ICT asked a few of the authors of the whitepaper, "Educate, Empower, Engage: A Collaborative Interdisciplinary Call-to-Action for Reducing Surgical Site Infections," to share their insights on key issues relating to HAI prevention.
Our experts are:
Richard P. Dutton of the Anesthesia Quality Institute in Park Ridge, Ill.
Steven Gordon of the Cleveland Clinic Foundation in Cleveland, Ohio
Kathleen Kohut of the NCH Healthcare System in Naples, Fla.
What are some of the breaches in proper aseptic practice that you are seeing in your respective area of expertise?
Dutton: Although anesthesia compliance with the most-established measures (antibiotics, normothermia, aseptic technique for placing lines) is very high (>95%), there is more variability in the more controversial areas: postoperative oxygen administration, control of blood sugar, and management of pain. Maintaining aseptic technique during emergency cases is also a challenge.
Kohut: Incorrect traffic patterns that place sterile set-ups at risk, poor attention to surgical attire, hair covering (or lack thereof), surgical skin prepping, and hand hygiene.
Are these breaches related to a knowledge gap, an implementation gap, or both?
Dutton: Mostly due to an implementation gap. We need easy and passive technologies to help us do the right thing.
Kohut: Both, knowledge must be assessed because people may have learned from many different sources which may or may not have been reliable. Some practices simply evolve over time as part of the culture of the facility. Objective review of processes from time to time can assist in modifying bad habits. Some practices are simply limitations of the physical plant itself with poor architectural design i.e. rooms that are too small, door placement, etc.
What can infection preventionists do very specifically within the E3 strategy to help practitioners overcome the barriers cited in the whitepaper and improve outcomes related to SSI prevention?
Dutton: Educate, provide feedback with data on outcomes, help to design passive systems and strategies to lower risk.
Kohut: Objective observation of work flow and processes to assess opportunities. Bring multidisciplinary work teams together to problem solve and team build. Provide concrete and timely data to the bedside workers to motivate and validate practices, opportunities, and accomplishments.
Gordon: Stay engaged and positive and lead by example. Communication, communication, communication.
How can practitioners secure administrator/hospital leadership/ department manager buy-in for the E3 concept in order to get the resources, staff, tools and tools they need to fight infections?
Dutton: Data, data, data. Information linking the occurrence of SSI to increased expenditures is especially important to help us make the case for investment in preventative technology and education.
Kohut: Formulate process improvements teams with senior administrative representatives. While going through the process, they begin to understand the synergy, workflow, and challenges of the environment that impacts the patients and the efficiency of care.
Gordon: Use epidemiologic principals (intervention and metrics) to document improvement; keeping patients first is the right thing to do; communication (with patients and between providers) is key.