Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/124399
S U R G I C A L S K I N A N T I S E P S I S thesia providers, present the findings of involved from the beginning on any to introduce completely new products; it your literature review and identify which process improvement project. was a matter of reinforcing best practices for the ones we already had in stock. prepping products will be used moving for- It also helped that our cardiac surgeons ward. Focus on the evidence that supports were already using the CHG/alcohol prod- Consider creating a poster that charts the agents that are most effective for the uct and that the neurosurgeons were using the evidence about effectiveness for each procedures you host, notify the surgical the iodine/alcohol product. We didn't have of the prepping agents, including those no team that surgeon preference cards will be AT-HOME PREPPING adjusted and remove all non-approved 3 Tips for Reinforcing CHG Wipe Use products from the ORs and supply inventory. Share the same information at a followup operative staff meeting, and post a summary of the findings on a prominent bulletin board (or email a copy to the staff). Stress to your nurses that the infection control department (or your infection preventionist) backs the change to the prepping regimen, and that the surgeons had agreed on the standardized products. Standardized prepping practices will empower nurses, who won't be afraid to suggest the appropriate product when it's called for. They'll reminded surgeons in the ORs, "Hey, CHG would be best for this patient, based on the literature and the procedure. We're going to use that, OK?" If another one of your preps is more appropriate, they can suggest its use. This soft- 1 9 SUPPLEMENT TO FORMULA ONE Stanford's infection control leaders, surgeons and nurses were able to agree on single-use CHG/alcohol products as their preferred choice. sell approach won't be confrontational if everyone is on board with the effort to standardize your preps. 2. Reinforce compliance CHG/alcohol single-use products became our first product choice (due to their longlasting properties), iodine/alcohol singleuse second, and traditional povidoneiodine paint-and-scrub third. When all the noncompliant products were removed, there wasn't much complaining, likely because the surgeons had helped initiate the change — it's really key that they be O U T PAT I E N T S U R G E R Y M A G A Z I N E | M AY 2013 A s part of our change in surgical skin up to surgery, and that they should not use prepping, we also began giving all them above the neck or on any exposed patients chlorhexidine-gluconate- membranes (female genitalia, for example). impregnated wipes to use at home before the 2. Don't use the 4% product for patients day of surgery. Current literature doesn't yet who aren't high-risk. We started giving those show efficacy specific to these wipes, but we to patients, then discovered that doing so know that CHG has lasting effectiveness, and required a physician order. So we dropped it can't hurt. Here are some tips for integrat- back to the 2% formulation, which the nurses ing take-home CHG wipes into your skin prep- could hand out without orders or complication. We use the 4% only for select cases. ping protocols. 3. Add the issuing and use of CHG wipes to 1. Ensure that surgeons educate patients the nursing documentation. On the surgical in the pre-op clinic about the importance of day, pre-op nurses should ask patients, "Did using the wipes you use this product twice before you came once a day in to the hospital?" Infection control administra- the 2 tors can then track compliance and whether days usage correlates to SSI rates. — Sharon L. Butler, MSN, RN leading M AY 2013 | S U P P L E M E N T TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 2 0