Becker's Clinical Quality & Infection Control

27 Executive Briefing Sponsored by: N ew products and protocols, as well as payer penalties, have helped the healthcare sector make headway in reducing surgical site infections (SSIs). However, more work must be done. Amid the ongoing pandemic, patient safety has taken on heightened importance as people slowly return to healthcare facilities for both urgent and elective procedures. Becker's Hospital Review recently spoke with three experts from 3M about combining evidence-based best practices such as maintaining perioperative normothermia into a comprehensive action plan help to decrease the incidence of SSIs. To be successful, these plans must be supported with clinician education, process improvements such as surgical safety checklists and collaborative partnerships among patients, providers and solutions manufacturers. SSIs are a persistent problem, yet over half are preventable SSIs continue to be a challenge in healthcare. One contributor is the growing complexity of care. The elderly population is growing as are rates of diabetes, obesity and other comorbidities. At the same time, medical advancements now enable healthcare professionals to treat sicker populations than before. The COVID-19 pandemic is also having an impact on SSI rates partly due to lack of personal protection equipment (PPE) and increased burnout. "A recent focus group revealed high levels of burnout among healthcare providers across the board. It's taking providers double or triple the time to complete tasks that used to take only a few minutes, due to the additional time needed to don and doff PPE. These challenges exist in perioperative environments, as well as the ICU and hospital floors," said Marlene Slaughter, BSN, RN. Ms. Slaughter is a member of 3M's Clinical Specialist team. Antibiotic resistance has become a higher-profile issue, now that healthcare facilities face penalties when patients are readmitted within 30 days with an SSI. "We suggest the use of povidone iodine antiseptics for nasal decolonization as one step in a preoperative protocol to help address the problem of antibiotic resistance," explained Donna Juntunen, BSN, RN. Ms. Juntunen is also a 3M Clinical Specialist. From a process perspective, more accurate data collection and SSI surveillance are critically important. SSIs are associated with poor clinical outcomes, reduced patient satisfaction and higher healthcare costs. Although the healthcare sector has made progress on reducing patient infections, SSIs are still far too common. According to Infection Control and Hospital Epidemiology, SSIs may be preventable in up to 60 percent of cases. The CDC SSI risk equation offers a way to assess a patient's potential risk for development of an SSI. The equation works by multiplying the dose of bacteria by the virulence of the bacteria and dividing it by the resistance of the patient. "SSIs create physical and emotional trauma for patients and the care team. Based on the SSI risk equation, we must identify products and solutions that can reduce the patient's microbial load and improve the patient's resistance through best practices like nasal decolonization, patient skin prep, maintaining normothermia, and surgical incision management. Every touch point counts," said Bret Hampton, Marketing Manager at 3M. SSI prevention depends on a comprehensive, bundled approach to risk reduction One way that healthcare organizations are reducing the risk of SSIs is by implementing evidence-based best practice guidelines recommended by agencies like AORN and the CDC. These guidelines fall into seven categories: surgical preparation to reduce the microbial load on the patient's skin, prophylactic antibiotics, temperature management, sterilization monitoring and aseptic technique, the surgical environment, surgical incision management and surveillance. Processes and protocols also complement these guidelines. Preoperative checklists are very important. Facilities begin by collecting the patient's comprehensive health history. This ensures clinicians can address comorbidities that may increase the risk of developing an SSI. The healthcare team can then implement a surgical protocol or bundle to improve patient outcomes that usually includes three to five evidence- based guidelines. "We see much greater success in facilities when they use a surgical safety checklist or follow a preoperative protocol," Ms. Slaughter said. "Examples of these protocols include nasal decolonization, preoperative chlorhexidine gluconate bathing and hair removal outside the operating room. Tools like checklists standardize processes and improve teamwork and communication in the perioperative arena." New roles like nurse navigators are another way healthcare providers are reducing SSIs. "Healthcare organizations that perform joint replacements often assign a nurse navigator to follow patients through the entire perioperative pathway with the goal of optimizing outcomes," said Ms. Juntunen. Nurse navigators engage patients in their care and provide education prior to the procedure. When it comes to SSIs, degrees make a difference Maintaining normothermia throughout the perioperative journey can mean the difference between a positive patient Over half of all SSIs are preventable: Here's what your health systems can do about it

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