4 Essential Steps to Help Reduce Your ASC's Surgical Site Infections

By: Aorn Staff

Published: 10/22/2019

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Publish Date: March 13, 2019

 

The patient arrives at your ASC. Their paperwork is in order, and they pay off the remainder of their balance. The procedure can proceed as scheduled. The patient is admitted, and eventually brought into the operating room. There are no complications with anesthesia, and the surgery goes as planned. The patient is taken to the recovery area and eventually discharged. It's a job well done … or so it seems.

A few days later, you get a call from the surgeon with an update. The patient has reported redness and pain around the surgical site . The patient also reports they have had a fever. What's happened? A potentially good outcome has been complicated by a surgical site infection (SSI).

ASCs have a responsibility to provide the safest, highest quality care possible, says Angela Vassallo, MPH, MS, CIC, FAPIC, infection preventionist for Health Services Advisory Group, which is why SSI prevention must be made a priority. She identifies four key steps ASCs should follow to reduce the likelihood of SSIs.

  1. Use NHSN criteria when conducting SSI surveillance. Vital to any ASC's SSI prevention program, Vassallo says, is following National Healthcare Safety Network (NHSN) criteria to determine if an SSI is reportable.

    "In ASCs, we are too often dependent upon subjective information to define SSIs," she says. "Although a surgeon's perspective on their patient is extremely valuable in determining if a patient had an SSI and what could be done to prevent it. NHSN provides objective criteria that ensure consistency across all facilities in determining SSIs. An example is that what one person calls cellulitis might be a superficial SSI to another. NHSN criteria also help us set nationwide standards."


  2. Report SSIs through NHSN's outpatient module. NHSN's outpatient module creates a framework for ASC infection preventionists to track and trend their facility's data, Vassallo says. "It also helps us understand SSI data at a national level. Until ASCs throughout the United States are reporting to NHSN, we cannot assume we know ASC SSI rates. Also, using the NHSN framework to define and report SSIs from ASCs will assure that we are all using the same criteria."

  3. Take a bundle approach. Preventing SSIs is best accomplished when an ASC's entire surgical team uses a bundle approach, Vassallo says. "There are many moving parts and lots of people who can and do affect surgical outcomes in patients. Starting from preop through discharge, there are myriad things that should be done to prevent SSIs."

    She advises ASCs to closely review the Centers for Disease Control and Prevention Guidelines for the Prevention of Surgical Site Infections (2017). "This provides evidence-based recommendations for the prevention of SSIs that are relevant to ASCs. These recommendations provide a bundle of measures that should be used to prevent SSIs from occurring, such as preop bathing, surgical skin prep, hair removal, hand hygiene, cleanliness of the environment and equipment, instrument sterilization and patient education, to name a few components."


  4. Don't cut corners. Vassallo says the measures included in the bundle are all important to SSI prevention. "If any of these areas are overlooked, the entire chain can collapse, and an SSI can occur. The best approach is to create an SSI reduction team — which should at least include representation from nursing, physicians, nurse technicians, sterile processing, housekeeping and infection prevention — and secure buy-in from everyone involved."

    She continues, "As the landscape of healthcare changes and many surgical procedures move from hospitals to ASCs, it is important that ASC staff work as a team to prevent SSIs and improve overall infection prevention practices. Our patients are counting on us."

Learn more about SSI infection prevention in ASCs by attending Vassallo's presentation at AORN's Global Surgical Conference & Expo, April 6-10 in Nashville, Tenn. She will be speaking on "Knock Out Infections: ASC Infection Prevention Initiative" on Tuesday, April 9, from 2:00 pm - 3:00 pm.

 

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Guideline Essentials: Easy-to-use Guideline implementation tools for environmental cleaning, hand hygiene, high-level disinfection, processing flexible endoscopes, skin antisepsis, sterile technique, sterilization, surgical attire, and transmission-based precautions:

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