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• Proper hand scrubbing. At the beginning of each day, the center's clinical team members scrub their hands with soap and water for at least 20 sec- onds and rub in hand gel. After that, they apply hand gel as needed at patients' bedsides. Team members are instructed to use three pumps of gel — one for each hand, and a third to apply on the forearms up to the elbows. Secret shoppers monitoring for compliance offered on-the-spot corrections if they saw errors in application. Presentations on how to apply the sanitizer correctly are now provided during con- tinuing education events and at annual competen- cy reviews. • Monitored breaks. The facility's nurses get 15- minute morning and afternoon breaks. When nurses who are working joint replacement cases return from breaks, they must rescrub, put on new gowns and gloves, and re-enter the OR from the sterile core in order to minimize airflow disruptions. Signs hung near the entrances of each OR alert staff of the traffic restrictions. "These action items, combined with improved hand hygiene and antibiotic prophylaxis practices, have been effective in achieving our goal of zero SSIs for some procedures, and will allow us to achieve our goal of having a less than 1% infection rate for others," says Ms. Wolaver. OSM S E P T E M B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 4 7 Prepping Switch Lowered Infection Risks HONORABLE MENTION The staff at Baystate Medical Center in Springfield, Mass., noticed an increase in infection rates among hysterectomy patients, so they updated and improved their prepping prac- tices — with great results. Over the last two years, infection rates among vaginal hysterec- tomy patients dropped from 2.17% to zero. The decrease in SSIs for patients who under- went abdominal hysterectomies was even greater — from 8.77% to 2.14%. Baystate Medical acheived these results through research and staff education. A review of the literature showed povidone- iodine (PVP-I) isn't an ideal solution for vaginal surgical prepping, as its use can lead to iodine absorption through the vaginal lining, skin irri- tation, diminished effect of the solution in the normal PH level of the vagina and inactivation by blood, says Karen Paluch, RN, CNOR, Baystate's supervisor of the IVF, GYN and urol- ogy surgical service lines. The facility therefore switched to a 4% chlorhexidine gluconate (CHG) solution, which is recommend- ed by the American College of Obstetricians and Gynecologists (ACOG). The FDA hasn't approved CHG for vaginal use, but it's widely used for prepping GYN patients, a practice the ACOG says is a safe and effective off- label use of the product, according to Ms. Paluch. All GYN patients are asked to shower the night before sur- gery with a CHG prep kit provid- ed by the hospital. (Patients with an allergy to CHG can bathe with antibacterial soap.) Pre-op nurses ask patients if they complied with the directive. Those who did not are given CHG wipes to cleanse themselves before they're brought to the OR. CHG skin prep prophylaxis is document- ed in the patient's chart as part of the pre-op checklist. Random audits and continuing education for new and existing employees are ongoing to keep Baystate's vaginal hysterectomy SSI rate at zero, says Ms. Paluch. — Adam Taylor PROPER PREPPING Baystate Medical Center has switched from povidone-iodine to chlorhexidine gluconate for prepping patients undergoing vaginal and abdominal hysterectomies.