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Group G: Prevent infection NPSG.07.05.01

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joana silva

on 29 April 2016

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Transcript of Group G: Prevent infection NPSG.07.05.01

Preoperative
What are Surgical Site Infection (SSI)?
What are National Patient safety goals?
13. Preoperative/post-operative order sets are developed/ revised to match SSI evidence-based practices (EBP) (such as NPSG.07.05.01 and SCIP measures)
Intraoperative
Post-operative
1. support of SSI reduction by top level leadership
2. Resources are dedicated to decrease SSI rates
3. Financial incentives for practitioners to reduce SSI
4. Practitioners accept and /or take accountability/reposibility
5. Highly engaged physicians are champions to reduce SSIs in their service(s)
6. Anesthesia practitioners provide prophylactic antibiotics
7. Use of multidisciplinary team(s)
8. Use of performance improvement tools
9. Use of benchmarking/comparison of SSI rates
10. Use of information technologies (IT)
11. Aligned and coordinated SSI education of staff and licensed independent practitioners
12. Participation in an SSI-focused collaborative (e.g., SCIP, IHI)
13. Preoperative/post-operative order sets are developed/ revised to match SSI evidence-based practices (EBP) (such as NPSG.07.05.01 and SCIP measures)
14. Decreasing operating room (OR) traffic
15. Direct observation of evidence-based practices (EBP) in OR by IC staff (M.D. or R.N.)
16. Using chlorhexadine for preoperative baths
17. Daily SSI vigilance
18. One-to-one education of physicians when an SSI issue is identified
19. Post discharge surveillance of SSIs are reported to a hospital committee
20. Focus on implementing evidence-based practices (EBP) in the hospital
21. Acting on identified SSI issues
22. Support of migration of SSI evidence-based practice from one medical servise to another
23. Use of specific SSI-focused processes for patient education
Nursing Responsibility

16. Using chlorhexidine for preoperative baths
•Prophylactic antibiotic received with in 1 hour of incision
St. Jude & St. Joseph: Exception IVPB Vancomycin given within 120min of implantation's or high risk infection

•Prophylactic antibiotics discontinued within 24 hours after surgery end time (48 hours for cardiac patients)

•Antibiotic doses are administered by anesthesiologists in OR hold





•Discontinue of all antibiotics within 24 hours post-op, 48 hrs for cardiac
•Normothermia immediately post-op
In 2001, a published study reported that colorectal surgery patients who had either local or systemic warming during surgery had SSI rates more than 50% lower than those who had none.
http://www.nursingcenter.com/lnc/journalarticle?Article_ID=610072
•Foley catheter removal by the end of post op day 2, unless otherwise indicated (only trained healthcare professionals should insert urinary catheters by using aseptic technique and sterile equipment)
•Documentation of all insertion and removal dates is required in every patients chart
Fountain Valley Regional


7. Use of multidisciplinary team
Fast Fact: Strategies that work

Education: Discharge instructions
Only authorized personnel may enter the OR and PACU.
Personnel shall change into operating room attire in the locker rooms prior to entering the semi-restricted and restricted areas.
The operating rooms are limited to those personnel caring for the patient in that room.
Only supplies that are removed from external shipping cartons are transferred to the OR storage areas.
14. Decreasing operating room (OR) traffic
The CDC recommends educating patients to shower or bathe with an antiseptic agent the night before or morning of surgery.
The patient shall shower, shampoo or wash the surgical site area with an antiseptic agent the night before the procedure, if able.
Fountain Valley-prep within 12 hours with 2% Chlorhexidine Gluconate cloths
The surgical team may wash the surgical area, prior to prepping the skin with an antiseptic agent.
An antimicrobial agent with a broad-spectrum germicide action shall be used for the surgical prep.
St. Jude & Joseph-iodine-based products are acceptable use as antiseptics
Other Instruction:

·Proper hand hygiene should be done immediately before an after any surgical procedure.

·Fingernails must not exceed 1/4 inch beyond the fingertip.

·Cuticles, hands, and forearms must be free of jewelry, open lesions or breaks in skin integrity.

·Fingernail polish must be free of chips and cracks.
West Anaheim-nail polish no older than 4 days

·Use of artificial nails is NOT acceptable for personnel in the operating room
TEAM WORK
Prevention of SSI’s by appropriate interventions,
collaboration
, and through follow up decreased hospital money spent happy hospital and happy patients!!!!

According to an evidence-based study conducted by the Association for Molecular Pathology (AMP) "The administration of antibiotics prior to surgery is commonplace and of proven benefit in many circumstances to minimize postoperative SSIs"
http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/savino.pdf
A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. It usually causing readmission within 30 days of the original surgical procedure.
The ultimate goal is to optimize care while minimizing costs:
•If on beta blocker at home, given with in 24 hrs.

•Quit smoking for at least 30 days before procedure

•Controlled glucose level- serum level <200 mg per dL

•Hair removal: NO RAZORS only clips
Los Alamitos-exception of neuro trauma and scrotal can use razors and is perform
only
by operating room personnel
West Anaheim Medical Center-remove only in holding area
•Notify doctor if you have any signs and symptoms of infection
the surgical area hurt more than expected and is red
cloudy fluid drain from your surgery site
have a fever
•Make sure that everyone who touches you washes their hands with soap and water or alcohol based hand rub
•Family and visitors should not visit if sick
•No visitor should touch your surgery


use sticker for
ALL foley patient
to document need,
or telephone
order. MUST include
reason for continuing
Antisepsis for the Operative Personnel:
According to the Joint Commission, approximately 500,000 SSIs occur every year with significant morbidity and mortality for patients and up to $7 billion annually in health care costs. Patients with an SSI have a two-to-11-fold increased risk of death. On average 2.7 percent of surgeries result in SSIs. SSIs create an increased length of stay, a reduced quality of life and death. It is estimated that 40-60 percent of SSIs are preventable. The Joint Commission has published a National Patient Safety Goals (NPSGs) that focus on HAIs, including: surgical site infections (SSIs).

http://www.jointcommission.org/assets/1/18/Implementation_Guide_for_NPSG_SSI.pdf
The Joint Commission’s Implementation Guide for NPSG.07.05.01
1. Support of SSI reduction by top level leadership
leadership effective practices
practitioner-focused practice
process improvement practice

2. Administrative support
dedicated resources to decrease SSI rates

3. Financial incentives provided

4. Nursing
rewards and recognition for staff

Leadership effective practices

National Patient Safety Goals are used to improve patient safety. The goals focus on problems in health care safety and how to solve them.
According to an article in the Nursing Management April 2006, "Chlorhexidine has been shown to reduce bacterial colony counts nine fold compared to povidone-iodine which reduce bacterial colony counts of 1.3 fold"
http://ezproxy.cyclib.nocccd.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=20430312&login.asp&site=ehost-live&scope=site
References

p46-52. Academic Search Premier. Retrieved February 22, 2015, from http://ezproxy.cyclib.nocccd.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=20430312&login.asp&site=ehost-live&scope=site
NPSG.07.05.01 on Surgical Site Infections. Retrieved February 22, 2015, from http://www.jointcommission.org/assets/1/18 implementation_Guide_for_NPSG_SSI.pdf

The Joint Commission (2013) The Joint’s Commission Implementation Guide for
Segal, C.G. (2006). Infection control: Start with skin.
Nursing Management, Vol. 37 Issue 4,

(2015). Implementation of an Evidence-based Protocol for Surgical Infection Prophylaxis. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/savino.pdf

Savino, J., Smeland, J., Flink, E., Ruperto, A., Hines, A., Sullivan, T., Risucci, D.
Nursing Management, Vol, 36 Issue 11, p20-26. Retrieved February 22, 2015, from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=610072
Griffin, F.S. (2005). Best practice protocols: Preventing surgical site infection.
Prevent infection NPSG.07.05.01

Joana S. Silva
Ashley N. Sousa
Christine H. Lee
Allen Ripors
Janice M. Osborne
Anh N. Tran


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