Becker's ASC Review

ASC Quality & Infection Control 48 Community Health Worker Model Yields Better Outcomes for Patients in Outpatient Settings By Mary Rechtoris A Philadelphia-based Perelman School of Medicine study as- sessed the Community Health Worker model, which reduced pa- tient admissions and yielded better outcomes for hospitalized patients. Researchers found it may also yield promising results for patients in outpa- tient settings, according to AJMC. Researchers conducted qualitative in- depth interviews with 21 chronically ill, uninsured or Medicaid outpatients from low-income zip codes and 30 members of their primary care practice staff. Then, the researcher devised an outpa- tient manual for providers to adminis- ter treatments outside of the hospital setting, hire additional staff and work with primary care facilities in Philadel- phia to implement the CHW model in their facilities. The outpatient version of CHW is titled Individualized Management for Patient-Centered Targets. Here are four things know: 1. With the IMPaCT approach, resi- dents are recruited and trained as community health workers who work with patients and their providers to set health goals. 2. The residents also help patients develop individualized plans, and help those patients achieve those goals laid out in the plans. 3. In IMPaCT, patients focused on one of their chronic conditions. 4. Patients were provided access to additional support through a weekly clinic-based support group. "Our findings are relevant to the growing interest in community health worker programs across the United States," said Shreya Kangovi, MD, MS, executive director of the Penn Center for Community Health Workers and the lead author of the study. "But many payers and provider organiza- tions are tempted to use a trial-and- error approach. This results in a lot of reinventing the wheel, which is costly, time-consuming and leaves programs open to making common mistakes. Our study describes a way to balance fidelity and fit." n ASC Infection Control: Sterilization Wraps vs. Rigid Containers — Which is Best? By Laura Dyrda R igid containers and sterilization wraps are two major sterilization packaging types for sterile instruments used in the healthcare setting. Rigid containers are reusable and come in vari- ous sizes and materials, many of which have a filter mechanism to allow sterilizing agents to en- ter and exit the container; sterilization wraps are a three-layer laminate made of meltblown polypropylene bonded on both surfaces with a layer of spunbonded polypropylene. A recent study published in the American Journal of Infection Control examined the efficacy of rigid containers and sterilization wraps and found almost all — 97 of 111 — rigid containers failed to prevent bacte- rial ingress post-sterilization. All 161of the trays wrapped in steriliza- tion wrap maintained sterility. "e failure of rigid containers to protect surgical instruments post- sterilization until use in the OR increases the likelihood of introducing bacteria to the surgical instruments and, ultimately, increasing the risk for surgical site infection," says Peggy Luebbert, MS, MT, CIC, CHSP, CBSPD, infection preventionist at Nebraska Orthopaedic Hospital and owner of Healthcare Interventions. "Moreover, the study found that rigid containers become less effective the longer they are in use." e rigid containers and sterilization wrap were tested in hospital-like conditions, but ASCs are also noting the results given their high case volume and increasing "wear and tear" on containers. e rigid containers and sterilization wraps are designed to protect surgical instruments from contamination, but these findings challenge previously-held beliefs that the rigid containers are effective to maintain sterility of their contents. e study also showed the unused containers failed to maintain barrier performance under the study's test conditions. "Infection preventionists and others working in this field may be unsettled to learn that the equipment they rely on day-to-day may not be protecting their patients from risk of infection," says Ms. Luebbert. "is new evidence should prompt everyone within the ASC to take a closer look at the sterilization packaging systems used and determine whether they can trust the equipment to get the job done." Infection preventionists in the hospital and ASC setting are staying abreast of new scientific data to make the best decisions for their pa- tients. eir job is to minimize SSI risk and ensure sterility. "is recent scientific study clearly demonstrates the ability of trays wrapped with sterilization wrap to maintain sterility of their contents post-sterilization and prior to use in the OR," said Ms. Luebbert. "Even more compelling is the fact that this is the second study in a decade to produce these findings. is is information that cannot be ignored." n Peggy Luebbert

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