Agenda
For
Surgical Site Infection Prevention Collaborative Meeting
Meeting Date: / Tuesday, April 7th 2009 / Leaders: / Stephanie Randa and Dr. Addison May / Facilitator: / Susie Leming-Lee & Mary Kay MatthysTime: / 3:00 P.M. to
4:00 P.M. / Attendance: / Rob Atkinson
Susan Cortez
Mary Duvanich
Nancye Feistritzer
Nicole Herndon
Dr. Addison May
Susie Leming-Lee
Barbara Martin
Mary Kay Matthys / Brian Nelsen
Donna Nolan
Mary Peterson
Julie Poulsen
Sandy Smith
Dr. LeAnn Stokes
Project: / Surgical Site Infection Prevention Collaborative
Location: / The Cigarran Conference Room 4212 MCE. / Guest/s:
Dr. Ginger Holt
Cindy Brown or designee, and Mike Hughes
Note: Record additional attendance on opposite side
Objective(s) of the meeting
1. / To discuss OR Traffic2. / To review Flashing of Instrument Report
3. / To review Monthly Infection Control Data Report
4. / To review Standardization of Process to Reduce Surgical Site Infections
5. / To determine Next Steps
Time / Who / Topic / Summary or conclusions, decisions, assignments, and next steps /
I. INTRODUCTIONS
2 mins / Dr. May/Group / A. Introduction of Guest or New Members / Discussion:Round Robin introductions were requested by Dr. May. This was done.
Conclusion/Action Steps:
No further action required.
2 mins / Dr. Addison May / B. Reason for Today’s Meeting / The hope of these meetings is to reduce infections in our adult side hospital, then pass along any successes to other locations. We would also like to take from their successes.
II. NEW BUSINESS
15 mins / Dr. Ginger Holt / 1. OR Traffic Report & Discussion / Discussion:
Dr. Holt was a guest speaker on observations and problems with too much OR traffic.
She gave a small history of the Orthopedic Department growing pains and how it related to the OR traffic. She explained that they began to notice that OR rooms with less flow in and out had a lesser rate of infection. She attributed this to:
• Techs, nurses, and doctors going in and out of the room for various reasons.
• OR door opening and closing too many times, bringing in different air flow from hallway (causing changes in air pressure, dust flow and bacteria).
• No educational procedures to alert people to the problems this causes (skin shed; addition of more bacteria in room, etc.).
She noted that they tried various procedures to keep traffic flow down but nothing seemed to work. She provided a hand out containing literature dating back to 1965 discussing change of controlled air flow helped to reduce infection. Therefore reducing the number of people in the OR, we reduce the amount of skin shed and the amount of additional bacteria. Limiting the traffic in the OR should be an easy thing to do. Literature supports re-education of people regarding this issue.
Possible Solutions:
• Phone into the OR instead of walk in.
• Tape up one of the doors to keep traffic down.
• Re-educate people to the culture of limiting traffic.
Dr. May asked if Dr. Holt had corresponding infection rates since their move. Dr. Holt answered that this year’s rates are not available yet.
The question was raised to Dr. Holt of who are the majority of people coming in and out that she has observed. She answered that the worst traffic came from anesthesia (techs, CRNAs, etc.) in her area. She thinks the traffic has always been there but she just never noticed. Dr. May stated that he felt comfortable saying that all attendees here today would be 100% on board with everything Dr. Holt says, but what is the best way to effect a change? He noted that re-education rarely effects a long term change in behavior. He is looking for solutions other than re-education, which is very labor intensive. Ms. Mary Peterson wondered if an audit of in/out would help. Ms. Leming-Lee mentioned that an audit had been done before. Ms. Nancy Feistritzer suggested that this group define the criteria by which someone can enter an operating room and put it in a policy. It would be a global enough policy for all types of surgery. Dr. May requested that Dr. Holt come up with a list of standardized practices to limit the OR traffic, based on all her literature review. He felt that it should be signed off by the Department of Anesthesia to police their own people. Dr. Holt added that it should be a broad enough policy to cover all ORs. Dr. May thought if a list is put out that actually effects a change for a local group, that information could be sent to the PODS. It would be best to have a tool that works really well for “x” group, the PODs can take it and go from there. Ms. Feistritzer explained that since they are in the process of designing the Case Cart system for the Critical Care tower, it would be very helpful to have a base set of standards that is recommended by this group, taken forward to the appropriate key stake holders. That in turn would drive a whole set of system decisions that need to be made now during the designing of the Case Cart system. Dr. Holt said that once their case cart entered the room, there would be very little reason to leave the room, but that understands that isn’t the case for all surgeries. Dr. May asked if there will be an intercom system in the new Surgical Tower? It was noted that Anesthesia has the Vigilant system, and they should be challenged to find a way to use that instead of going in and out.
Conclusion/Action Steps:
A. Dr. Holt will design a draft set of standards for entering the OR of what works for them.
This draft will be dispersed to the PODs.
This draft will do the following:
1. Provide the support of saying “this is what needs to happen.”
2. Provide educational support and then push it up through Perioperative Executive Committee
3. Push it out through the whole Perioperative structure.
B. Ms. Leming-Lee will send the Cardiac Infection Prevention Standards to Dr. Holt.
C. Dr. Holt will do the draft criteria within the next 2 weeks. She will send it to Dr. May and Ms. Leming-Lee. They will send it to certain others for their input. This draft will then be sent to the PODs.
15 mins / Mike Hughes / 2. Flashing of Instrument Report / Discussion:
Mr. Mike Hughes gave a brief overview of flashing. He explained that the reduction of flash sterilization rates of instruments is a CDC guideline in reduction of surgical site infections. This is for 2 reasons: Does flashing clean at the same level as the autoclave; and how is it then transported to the OR? There are too many variables with this.
His department was asked to complete the form in the handout to test some of his department’s processes of change. They had 2 goals in doing this:
1. 1. His department is trying to look at their instrument inventory and decide what they need more of to increase the circulating volume of instruments and prevent flashing. Censitrac was used to track the instruments. This gave them a list of “high turn” items (items that there are limited numbers of), or do they need more of the “major instrument trays” that are used by everyone. One thing discovered through this is that they did not have enough minor basic trays and tracheotomy trays.
2. 2. To increase the staff, nurse, and surgeon knowledge on the appropriate use of flash sterilization. He explained that Mr. Kevin Allen has taken point on that. Steps in this process include re-educating the staff on who should be running the autoclaves in the ORs. It is difficult to have competency with such a large staff. They are working on getting it down to a core staff of ORTAs and managers that know how to run the autoclaves correctly. This is an ongoing educational process, as is the instrument inventory. As new doctors are added, new or greater inventory is required.
Dr. May asked Mr. Hughes if there is an industry standard for flashing percent. He stated that there was not. Ms. Feistritzer wanted to add that she received an e-mail from UHC list serve stating that they are in the process of initiating a benchmark between UHC facilities to determine this rate. She suggested they participate. She stated it gave a fairly detailed analysis of why and under what circumstances flashing should be used. She also said that given the data available, it should be a fairly easy to populate, and by participate you receive every other participant’s data and your relative standing within that. She will forward the information to Mr. Hughes and copy Ms. Leming-Lee.
The last piece of information Mr. Hughes felt was highly important, was the record keeping. They were originally hand counting on an Excel spread sheet, and were supposed to move to Connect-Assure 2 (CA2) last October, which didn’t happen. It did go live in the main OR February 09. The handout reflects “live” scanned data using this program, which can be used for actual comparisons between ortho and cardiac. “Buy” decisions can be made from this data. Their goal is to get this software in use in the other PODs, but it was felt that since most autoclaving was done in the main OR, they would stay there. Ms. Feistritzer asked Mr. Hughes when they plan to have Connect-Assure available across the house. It was her understanding that since there are autoclaves
in all areas, the standard was that we were moving to it everywhere. He explained that the other areas have been wired; it is now a decision to spend the money and pay for the hardware. He noted that the hardware was fairly inexpensive, and based on the early information; this is a very positive form of documentation and should be implemented fairly quickly in his opinion.
Dr. May asked how to help move this forward? He offered to have this information reported “up” to the Perioperative Leadership Committee. It was also be reported at the next IT Operations Committee Meeting.
Conclusion/Action Steps:
1. With the above steps in place, the percent of flashed instruments have been reduced by approximately 20%. These steps need to be ongoing to continue to decrease flashing.
2. Participate in the UHC flashing benchmark study.
3. Make Connect-Assure available to all ORs. Dr. May and Ms. Feistritzer will help to push this forward through IT and Perioperative Leadership.
5 mins / Vicki Brinsko/ Tom Talbot / 3. Monthly Hospital Infection Control Data Report / Discussion:
No one from the group was present to report at this meeting.
Conclusion/Action Steps:
No further action required
3 mins / Dr. May / 4. SSIPC Activities Update Report to the Perioperative Enterprise Committee / Discussion:
Dr. May wanted to note that he is always unable to attend because of a meeting conflict overlap with another meeting he attends. He wanted an approximation of how often this meeting needs to be reported up, so he could make plans. Ms. Feistritzer thought quarterly would be sufficient, or as new initiatives evolve. For example, the Traffic Control should be added to the agenda in May.
Conclusion/Action Steps:
The group will try to facilitate to Dr. May’s schedule when he is presenting.
III. OLD BUSINESS
1. Initiative Directed Toward SCIP Elements Compliance
5 mins / Dr. May / a. Standardization of Surgical Skin Prep Across Pods
1) Email Notification Process Example / Discussion:
At the last meeting, a question was raised as to what is the most effective way to communicate to the POD leadership and receive action on that e-mail. People are not responding to the e-mails. Ms. Leming-Lee came up with a mechanism by which you can check whether or not there is a response. They received 1 response this way, and are still looking for a better way to receive responses. Ms. Feistritzer suggested giving the form to the POD manager to fill out and bring back.
[An example of the sample draft e-mail notification process is included in the handout.] Children’s does not plan to standardize prep at this time due to wide age variation..
Conclusion/Action Steps:
Each POD will choose one primary and one secondary prep. The POD nurse leader will e-mail their thoughts and verbiage to Dr. May or Ms. Leming-Lee.
5 mins / Cindy Garcia/Audrey Kuntz / b. OR Attire Policy: Reinforcement of Policy Update and Use of Visual Controls (Signs, Posters, etc)
5 mins / c. Standardization of Sterile Procedure Hand Scrub Protocol
Audrey Kuntz / 1. Number of Staff, Nurses, Physicians Completed Module / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred to the next meeting.
Cindy Garcia/Audrey Kuntz / 2. Hand Scrub Auditing Tool / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred to the next meeting.
Audrey Kuntz and Cindy Garcia / 3. Send Sterile Procedure Hand Scrub Protocol to the Clinic for Distribution / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred to the next meeting.
5 mins / Cindy Brown / d. Colorectal Initiative Update / Discussion:
Ms. Leming-Lee reported that Ms. Cindy Brown sent an update. They are moving ahead to develop a check list similar to the cardiac check list. She will attend next meeting to present it.
Action/Conclusion:
The check list will be presented at the next meeting.
IV. ON GOING INITIATIVES
3 mins / Dr. May / 1. Infection Control Database Update / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred to the next meeting.
2 mins / Dr. May / 2. VPIMS Reports Update / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred until the next meeting.
2 mins / Stephanie Randa / 3. Aseptic Technique Training: Back To Basics Update (Started in October 2008) / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred until the next meeting.
3 mins / Stephanie Randa and Dr. May / 4. Prep ( Intraoperative) Standardization Update / Discussion:
Conclusion/Action Steps:
No further action required
2 mins / Dr. May / 5. SSIPC and Acute Operative Services, EGS, Trauma Collaboration-Follow-up: Standardization of Practice to Prevent Surgical Infections Issues / Discussion:
Dr. May wanted to note that it has been difficult to move forward with an arm of the EGS trauma initiative because they do not have a lot of scheduled in-house cases. One of the solutions the nurses tried to come up with was using a MAR (medical administration record) to pass off the medication. The result was that they found that unless the medication has been previously documented as given, it will not show up on a MAR. Therefore any order for a NOW pre-op, there is no method that exists in the hospital at present to do that. This was discussed with the IT people a month ago, but has not been solved. There is a similar mistake on the pre-op check list. It talks about what antibiotics they are currently getting. There is no section for any new orders or
medications, etc. Dr. May wants to make sure that this problem stays on the high priority list with the IT people. The surgeons would like to be able to put in a standard order set. Currently they have to send it with the patient. Currently, there is no consistent way to come up with an order set that hits all patients. It was noted there is a disconnect between all the medication administration electronic systems. PACU and Holding need to be integrated at the very least. Dr. May asked what is the most effective fix?
Conclusion/Action Steps:
Ms. Feistritzer will take to the Perioperative Informatics team on Monday for an answer.
3 mins / Stephanie Randa / 6. UTI Initiative- Catheter Associated Urinary Track Infection / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred to the next meeting.
3 mins / Stephanie Randa / 7. Criteria for Silverlon Dressing / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred until the next meeting.
5 mins / Barbara Martin / 9. SCIP Data Report / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred until the next meeting.
3 mins / Barbara Martin / 10. Out Patient Surgical Procedure Report ( new report to start February 3rd 2008) / Discussion:
There was no discussion.
Action/Conclusion:
This report was deferred until the next meeting.
3 mins / Dr. May /
V. NEXT STEPS
Next Meeting