Issue link: https://beckershealthcare.uberflip.com/i/981659
57 Executive Roundtable Sponsored by: s hospitals and health systems work to prevent surgical site infections — particularly in high risk abdominal surgeries, such as colorectal procedures, where patients face a signifi- cantly higher infection risk — surgeons can incorporate emerging medical technology during the intraoperative stage to protect pa- tients against harmful bacteria that enter incisions during surgery. Infection control during surgery is key to delivering better patient outcomes at a reduced cost. Financial and clinical repercussions of SSIs include increased morbidity, longer hospitalizations, higher readmission rates and greater healthcare costs. They represent a particularly important problem in colorectal and abdominal surgery, for which infection rates are disproportionately high. Colorectal surgery is consistently associated with SSI rates between 5 percent and 45 percent greater than other forms of surgery, according to a 2017 study 1 by the American College of Surgeons. Traditionally, practices for preventing SSIs involve intravenous and oral antibiotics, controlling patients' glucose levels, using skin prep agents and maintaining optimal temperatures. Although these methods are effective and important components of any infection prevention bundle, many surgeons are still challenged to eliminate SSIs completely. In the pursuit of zero percent infection rates in high-risk procedures, intraoperative infection control systems have emerged as a more technologically advanced approach to intraoperative surgical site infection control. These systems can be harnessed in conjunction with traditional infection prevention protocols in colorectal and abdominal surgery and aid surgeons toward the lowest possible infection rates. Prescient Surgical, a medical device innovator in San Carlos, Calif., developed CleanCision, an intraoperative infection control system that works to potentially reduce patients' SSI risk. The system utilizes a novel active cleansing technology to combine wound protection and irrigation into a retraction system, which can actively and consistently clear harmful bacteria that may invade the incision during surgery. After being incorporated into surgical and infection reduction protocols, CleanCision has been shown to reduce contamination following a colectomy by 66 percent 2 and SSI by 61 percent 3 in a clinical study. To ensure patients are healthy after surgery and prevent costly penalties from high SSI rates, hospitals can incorporate intraoperative systems into their infection control bundles, which are sets of interventions hospitals use to promote better patient outcomes and prevent SSIs. Becker's Hospital Review joined three industry leaders in infection control to discuss evolving methods for SSI prevention, gaps in current SSI approaches and ways surgical teams and other hospital staff can more closely collaborate to reduce SSI risk. Roundtable participants included: • Harry Papaconstantinou, MD, Chair, Department of Surgery at Temple, Texas-based Scott & White Medical Center and colorectal surgeon • Charles Edmiston, PhD, emeritus professor of surgery and director of the surgical microbiology and hospital epidemiology research laboratory at Milwaukee-based Medical College of Wisconsin, State of Wisconsin Peer Champion for SSI Reduction • Mark Welton, MD, MHCM, CMO of Minneapolis-based Fairview Health Services, colorectal surgeon and co-founder of Prescient Surgical Note: Responses have been lightly edited for length and clarity. Question: What are some of the biggest challenges in SSI prevention and control today? Dr. Harry Papaconstantinou: If you look at different surgical procedures, colorectal surgery has the highest SSI rate and is often an unclean procedure. In colorectal surgeries, surgeons have to go across the bowel while doing a resection, which can cause bacterial exposure to a sterile field. We have to think about how to reduce that risk and how to prevent exposure to the wound. Dr. Charles Edmiston: One of the biggest challenges in infection control and prevention is consistent compliance to infection control bundles. To improve compliance, I meet with surgical teams and operating room teams at hospitals that may have SSI issues to discuss evidence-based infection control bundles for their specific practices. In 2011, I spoke with seven colorectal surgeons and the chief of surgery at a U.S. hospital with a large colorectal practice to figure out what would be an appropriate number of evidence-based interventions to include in a surgical bundle. After hammering it out, everyone agreed to accept this bundle concept. Months later, the chief of surgery told me, 'What you're selling isn't working. We put your bundle of interventions in place and it didn't reduce our SSI rate.' When I asked what the compliance of these bundles was, he had no idea what that was. I learned a lot from that experience because surgeons have historically been perceived as captains of the ship, but they're not masters of their patients' destinies. There are so many things happening around patients that surgeons cannot control, and I realized that if I propose a bundle to a healthcare professional, there has to be some mechanism in place to provide compliance to that bundle. Now, as I talk to my surgical colleagues about how to improve their practices, I need to have the complete buy-in of not just the surgeon, but the institution, particularly the institution's quality personnel, because they actually measure how the hospital is complying with each component of the infection control bundle. Risk reduction is not a solo recital — it's a symphony, and everyone in healthcare is a member of the orchestra. Q: Why are some hospitals more effective at lowering SSI rates than others? Dr. Mark Welton: First, hospitals that are more effective at lowering wound infection rates engage physicians and hospital leaders to focus on the importance of driving these rates down. The second part is hospitals have to commit sufficient resources to those areas to increase awareness and innovate ways to drive rates down. Driving wound infection rates down is a multidisciplinary task involving a hospital's anesthesia, surgery and nursing departments. How hospital leaders can harness intraoperative technology to fight SSIs in high-risk surgeries A