Prevalence of SSIs Magill ID week abstract Oct. 2017 Results point - PDF document

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Surgical Site Infections (SSI): The Perfect Storm: Current Guidelines Including Environmental & Sterilization Challenges Linda R. Greene, RN,MPS,CIC, FAPIC Manager of Infection Prevention Highland Hospital Rochester, NY University of Rochester Medical Center linda_greene@urmc.rochester.edu Prevalence of SSIs Magill ID week abstract Oct. 2017 Results point prevalence study 2015  Now 3 rd most common HAI from 2015 data  SSI HAI among all hospitalized patients in the survey fell by 41% between 2011 and 2015 (from 1.00% to 0.59%; P = .001).  Attributed to better adherence to guidelines Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 1

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Burden  Cost $3.5 -$10 Billion annually  Estimated cost per infection ranges from $11,000 - $35,000  Colon and Hysterectomy contribute to HAC reduction and Value Based Purchasing  Contribute to 30 day unplanned readmissions Etiology Surgical Site Infections can be attributed to the patient’s own endogenous flora or from exogenous sources. Example:  Patient’s skin  Contamination during surgery  Oropharyngeal contamination  Patient’s natural immunity Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 2

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Observations  All surgical wounds are contaminated by bacteria but only a few get infected  Different operations have different inoculums of bacteria  Similar operations performed by the same surgeon in different populations have different rates of infection  SSIs have varying degrees of severity Challenges - Time - Turnover -Surgeon preference -Adherence factors Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 3

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Bacteria get into wounds Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 4

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Topics  Core :  Arthroplasty Antibiotic Prophylaxis Transfusion Glycemic control Immunosuppresive therapy Normothermia Anticoagulation Tissue oxygenation Orthopedic space suit Skin Preparation Antimicrobial prophylaxis with drains biofilm Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 5

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Recommendations Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 6

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 7

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Improvement Opportunities Are there gaps between policy and practice? Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 8

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Where to Start  Gap analysis  Evidence based guidelines  Cleaning  Sterilization Etiology Exogenous sources:  Hands of care givers  Exposure to non sterile environment  Contamination of fluid, supplies or equipment  Air flow Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 9

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Where are the Pathogens ? Pathogen source for most SSIs is endogenous flora of the patient’s skin, mucous membranes or GI tract. 20 % of the skin’s pathogens live beneath the epidermal layer in hair follicles and sebaceous glands. Any incision can carry some of the bacteria directly to the operative site. Risk Factors for SSI Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 10

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Surgical Technique  May have to look beyond the bundle  Sterile fluids  Soaking  Wound closure technique  Intraoperative management Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 11

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Gaps in OR Cleaning  Many persons involved in OR cleaning: EVS Nurses Multiple turnovers Equipment moved from room to room Multiple patients General Review Standards and Guidelines  Beginning of day:  Horizontal surfaces  Furniture  Equipment  Surgical lights  After each procedure: • Frequently touched areas • Appropriate disinfectant or detergent Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 12

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention How about Cleaning?  Tiered approach  Direct practice observation  Environmental Monitoring Swabs ATP Fluorescent Markers PCR Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 13

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 14

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Traffic Control Tracers in OR Primary Hip observed- 27 different entries into OR room Hysterectomy Davinci - 31 entries What does the evidence tell us? - Doors open average of 9.5 minutes per case - Loss of positive pressure - 77 of 191 cases had doors open long enough to defeat positive pressure Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 15

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention • Enhancing air quality by reducing airborne contamination has been shown to be of great importance, especially in relation to implant surgery. , • Suggested levels be maintained at <10 CFU/m during implant surgery, and that clinical benefits can be expected by reducing it to 1 CFU/m • Very low levels of clinically relevant coagulase-negative staphylococci can initiate a device-related infection Traffic Flow Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 16

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Strategies 2018 Top Ten Health Hazards Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 17

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Decontamination Decontamination  Starts in surgery  If initial decontamination does not take place in surgery; it may be impossible to properly clean instruments Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 18

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Looking Clean What about IUSS? Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 19

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Do you track IUSS Use? Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 20

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Implants Implants should be free of all contaminants and residues which could harm a patient Lubrication Issues Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 21

Chasing Zero Infections November 16, 2017 Connecting the Dots to Reduce Patient Harm: Hot Topics in Infection Prevention Other issues  Walking rounds  When does decontamination occur  Appropriate PPE  Vendors  Instructions for Use ( IFUs)  Appropriate cleaning Conclusion  SSIs are a complex problem  Need a team approach  Start with the basics and move forward Mission to Care | Florida Hospital Association Hospital Improvement Innovation Network 22