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Despite general consensus that infection control prevention is vital to the health of patients, along with the added benefit of generating significant cost savings, health care- acquired infections (HAIs) remain a problem in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), 1.7 million people acquire HAIs each year, and HAIs are attributed to 271 deaths per day. Unfortunately, one-third of HAIs are considered preventable. The estimated overall annual cost for the five major types of HAIs is $9.8 billion, and they often can prolong hospitalization and increase the rate of intensive care unit admission. Given the impact on the system and the individual patient, there is an ongoing need for education and training to standardize procedures and maintain a culture of change in facilities, including ambulatory surgery centers (ASCs). ASCs now handle more than 60 percent of surgeries annually and, therefore, have an opportunity and obligation to increase efforts to standardize skin antisepsis protocols. CMS Sets Standards for ASCs Like other health care facilities, ASCs are required to be compliant with Centers for Medicare and Medicaid Service (CMS) Demand Infection Control policy, introduced in 2009. To meet requirements, ASCs must implement and actively maintain a nationally recognized infection control protocol, such as those developed by the CDC/HICPAC (Healthcare Infection Control Practices Advisory Committee) or AORN (Association of periOperative Registered Nurses). Room for Improvement Studies have shown that a standardized infection control protocol supports quality initiatives, increases health care professional satisfaction and streamlines implementation. Major skin antisepsis guidelines, such as those provided by AORN or the Association for Professionals in Infection Control and Epidemiology (APIC), provide standardized patient preparation procedures that explain how skin preparation should remove bioburden (i.e., soil and transient microorganisms) from a patient's skin, decrease resident microorganism counts quickly while not irritating tissue, prevent regrowth and rebound of microorganisms and have a persistent effect. Also, the CDC prefers agents that provide rapid, persistent, broad-spectrum antimicrobial activity. Decreasing Variability Despite this clarity of purpose, HAIs still occur and ASCs can improve protocol compliance. For example, health care professionals should be monitored regarding the appropriate application of skin antisepsis agents according to U.S. Food and Drug Administration approved labeling. Data show that older products are often applied inconsistently. Re-training on how to apply products, new and old, as well as analyses regarding how selecting a one-step vs. two-step agent might improve application consistency and might also enhance patient care. Health care professionals must be proactively engaged to monitor adherence to guidelines, report discrepancies and teach standardized methodology, as needed. For example, CareFusion's Focus on Quality Care Program (CFQC) and Quality Assurance and Performance Improvement Program (QAPI) tool take a data-driven approach to identify sources of skin antisepsis variability. Variables assessed include glove usage, adherence to Directions for Use (DFUs) and monitoring application technique, as well as results reporting. Data-driven assessments and leadership combined with collaboration across surgical teams can lead to better outcomes and improved patient care. This article was prepared in partnership with CareFusion and Gregory Hickman, M.D., medical director and director of anesthesia at the Andrews Institute Ambulatory Surgery Center. How ASCs Can Improve Skin Antisepsis and Patient Care Through Standardization Data presented at the OR Manager Conference (September 17-19, 2014) demonstrate that current guidelines and product directions for surgical skin preparations often are not followed in practice, particularly in ASCs compared to hospitals. For this study, there were n=3176 observations tracked via CareFusion's OR Observation Tool across surgical categories (111 observations at ASCs and 3065 observations at hospitals). Adequate skin prep time used Adequate skin prep drying time used Gloves used Sterile gloves used Skin prep application method followed label directions Skin prep application beginning at surgical/incision site and out to periphery 52.7% 45.5% 49.8% 24.5% 89.1% 87.4% 75.6% 69.4% 68.5% 68% 88.3% 88.3% ■ Hospitals (n=3065) ■ ASCs (n=111) * | | | | | 0 20 40 60 80 100 PERCENT OF OBSERVATIONS *Values for ASCs and hospitals significantly different by Fisher's exact test, p < 0.0001. Due to the small sample size of ASCs, however, comparisons between them and hospitals should be considered preliminary. Overview of Skin Prep Procedure Compliance Advertorial Key Findings: • Close to 50 percent of the time, skin preparation procedures do not match recommended skin prep time and prep dry times. In the analysis, ASCs were non-compliant with skin prep dry times about 75 percent of the time. • A significant percent of the time, surgical skin prep solutions are not properly applied. Older, traditional skin prep agents available in the market for more than 30 years were least in compliance with product label directions. References available upon request