places them on a table in the corner of the room. They then re-drape
the patient and re-gown and re-glove themselves before opening a
new set of sterile closing instruments. The extra precautions decrease
the likelihood of contaminating the surgical wound with bacteria after
it's been flushed with saline in preparation for closing.
• Wound protection. Surgeons apply a wound protector around the
surgical site. The device, which is available in a number of sizes, main-
tains moisture at the incision site to promote healing and shields the
wound from exposure to bacteria.
• Gum chewing. Patients are encouraged to bring packs of their
favorite gum on the day of surgery because chewing gum after
abdominal surgery helps kickstart the digestive system, which
increases blood flow to the intestines and throughout the rest of the
body. Ms. Burwell says there's no direct link between gum chewing
and reduced risk of SSIs, but she points out that increasing blood flow
does speed recovery and promote wound healing.
Total team effort
Ms. Burwell assigned elements of the care bundle care to individual
nurses, who were in charge of educating their colleagues about the
importance of, for example, extending CHG wipes beyond the surgi-
cal site and putting on new personal protection equipment before
wound closing. The nurses must also audit the staff's performance
and document each practice to ensure the elements are implemented
properly and consistently. That standardized documenting process
lets leadership track real-time compliance with the overall infection
prevention program and intervene if the staff's performance begins to
drift long before minor issues become major oversights.
The hospital's success in reducing SSI rates primarily protects
S E P T E M B E R 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 8 3