The Little Things That Kill … And Cure

The Little Things That Kill…. And Cure by Jeff Reinke

Although the good certainly outweighs the bad, the U.S. healthcare system is still an easy target on a number of fronts. Perhaps the two most common criticisms can be attributed to cost and seemingly preventable procedural errors – both of which have significant impacts on the patient and surgical community.

Infection control can be seen as a source of both promise and pain in each of these areas. On one hand, the proper procedures and investments in time and resources help keep treatment costs down and prevent longer than necessary hospital stays. On the other hand, proper infection control equipment and products are not inexpensive, and the related processes often require healthcare professionals to slow down and take a little extra time in washing hands, applying antibacterial materials, etc.

One of the factors driving infection control developments is, undoubtedly, the havoc that superbugs can release on patients and facilities. Dr. Hudson Garrett, Senior Director of Clinical Affairs for PDI Healthcare, offers some perspective. “According to recent estimates from the U.S. Centers for Disease Control and Prevention, antibiotic-resistant bacteria annually cause at least two million illnesses and 23,000 deaths in the United States.”

Bernie Dutton of Palmero Health Care feels that “superbugs are always a concern but would not be as prominent if the spread of MRSA and Staph could be controlled. The need to control MRSA and Staph could, in turn, reduce the frequency of superbugs. Infection control needs to start at the source.”

Back to the Basics

Many of Dutton’s colleagues seem to agree. At the heart of numerous infection control best practices and prevention strategies are actions that attack the root cause, and often entail simply, basic, yet effective approaches.

“Most healthcare associated infections (HAIs) are caused by contamination originating from the healthcare providers’ hands, the patient’s own skin, or the environment surrounding the patient,” offers Garrett. These common sources of contamination can easily be mitigated through proper hand hygiene (for both the patient and healthcare provider) and ensuring proper skin antisepsis is performed.”

Garrett also looks at surgical site infections (SSIs) as primarily attributable to skin antisepsis procedures not being performed accordingly. “I would confidently say that skin antisepsis is rarely performed in accordance with the manufacturer’s complete instructions for use. It is critical for the clinician to adhere to instructions for the prepping mechanism, contact time necessary on the skin, etc. The longer a skin antiseptic is scrubbed onto the skin, the more substantial microbial kill will be achieved, resulting in reductions of bioburden and flora on the patient’s skin,” he adds.

Another element to consider when looking at some of the basic elements that can aid in minimizing infection control risks is OR accountability. “It can be so simple,” offers Vicki Allen, MSN, RN and Vice Chair for the Association for Professionals in Infection Control (APIC).

“Just think about all the traffic going in and out the OR, especially for something like a total joint procedure,” she states. “You have a lot of staff, possibly even vendors, going in and out of the operating room. So you have to be cognizant of factors that you might not think about, like are these individuals wearing the appropriate attire. Regular assessments or audits can help spotlight those areas that are easily missed, and if you perform them routinely instead of just when trying to hunt down a problem, the staff is more likely to remember and follow through.”

It’s also worth noting that many of the most basic, yet essential components of a solid infection control approach do not demand high levels of investment. Soap and water and alcohol hand wipes are not expensive, but failing to properly utilizing these basic resources can lead to hospitals and surgery centers paying a steep price in the long run.

Continuing Education

“Microorganisms and germs can live on unanimated objects for days to years. So it is imperative that OR Staff be trained on infection control from hand scrubbing to cleaning surfaces,” states Dutton in emphasizing another basic yet essential weapon that must be a part of any infection control arsenal.

Allen adds to the significance of this educational component when referencing an Executive Order from last fall in which funding for antimicrobial stewardship programs was doubled. She feels that attention from such a high level will help hospitals and surgery centers to be more proactive in their infection control approaches.

In addition to being more proactive, Allen points to the benefits of consistent reminders that keep OR staff focused on the significance of proper practices and their long-term impact on both costs and care. “There’s turnover, equipment changes, new hygiene products and just the hecticness of the environment, so it never hurts to keep reminding people of the right way to use new processes or products,” she states.

Investing in the time and resources necessary to keep proper infection control policies top of mind with OR staff not only provides patient care benefits. “We can also show an ROI by identifying economic benefits,” offers Allen. “Patients are aware of ratings from the CDC, which could impact where they have an elective procedure performed. Senior management teams are also focused on infection prevention to help avoid insurance payment penalties, shorten patient stays and improve outcomes.” All of these elements help improve overall financial performance while enhancing standards of care.

The Right Investments – For Staff And Patients

In addition to training and processes, healthcare facilities also need to make good decisions when selecting products focused on patient care, as well as personal protective equipment (PPE) for OR personnel. Some basic things to consider when purchasing these products include:

  • Heat-sealed seams can help prevent or at least minimize fluid contamination.
  • Determine what type of disinfectant works to maximum the best results for your facility.
  • Ensure that the soiled garments and material can be disposed of properly at your facility to prevent cross contamination.
  • Work to develop a familiarity with the equipment being used or considered for purchase, and keep the lines of communication open with vendors in staying knowledgeable of upgrades and enhancements.
  • Embrace how different procedures present unique infection control challenges and procurement infection control products accordingly.
  • Know and understand product differences before purchasing.

“It is important to understand the product being used,” adds Dutton. “For example, a product that on the surface appears more expensive may in the long run save money. Read the label and understand that if the product says it has a kill time of one minute for TB but takes 10 minutes to kill MRSA, the product needs to be left on the surface longer. If the steps are not followed properly, no disinfection is occurring.

“A common error is the fact that the surface must stay wet for the whole time stated in the directions (based on what you are trying to kill) and if the product does evaporate you must start all over or monitor the area and keep applying more disinfectant. An example would be TB would be two minutes and MRSA three minutes. So the product would need to stay on the surface, wet for three minutes to properly disinfect TB and MRSA effectively. It is crucial that staff be trained properly to understand the kill times on the product being used and how to properly use the product,” he states

Infection control processes, products and protocols essentially have three core common elements.

  1. They positively impact patient care and staff safety.
  2. Their impacts can be measured economically and in improved outcomes.
  3. They are easily constructed, implemented and understood.

However, just because the answer might sound simple, that does not make it easy. At the end of the day, your facility’s ability to control/prevent infection will need to comprise not just an understanding of what needs to be done, but a willingness to combine all these elements in putting a dedicated plan into action that consistently ensures positives outcomes, both immediate and long-term, for patients and staff.


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