Issue link: https://beckershealthcare.uberflip.com/i/981659
58 Executive Roundtable Q: What risks do hospitals face if they are unable to keep SSI rates down? HP: Risks include the cost of care, CMS penalties and reimbursement issues. Since the average SSI can cost between $3,000 and $15,000, this added expense can be quite taxing to a hospital's financial stability. Reducing the incidence of SSIs across the board is not only important financially, but can also impact hospital reputation and referral patterns through public reporting of outcomes. CE: CMS' Hospital Compare website lets patients search hospitals by zip code and look at their healthcare-associated infections, readmission rates and other morbidities to see if that hospital is either at, below or above the national level. Patients are consumers, and if they feel uncomfortable with the Hospital Compare results, such as seeing a hospital that is unable to keep SSI rates down, that's a patient that institution could lose. Q: What is the role of SSI infection control and prevention methods during the intraoperative stage in colorectal and abdominal surgeries? CE: In terms of standard interventional strategies that can be used intraoperatively, in colorectal surgery, we have used supplemental oxygen to enhance immune process in the tissue bed, change gloves at closure and have also given patients oral antibiotics and mechanical bowel prep. Additionally, many colorectal surgeons have embraced wound edge protectors, which are plastic, sleeve-like devices you put into the wound to protect its internal margins. Another strategy that I've been interested in is wound irrigation. There is an old surgical adage "the solution to pollution is dilution," which makes a lot of sense. We are seeing more and more interest in what kinds of irrigation fluids would be optimal for some of these higher-risk procedures that have a potential risk for bacterial contamination. Q: Overall, SSI rates have been declining in U.S. hospitals, yet published data suggests SSI rates are still high for certain types of high-risk abdominal surgeries. Should hospitals consider newer methods of SSI prevention and control for these surgeries? MW: Yes, hospitals should consider newer methods for these surgeries. Since hospitals and clinicians can't address patients' preexisting conditions, such as obesity, which is a major risk factor for SSIs, we have to think about ways to innovate around these preexisting conditions and gain better local control of the wound. Additionally, a risk factor for wound infection is a dry, desiccated and cold wound, so hospitals need to consider how to keep the wound warm and moist. Q: What role does emerging medical technology play in the new bundle approach to infection prevention and control? HP: In terms of new technologies, we're always looking to see if a technology might reduce the complication rate while providing value to the patient and procedure. In a published study where we looked at a novel wound retractor that combines continuous irrigation and barrier protection, the retractor was shown to reduce wound contamination in colorectal operations. MW: Incorporating an emerging medical technology such as CleanCision into a bundle approach is a difficult decision for a hospital to make because they are focused on the upfront cost compared to other options. But I think it's an easy decision if you look at bundled care. My argument would be that hospitals can use these technologies to drive down wound infection rates, which also decreases the facility's readmissions and skilled nursing visits for wound dressing changes multiple times a week. The upfront cost is mitigated by the understanding that you're preventing all these other future costs. Q: How should medical technology aid the efforts of surgical and infection control teams and processes? CE: To validate whether an innovative technology really is beneficial in aiding the efforts of surgical and infection control teams and processes, hospitals need to consider four metrics. The device needs to be safe, whether it is being used intraoperatively, postoperatively or prior to surgery. If it is an antimicrobial technology, it must be effective against gram-positive and gram-negative surgical wound pathogens. The third metric is evidence-based clinical effectiveness, and the final metric is cost effectiveness. If I use this technology to reduce infection risk and get that patient home and back to work, that's a very effective technology. Q: How can surgical and infection control teams better collaborate to prevent and control SSIs? HP: No. 1 is transparency and communication. I frequently see a lack of effective communication between teams about specific nuances of cases. There are a lot of things to learn about every SSI case, and the best way to learn is to have a multidisciplinary approach to talk about it. If an SSI comes up, that case is reviewed not only by the infection control group, but also by the surgeon that performed the operation. They talk about the case to ensure documentation is correct and discuss strategies that could have prevented the SSI. As a result of this multidisciplinary approach, we have standardized strategies such as changing our gowns and gloves and using newly opened sterile instrument trays before surgical wound closure. CE: When I was a hospital epidemiologist, I realized we need to have an open dialogue with surgical practitioners so they would be willing to come to us when they have a problem and are receptive to us when discussing the issue. I also realized surgeons know their patients better than we were ever going to. The surgeons could provide more conclusive insight in terms of what was going on during the operation or what their thoughts were about the patient in terms of comorbid risk. Q: Dr. Welton, what are some of the reasons why you co-founded a company devoted to infection control and prevention technology? MW: My primary motivation in being part of this company was to improve outcomes for the patient, rather than develop a technology that would decrease hospital readmissions or length of stay. Patients view wound infections as a devastating complication, a sign that something went wrong during the operation. They have to pack their wounds and have prolonged hospital stays, as a result of these infections, which can be a difficult and unpleasant experience. I thought this technology was the best thing for patients because when they have a clean incision that heals nicely, they avoid the complications of an incisional hernia or another operation and won't have to take as much time away from work and their families. As colorectal surgeons, we recognize that we may see wound infections because we're opening the colon. But, we'd all like that number to be zero. The CleanCision technology could potentially allow us to leapfrog ahead to get closer to that goal. 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. References 1 Connolly T.M., Foppa, C., Kazi, E. et al. (2015) 'Impact of a surgical site infection reduction strategy after colorectal resection,' Colorectal Disease (Published online Oct. 12, 2015) DOI: 10.1111/codi.13145. 2, Papaconstantinou, H.T., Ricciardi, R., Margolin, D.A. et al. (2018) 'A Novel Wound Retractor Combining Continuous Irrigation and Barrier Protection Reduces Incisional Contamination in Colorectal Surgery', World J Surg (Published online March 9, 2018) DOI: 10.1007/s00268-018-4568-z. 3 Papaconstantinou HT, Ricciardi R, Margolin D, et al. Impact of Novel Wound Protection Device on Observed vs. Expected Surgical Site Infection Rates Following Colectomy Using the National Surgical Quality Improvement Program Risk Calculator. Paper presented at: WSA 2017 Annual Meeting2017; Scottsdale, AZ.