Surgical Site Infections Sterile Processing

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers Jody Church/Martha Young Centralization optimum, recommended by AAMI. Important for patient safety. Supporting resources: AAMI Guideline 2010 with 2012 Amendments, AORN If you need help convincing your administration, use real life examples of breaches in patient safety.

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers Causes of possible safety risks: No consistent level of staff to do the processing, e.g., MAs, LVNs, techs No well planned space, equipment, time Inadequate pre-cleaning No knowledgeable oversight, no “expert” Not following professional organizations practice recommendations

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers Causes of possible safety risks: Not following manufacturer’s written recommendations, current IFU (instructions for use). Relying on verbal instructions from sales reps. Use manufacturer’s corporate website for IFU. Resource for IFU: Pay a yearly fee.

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers AAMI recommendation that SPD staff be certified within 2 years of employment. Joint Commission has been asking this question. TJC is now trained by AAMI in HLD /sterilization and citations have gone from 10%to 40%.

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers Set up of area : Should be unidirectional from dirty to clean Transport from exam room in covered bin, moistened with wet towel or foam Full PPE (fluid resistant gown) and eyewash station available. Need heavy duty, long, cuffed, water proof gloves Need soiled receiving area, sink for washing, sink for rinsing Clean area for milking, drying and wrapping, sterilization May need plexi-glass barrier to separate clean from dirty

Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers Set up of area: Sinks large enough and deep enough (8-10 inches deep) for trays of instruments to be submerged Final rinse in “special water” e.g., RO, DI, or distilled water Range of temp and humidity degrees and % humidity Brushes are single use or if reusable, decontaminate and HLD/sterilize after each use

Lessons from the Hybrid Room Heather Hohenberger “Hybrid room” or space can be either an OR room, Diagnostic Imaging room (Interventional Radiology), Cath lab. Flexibility maximized if in OR. Area where both diagnosis AND treatment/procedure take place in same room. “All in one” room for minimally invasive procedures. No wait for OR space after diagnosis made. Especially important for critically ill patients.

Lessons from the Hybrid Room No standard definition, location, design, type of patient, staffing matrix, procedure type. Most often for cardiac, ortho, or neuro cases Different from the OR because it has diagnostic capabilities (fluoroscopy, CT, MRI or fixed angiography), a control room, special fixed bed with no metal attachments, monitors in physician’s line of site.

Lessons from the Hybrid Room Different staffing mix: Only consistent staffing is MD and anesthesia. Often has no scrub nurse, may be a variety of techs. Often product reps in room. Staff may need orientation to sterile OR procedures: Surgical attire, skin prep, draping, traffic patterns, sterile field and surgical conscience

Lessons from the Hybrid Room Possible procedures Cardiac-percutaneous valve replacements, VSD closures, cardiac rhythm device, valve repairs, lead implantation, congenital cardiac repairs Neuro/Ortho-tumor resections, aneurysm coiling, traumatic fracture of spine and pelvis

Lessons from the Hybrid Room If the hybrid room is in the OR, must use OR standards/policies. Must be adequate air exchanges to convert to open procedures if necessary. If in IR, may need additional/new policies and must use OR standards when the procedure begins.

Oral Abstracts Community Medical Center’s Approach to Reducing Joint Replacement SSI- Alison Essenmacher In , experienced a spike THR and TKR SSIs One OR room, 2 surgeons, and multiple environmental organisms identified Multidisciplinary team formed Rate to 0% during study period

Oral Abstract Community Medical Center’s Approach to Reducing Joint Replacement SSI Focused on back to the basics: Drains, faucets and aerators removed and cleaned Mandatory surgical attire Standardizing CHG prep Traffic control 100% Certification in SPD Maintaining positive air flow in all rooms Cleaning vents (bat and rat hair found) Terminal cleaning of rooms daily Lab coat covers when out of dept

Oral Abstract Reduction in C Section SSIs Through Surgical Instrument Repair- Elizabeth Stutler Original investigation focused on skin prep, antibiotic dosing, patterns of organisms. Eventually found problems with instruments, with pitting, staining and chipping. New work flow in dept had caused prolonged soaking of instruments before they went to SPD. Immediately signed a contract for repair and maintenance of instruments and outbreak stopped.

Oral Abstract Reduction in C Section SSIs Through Surgical Instrument Repair- Elizabeth Stutler Never assume you know the problem- go out and look. Validate! The answer won’t be found in a chart.