Infection prevention in surgery centers begins with action and commitment at the top. ASC leaders must commit to supporting the infection preventionists, staff education, monitoring reprocessing, disinfection, hand hygiene, surgical site infection prevention strategies, and other prevention activities.
“It’s about changing the culture,” says Bruce Crookes, MD, chief of the division of general surgery and an associate chief quality officer for perioperative services at the Medical University of South Carolina. “You change the culture of staff to help them realize they’re important in infection prevention.” If leaders provide more training for staff in infection prevention, it’s less likely the ASC will experience a costly event, says Patrick Haley, CASC, manager of Central Coast Surgery Center.
Haley and Crookes provide these best practice strategies:
• Improve surgery site infection prevention. “A typical surgical site infection will cost about $40,000, so that’s a big deal,” Crookes says.
The cost includes rehospitalization, IV antibiotics, and additional procedures. Another issue is that surgery site infections for several surgeries are publicly reportable. Each surgery center has to report its rate, and if its infection rate is higher than a competitor’s, the site might lose business.
“It will ultimately hurt our referral base,” Crookes says.
When creating a workplace environment that is focused on infection prevention, these are the points to emphasize to staff, he says.
“One, surgical site infections are really expensive for the patient, really expensive for the hospital, and they hurt your business,” Crookes says. “Two, it’s suboptimal care. If your patients are getting infected at a much higher rate, then no one wins.” Surgeons and surgery centers must keep these points in mind, he adds. “To me, one of the problems we have is our care is very siloed,” Crookes says. “We each participate in the patient’s care, but the groups cross-communicate with each other.”
The goal should be to get everyone across all siloes to understand their own important role in preventing infections. Everyone needs to buy into it and understand their facility’s surgical site infection rate.
• Be diligent in infection prevention and quality improvement. A quality assurance (QA) program, along with its quarterly reporting and studies, is a good way to maintain infection prevention adherence. Haley suggests linking the QA activities to infection prevention.
“Be diligent and persistent. It takes a lot of measures,” he says. “If you just educate people on prevention measures once a year, it’s easy for them to turn it off.”
Instead, an ASC must spend energy on retraining, monitoring, and reinforcement that will pay off in the long run. “For example, handwashing — everyone can wash their hands effectively by following steps,” Haley says. “Sing ‘Happy Birthday,’ and wash hands in that amount of time.”
Frequent monitoring can ensure handwashing doesn’t slough off and that people continue to wash the right way every time.
“Set infection prevention protocols and have an infection control nurse monitor that they’re being followed,” Haley says. “Like secret shoppers, monitors can sit quietly, looking like they’re working on a chart, while watching to see if the nurse who just touched a patient washed hands immediately afterward.” Monitors can watch the quality of the infection prevention actions and whether staff carried out the procedures well.
• Get staff buy-in. ASC employees must follow the center’s infection control and prevention protocols. It’s their job. But knowing this is not enough. They need to believe in it and feel a part of infection prevention actions.
“You have to identify a common goal, which is patient safety, and preach that from the get-go,” Haley suggests. “Everyone can get behind that.”
When someone follows infection prevention protocols correctly, then give that employee more responsibility. That person could be designated to train other employees.
“Get people you do trust to monitor those whose compliance is more questionable,” Haley says.
Obtaining buy-in also applies to contract staff. Even when housekeeping services are contracted out, these workers need to be trained and current on infection prevention protocols, he notes.
“You have to still monitor them, monthly, weekly, or a random audit, to make sure there is no dust in the vents,” Haley says. “Set up criteria to look at these things, and if housekeeping is not doing well with infection prevention, you have to see it and correct it.”