APIC 2013 Ft Lauderdale FL

1. APIC 2013Ft Lauderdale FL Surgical Site Infections Sterile Processing

2. Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical CentersJody Church/Martha Young • Centralization optimum, recommended by AAMI. Important for patient safety. • Supporting resources: AAMI Guideline 2010 with 2012 Amendments, AORN 2013. • If you need help convincing your administration, use real life examples of breaches in patient safety.

3. Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers • Causes of possible safety risks: • No consistent level of staff to do the processing, e.g., MAs, LVNs, techs • No well planned space, equipment, time • Inadequate pre-cleaning • No knowledgeable oversight, no “expert” • Not following professional organizations practice recommendations

4. Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers • Causes of possible safety risks: • Not following manufacturer’s written recommendations, current IFU (instructions for use). • Relying on verbal instructions from sales reps. Use manufacturer’s corporate website for IFU. • Resource for IFU: www.onesourcedocs.com. Pay a yearly fee.

5. Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers • AAMI recommendation that SPD staff be certified within 2 years of employment. Joint Commission has been asking this question. • TJC is now trained by AAMI in HLD /sterilization and citations have gone from 10%to 40%.

6. Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers • Set up of area : • Should be unidirectional from dirty to clean • Transport from exam room in covered bin, moistened with wet towel or foam • Full PPE (fluid resistant gown) and eyewash station available. Need heavy duty, long, cuffed, water proof gloves • Need soiled receiving area, sink for washing, sink for rinsing • Clean area for milking, drying and wrapping, sterilization • May need plexi-glass barrier to separate clean from dirty

7. Resources for Safe Sterile Processing in Ambulatory Health Centers and Ambulatory Surgical Centers • Set up of area: • Sinks large enough and deep enough (8-10 inches deep) for trays of instruments to be submerged • Final rinse in “special water” e.g., RO, DI, or distilled water • Range of temp and humidity 68-73 degrees and 30-60 % humidity • Brushes are single use or if reusable, decontaminate and HLD/sterilize after each use

8. Lessons from the Hybrid RoomHeather Hohenberger • “Hybrid room” or space can be either an OR room, Diagnostic Imaging room (Interventional Radiology), Cath lab. • Flexibility maximized if in OR. • Area where both diagnosis AND treatment/procedure take place in same room. • “All in one” room for minimally invasive procedures. • No wait for OR space after diagnosis made. • Especially important for critically ill patients.

9. Lessons from the Hybrid Room • No standard definition, location, design, type of patient, staffing matrix, procedure type. • Most often for cardiac, ortho, or neuro cases • Different from the OR because it has diagnostic capabilities (fluoroscopy, CT, MRI or fixed angiography), a control room, special fixed bed with no metal attachments, monitors in physician’s line of site.

10. Lessons from the Hybrid Room • Different staffing mix: • Only consistent staffing is MD and anesthesia. • Often has no scrub nurse, may be a variety of techs. • Often product reps in room. • Staff may need orientation to sterile OR procedures: • Surgical attire, skin prep, draping, traffic patterns, sterile field and surgical conscience

11. Lessons from the Hybrid Room • Possible procedures • Cardiac-percutaneous valve replacements, VSD closures, cardiac rhythm device, valve repairs, lead implantation, congenital cardiac repairs • Neuro/Ortho-tumor resections, aneurysm coiling, traumatic fracture of spine and pelvis

12. Lessons from the Hybrid Room • If the hybrid room is in the OR, must use OR standards/policies. • Must be adequate air exchanges to convert to open procedures if necessary. • If in IR, may need additional/new policies and must use OR standards when the procedure begins.

13. Oral Abstracts Community Medical Center’s Approach to Reducing Joint Replacement SSI- Alison Essenmacher • In 2008-2009, experienced a spike THR and TKR SSIs • One OR room, 2 surgeons , and multiple environmental organisms identified • Multidisciplinary team formed • Rate to 0% during study period

14. Oral Abstract Community Medical Center’s Approach to Reducing Joint Replacement SSI • Focused on back to the basics: • Drains, faucets and aerators removed and cleaned • Mandatory surgical attire • Standardizing CHG prep • Traffic control • 100% Certification in SPD • Maintaining positive air flow in all rooms • Cleaning vents (bat and rat hair found) • Terminal cleaning of rooms daily • Lab coat covers when out of dept

15. Oral Abstract Reduction in C Section SSIs Through Surgical Instrument Repair- Elizabeth Stutler • Original investigation focused on skin prep, antibiotic dosing, patterns of organisms. • Eventually found problems with instruments, with pitting, staining and chipping. New work flow in dept had caused prolonged soaking of instruments before they went to SPD. • Immediately signed a contract for repair and maintenance of instruments and outbreak stopped.

16. Oral Abstract • Reduction in C Section SSIs Through Surgical Instrument Repair- Elizabeth Stutler Never assume you know the problem- go out and look. Validate! The answer won’t be found in a chart.