Features

Safety and Quality Improvement - Leila Welborn

OR Dashboards - Pamela Fox, M.D.

Communication in the OR - Dr. Pratibha Kane

The Best Business Books for Operating Room Leaders - Dr. Sunil Eapen

Resources for OR Scheduling - Dr. Michael Vigoda

A Lesson From the Past - Dr. Jens W. Krombach

---

Preventing SSI – OR Back to Basics Campaign - Dr. Scott Helm

In our community hospital in Geneva, IL, we have actively pursued an initiative for the past year entitled “Project Zero.” The project is supported by the Board of Directors, the hospital administration, and the Medical Executive Committee. The goal of the project has been to reduce the incidence of hospital-acquired infections by half each year, and ultimately strive to achieve an infection rate of zero over time. The specific infection types which are being targeted and tracked include C. difficile, MRSA, ventilator-associated pneumonias (VAP), and surgical site infections (SSI). To reduce C. Difficile and MRSA infections, strict isolation precautions and antibiotic stewardship requirements have been put in place throughout the hospital and enforced. In order to reduce the number of VAP’s, the IHI VAP bundle was initiated and rigorously monitored in all of our ICU’s. In order to reduce the incidence of SSI, the SCIP bundle has been followed and monitored closely in the perioperative arena. The department of anesthesia has agreed to play a major role in assuring the compliance with the SCIP bundle. In our hospital, our department’s willingness to play this role is especially important, as we have a population of surgeons which is completely decentralized: most travel to 2, 3, or 4 different hospitals in a day, and it is difficult for them to keep track of specific initiatives at each hospital. Our hospital turned to us for help with SCIP compliance and reduction of SSI because of our unique hospital-based role. To that end, a member of our department (the author) was appointed Medical Director of Perioperative Services and charged with overseeing safety and quality initiatives, including SSI reduction, within our operating rooms.

Through the SCIP initiative and Project Zero, we have seen a 40% reduction in the number of SSI’s in the first year. However, in order to maintain and reduce this rate, we wanted to add additional measures. In collaboration with OR nursing, we have begun a “Back to Basics Campaign,” aimed at protecting the sterile environment in the OR. The project outline is given below:


OR BACK TO BASICS CAMPAIGN

Goal: In collaboration with Project Zero, the operating room staff is committing to do everything in their control to bring our infection rate to zero.

Standard: There is one standard of care that all physicians and staff members need to follow to protect our patients from the potential for infection.

Accountability: All members of the team are expected to hold other OR staff or physicians accountable to the standards without repercussion.

OR ENVIRONMENT

Traffic in the OR will be limited to necessary movement. All access will be through the sub-sterile room whenever sterile supplies are open.
No jewelry will be worn in the OR with exception of a watch for the anesthesia provider. Earrings must be covered by the hat or removed.
Scrub suits that have been worn outside must be changed prior to entering the OR.

Lab coats must cover scrub suits and be buttoned when leaving the department.  Masks must be worn in any OR that has open sterile supplies and removed prior to leaving the department.  No artificial nails are allowed and nail polish must be removed if chipped.

Hand scrub must follow the manufacturer’s recommendations for efficacy.
Betadine and Hibiclens---3 minute scrub
-Triseptin (brushless)---3 minute scrub
-Avagard---3 applications, not a timed scrub
Footwear—either shoe covers or dedicated shoes to the OR
All OR personnel must “foam in” and “foam out” when entering and exiting the OR area and when going from one OR to another.

Enforcement of all of the above requirements will be by secret observers. Similar enforcement has been effective in the past on the units for hand hygiene. Hospital employees found to be in violation of these standards receives a letter from the quality department and corrective action is taken by their respective leaders. Medical staff members receive communication from the Medical Executive Committee and Operating Room Committee.

As with all quality improvement and safety initiatives, the overarching goal is not to create an environment of fear or concern among staff and physicians. The goal is to achieve high levels of compliance on these important targets and ultimately drive down our hospital’s rate of Surgical Site Infection. We feel that the initiatives we have established will assist us in reaching this goal in the unique environment of the “decentralized” community hospital.

Scott Helm, M.D., Ph.D.
Attending Anesthesiologist
Medical Director, Perioperative Services
Delnor Hospital
300 Randall Rd.
Geneva, IL 60134