Missoula Bone & Joint received an honorable mention for OR Excellence in Outpatient Surgery. The article was published in the Outpatient Surgery Magazine’s September Issue. At Missoula Bone & Joint Surgery Center we pride ourselves on proactive protocols and practices that greatly minimize surgical site infections in our patient population. We are an orthopedic specialty ambulatory surgery center that has doubled our capacity and added total joint replacement and spine surgery to our scope of services since January 2020. We have notched up our diligence even more to prevent SSIs using many evidence based approaches to reduce risk. As a result, our rates of infection remain continuously extremely low.
The Protocols to Keep Infection Risk Low
First, we have implemented protocols for our higher risk patients who receive spine or total joint surgery to attend a comprehensive class offered by our Total Joint Coordinator. In the education provided, these patients are instructed to shower using a 4% chlorhexidine soap the night before, and morning of surgery. Also preoperatively, these patients are screened for MRSA and MSSA. Any positive results are treated with an antibiotic ointment nasal decolonization protocol and the addition of IV vancomycin pre-operatively. On day of surgery, all total joint and spine patients receive a rinse free head to toe pre-prep with 2% chlorhexidine gluconate disposable cloths for long lasting antimicrobial protection.
The Sterile Processing
The second area of continuous improvements in the fight against SSIs has occurred in our sterile processing department. Beginning in 2019, our CSTs performed a gap analysis on IUSS (Immediate Use Steam Sterilization), what it is, and why we should reduce the amount of times it was being done. After performing the gap analysis and realizing we were using IUSS too frequently, we set up a statistical graph to show the actual amount of usages per month. By acquiring more instrumentation and adding a designated sterile processing technician position, we were able to greatly reduce our IUSS rate to below 3% and keep it there. We also converted our instrument sets to rigid containers to reduce the use of blue wrap and the associated risk of holes in sterile wrap that could go unnoticed.
Routine Swab Testing to Keep Sterile Environment
Thirdly, we have heightened environmental cleaning surveillance throughout our facility, especially in our ORs, using a device that detects the presence of ATP (adenosine triphosphate), which is indicative of live bacteria. By swabbing high touch surfaces, we are able to monitor trends and adjust cleaning and disinfection practices. Our OR Supervisor met with our housekeeping staff to ensure terminal cleaning standards are being met on a daily basis. From our swab testing of high touch surfaces, opportunities for more thorough cleaning are shared with our OR and housekeeping staff. An example of an improvement we made using these results was the purchase of keyboard covers for the ORs to allow for easier disinfection of keyboard surfaces that were previously failing the cleanliness threshold.
Finally, we perform secret Hand Hygiene audits monthly using an observation method to verify compliance and share results. The audits include observations of our whole team, staff, surgeons, and anesthesiologists who care for our patients.
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Article written by Kelly O’Brien, Clinical Director MBJ ASC