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H A N D H Y G I E N E operative infections, and we SSI SOLUTION At a larger facility with a larger weren't sure why. It was clear The Importance of Discharge Details staff, such a team might include we believe the majority of the problem existed — that an administrator, managers or tom of this issue, so in more detailed directions for post-op care might be the representatives from periopera- December we decided to imple- solution to the rash of surgical site infections we'd seen tive and central sterile depart- among cosmetic surgery patients. ments, infection preventionists, ment an infection control quality study that focused on several potential risk factors, one of TOTAL PACKAGE Make sure your post-op instructions are detailed and complete. An attractive presentation doesn't hurt, either. them being hand hygiene. Marysville Ohio Surgery Center that we needed to get to the bot- Our patients were being sent home with only 1 post-op bra, and were not told how to care for it. It's entirely possible that they were wearing the same post-op garment all risk managers, housekeepers and others. Our quality improvement team cause of the infections bedevil- D week without washing it. So we began sending patients began meeting to brainstorm the home with 2 bras instead of 1. We set out to discover the possible causes of our infection uring the course of our hand hygiene quality In addition to educating our staff on hand hygiene, we improvement study, we pulled the sterilization also emphasized the importance of it to patients and their effect. We started by focusing records for the instruments used in cases that significant others. We demonstrated how to sanitize the on the issue right at our finger- resulted in surgical site infections during cosmetic proce- hands before changing their dressings or making other tips, one that played a part in in this effort, though. dures. We examined our aseptic technique inside the OR. contact with the surgical site. Patients were also instruct- every instance of nurse-to- Intriguingly, the pattern of infec- Our circulator ensured there was no contamination to the ed to refrain from sexual intercourse until after their fol- patient contact: basic hand tions we were tracking was surgical field. Our surgeons began using only antimicrobial low-up appointments. We sent patients home with bottles hygiene. occurring in the same type of suture and steri-strips for closing. Our OR staff were of hand sanitizer and non-latex gloves. patients every month: just required to wear only the surgical scrubs that we provid- among our cosmetic surgery ed, and only inside the surgery center. In order to maintain instructions, and added some upscale aesthetic appeal to patients. Our ultimate aim was properly timed antibiotic administration (within 1 hour of the discharge experience by putting the supplies and to entirely eliminate surgical site surgical incision), the circulator started IV antibiotics instructions into a glossy bag from their plastic surgeon infections in these cases. immediately before taking the patient back to the OR. that makes it look like they've been shopping. ing our post-op patients in order to minimize the infection rate among that population. We weren't without a starting point 3 Form a QI team Then we took a closer look at the post-op instructions Our facility is a small improvement team consisted of Tom, our SUPPLEMENT TO —Thomas Harris, BSN, and Christy Schofield, RN, BSN Implement a program of hand hygiene edu- cation for all staff members as a see among your patients, but also perhaps in response to administrator; Christy, our quality improvement RN; and clinical nurse man- observed issues in compliance ager Charlene Schuler, RN, BSN, who handles our monthly infection control report. 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 3 Watch and learn result of the infection rates you given to patients at discharge. As it turns out, this is where one, so our quality 5 We wrote all of these changes into our discharge issues and to put a plan into M AY 2013 | S U P P L E M E N T with proper practices. TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 6