The changes staff made to infection prevention protocols over the
past year are comprehensive, and have nearly eliminated infection
rates among total joint and colorectal surgery patients.
• Pre-screening. When patients arrive at the pre-admission testing
clinic, numerous actions are taken with SSI prevention in mind.
Clinicians note the patient's A1C levels and comorbidities, and insti-
tute enhanced recovery protocols by giving patients nutritional sup-
plement drinks 5 days before surgery. On the day of surgery, patients
are pre-warmed with a focus on maintaining core body temperatures.
• Instrument care. Ms. Luna and her team trialed multiple products
for maintaining the wetness of surgical instruments and to eliminate
bioburden buildup. They ultimately decided on a pre-cleanse wetting
solution rather than an enzymatic soak because they found it best
maintained wetness until delivery to sterile processing.
After thorough pre-cleaning in the OR, instruments are transported
to sterile processing in a closed case cart, with a wet towel placed
over the instruments to keep them moist.
Most surgical staffers were aware of pre-cleaning but didn't grasp
its importance. The hospital now audits for point-of-care cleaning in
the OR. "Any instruments that are sent to sterile processing without
maintaining wetness are reported, and we go back to the individuals
[who worked the case] and talk about it," says Ms. Luna.
• Decreased foot traffic. "Evidence-based research shows the
importance of decreasing movement in the OR — and not necessarily
just opening and shutting of the doors, people coming in and out —
but also the traffic in the room itself," says Ms. Luna. "Extra move-
ment in the rooms during the surgery stirs the air and any bacteria in
the room."
To minimize movement, renovated ORs at Saint Francis feature
more built-in cabinetry that can house rarely used or emergency
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