cedures, which are especially prone to surgical site infections.
Theresa Johnson, RN, formerly the orthopedic coordinator at the
Texas Children's Hospital in Houston, helped develop a protocol that
reduced the hospital's spine SSI rate from 6.3% to 1.5%. The key ele-
ments included scrubbing the surgical site first with Betadine, then
with ChloraPrep, and letting it dry for at least 3 minutes. With a goal
of standardizing prophylactic dosing time, Ms. Johnson determined
that the ideal time to begin administering antibiotics was when the
patient was flipped into the prone position. "It worked out well," says
Ms. Johnson, now the pediatric coordinator at the Woman's Hospital
of Texas in Houston, "because the time between the flip and the first
incision was typically between 30 and 45 minutes." Limiting traffic in
and out of the room during surgery was also a priority, helped by
signs on the door that said "Spine in progress." The final steps were
irrigating the surgical site, first with saline, then with a 50% dilution of
Betadine for 3 minutes, and sprinkling 2 grams of vancomycin powder
onto the soft tissue. OSM
E-mail jburger@outpatientsurgery.net.
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