costs to the hospital. Since we do not yet have data on CleanCision, I have anecdotally told stories about how it works and benefits patients. I have explained that there are no extra incisions. There is no trauma to the organ tissues. The surgery itself doesn't take any longer. And, there are benefits to patients because it cuts the infection rate. My hospital said let's do a one-year trial to gather data on the infection rate. Bastidas: I perform surgeries at three hospitals. Each has a different process for bringing in new technology. Some hospitals focus on the added cost of a device, while others focus on the overall savings. Since a wound infection might cost $15,000 to $30,000, it is a simple analysis to show that dropping your SSIs has high value. Conclusion Abdominal surgeries are complex and by their very nature increase the risk for SSIs. Surgeons are aware of the consequences of SSIs for patients and the financial implications for hospitals. Surgeons, in conjunction with hospital leaders, are embracing protocols and bundles to reduce SSI risks by implementing disciplined processes before, during and after surgery. However, to date most efforts to address SSIs have concentrated on activities before or after surgery. CleanCision provides an innovative tool to be used during surgery that has the potential to dramatically decrease infections. Surgeons who have used CleanCision are effusive in their reaction that this innovative device can reduce infections by protecting incisions from contamination and by continuously irrigating wounds with antibiotics. It is clear that adopting new technologies requires surgeons to make the case for how the technology will reduce SSIs, benefit patients and protect hospitals financially by preventing readmissions and reducing costs. n Based in San Carlos, CA, Prescient Surgical, Inc. is a medical device innovator dedicated to developing advanced tools and technologies to prevent surgical site infections (SSIs). With technological innovation, greater awareness, and ongoing collaboration with hospitals around best infection control practices, our company is dedicated to making surgery safer, improving the patient experience with surgery, and significantly improving post-operative outcomes.