M A Y 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 7
No stone unturned
The multidisciplinary team was made up of executive leaders, infection preven-
tionists, surgical managers, anesthesia providers, surgeons, nurses and educa-
tors. We mapped out all aspects of the care provided to surgical patients, from
pre-admission to discharge and beyond into extended care. Getting feedback
from representatives from every discipline that would touch patients along the
perioperative path was instrumental to our ultimate success. The team came up
with these evidence-based action items:
• Glucose monitoring. We previously had only checked point-of-care glucose
levels if physicians ordered the test or patients were known diabetics. Part of
our initiative involved checking blood glucose levels for every surgical patient,
and we discovered what had long been suspected: Many patients present for
surgery without knowing they're diabetic or have elevated blood glucose levels,
which increase SSI risk.
• Hair removal. We used to clip hair around surgical sites in the OR and col-
lect the trimmings with tape. To limit the infection risk those hair trimmings
posed, we now use clippers with a built-in hair collection system, and primari-
ly in the pre-op area. However, we still clip patients in the OR if the location of
the surgical site demands privacy or the prep needs to be revised.
• Pre-op CHG wipes. In pre-op, all patients receive 6 wipes impregnated with
chlorhexidine gluconate for treating the neck and chest, both arms, both legs
and back. Family members or nurses can help apply the wipes before patients
slip into a clean patient gown. Total joint patients are instructed to also use
CHG wipes the night before and the morning of surgery. The company we pur-
chase the wipes from improves compliance with those directives by sending
automated text or email reminders to patients. Total joint patients also receive
packets of disposable washcloths and towels to use before and after surgery.
• Nasal antisepsis. Pre-op nurses apply 2 minute-long swab applications of
