SSI-Preventing Wound Care

Four ways to protect patients’ most vulnerable areas, keep infections at bay.

The enduring threat of surgical site infections (SSIs) is alarming. A recent National Healthcare Safety Network report estimated the annual healthcare costs related to SSIs were $3.3 billion. Complications from SSIs extend hospital stays by 10 days and increase costs by more than $20,000 on average. Making SSIs a never events starts well before your patient enters the OR — and wound care is an integral part of the equation, says Lisa Gould, MD, PhD, FACS, South Shore Health.

“In terms of why wound care matters for outpatient surgery, if the incision isn’t cared for properly, it can become infected or take longer to heal,” says Dr. Gould, a nationally recognized expert on wound care. Here are four things to keep in mind to perfect your facility’s wound care plan.

1. A wall of options

The good news for surgical teams is that there is an array of options at your disposal to assist in closure, and incisions keep getting smaller and smaller.

Dawn M. Yost, MSN, RN, BSDH, RDH, CNOR, CSSM, says she sometimes spots a surgeon or other staff member at the suture wall at her facility, scanning for a particular product among a variety of options. Ms. Yost says working with your clinical and purchasing teams helps identify products needed across your various service lines. Her facility values the flexibility that comes with stocking multiple products, while understanding that most surgeons tend to find approaches that work and stick to them.

“Surgeons are notorious for not wanting to change, but sometimes they will try to use new products,” says Ms. Yost, business manager of perioperative services at West Virginia University Hospitals in Morgantown. There is no magic rule for how surgeons prefer to close, whether it is with staples, absorbable sutures, medical-grade skin glue, or a combination of dressings and devices. Multilayer closure strategies will vary depending on the patient and the procedure, such as using barbed sutures to eliminate the need to tie knots to secure the wound closure.

Besides sutures, negative pressure wound therapy is another tool in the toolbox for wound care. These devices essentially use vacuum pressure to drain fluid at the incision site and stimulate healing.

Vacuum-assisted dressings are a potential option to reduce complications, particularly for patients who have had issues in the past or who may not heal well due to diabetes, obesity or other risk factors.

“Using the incisional negative pressure wound therapy has pretty much stood the test of time,” says Dr. Gould. Lastly, picking the right dressing can ensure you are properly sealing a wound and setting patients up for success. A foam-based dressing may benefit wounds that have heavy drainage, while silver-coated dressings and other antibacterial and antimicrobial dressings seek to help reduce the chances of infection. Whichever option you choose, a neatly applied dressing gives patients a sense of confidence leaving the OR, Ms. Yost says. “It’s the first thing you see when you wake up,” she notes.

2. Education is everything

Like most aspects of surgery, sucessful outcomes are about more than a surgeon’s precision. After all, a patient who does not follow orders is more likely to come back with an incision that is changing colors, crusting over, or swelling in the days after surgery. Good hygiene is an important factor for succesful outcomes.

Patients and their caregivers need to have a thorough understanding of what is expected of them after surgery, says Deidre Frizzell, BSN, RN, director of clinical services at Covenant High Plains Surgery Center in Lubbock, Texas. Many times, basic questions about showering, changing dressings and dissolving stitches prompt confusion in the follow-up days after a procedure.

You can address some of these concerns during a next-day appointment, but it helps to have someone on your staff patients can reach in real time.

Sometimes things get lost in translation. Ms. Frizzell recalls a patient who bought non-medical super glue from the convenience store on the way home from surgery, thinking it could be used to address leaking at the incision site. The takeaway: Patients must know it’s OK to ask questions and call if they are unsure. “Some patients panic more than others,” Ms. Yost adds, “and sometimes they wait too long (to call).” Caregivers should be present to ensure patients know what to do and have the right supplies at home. It can be helpful to provide guides and have the patient and caregiver repeat back the information you have provided to ensure they have processed it properly, Ms. Frizzell says. “For someone who does not have a medical background, wound care can be very complex and difficult to be able to do,” she adds. “We just ensure that for anything that is out of the ordinary, we have patient instruction sheets that we give them during discharge and always provide the follow up with them as well.”

3. Perfect your preferences

PERFECT PREP Proper pre-op education gives patients and caregivers confidence to manage their wounds.        

Like other variables in your facility, wound care is very surgeon-specific, and there is no one universal roadmap to follow for success.

A surgeon who closes with a medical glue and another who uses an adhesive strip will have patients with different next-day needs. Instructions to patients for showering and best practices to keep the wound clean need to be tailored to these different closing techniques, says Ms. Frizzell.

“That patient teaching is just a little different, as far as keeping the wound open to air and dry after surgery,” says Ms. Frizzell. “It’s important for our nurses to know and communicate that to patients.” Choices for sutures, staples, and dressings come down to your patient’s needs, but everyone should be on the same page. Education to patients and staff will support good healing. “From the minute we meet a patient, we are thinking about what they are going to need,” Dr. Gould says.

4. What’s working, what’s not?

Ongoing review and monitoring help ensure you are doing everything you can to prevent SSIs and other healthcare-associated infections. You will not understand the scope of a problem or find opportunities to improve if you are not carefully tracking your patients’ postprocedure care.

When you notice general trends in your patient satisfaction surveys or postoperative follow-ups, it is time to get to work to understand what’s happening. Surgery is a team sport, so it can take a degree of detective work to understand where problems originate, whether it is in sterile processing, patient education, during the perioperative period, or in the aftercare.

If your patients are repeatedly noting issues with their incisions or dressings, it can help diagnose the true source of the problem. “Is it one surgeon or is it multiple surgeries in the service line?” Yost says.” What was the staffing in each case? They are looking for common denominators.”

A review of your quality data, consultation with infection control, and a 30-day postoperative follow-up will help you understand where you are falling short. It’s easy to take this work for granted when things are going smoothly, but you’ll be thankful you have review processes in place to catch issues before they lead to larger headaches.

“The surgeons that get the best outcomes are the ones who look at what has happened over their time and review their results and modify as needed,” says Dr. Gould. OSM