A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Joe Paone
Published: 9/11/2019
Last fall, Saint Francis Health System in Tulsa, Okla., made a big push to improve point-of-use instrument cleaning by posting a new regimen for staff to follow in every OR. "We're keeping our instruments soaking and wiped down during cases," says Tamra Luna, MSN, RN, CNOR, the OR manager of surgery services at Saint Francis. "As soon as the case is done and the patient's out of the room, we make sure we get all the "chunks and hunks' off the instruments."
Doing away with the "chunks and hunks" — along with the significant strides the staff has made over the past year toward eliminating SSIs — has earned Saint Francis the OR Excellence Award for Infection Prevention.
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.
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.
To minimize movement, renovated ORs at Saint Francis feature more built-in cabinetry that can house rarely used or emergency instruments, so if a surgeon needs such an item, it'll be in the room.
Another movement-reduction technique: All of the equipment in ORs is hung on built-in booms, meaning the equipment doesn't need to be rolled into and around the room as it's needed.
As a result of all of these changes, Ms. Luna says the ORs are "more contained," and St. Francis now exceeds the national standard in terms of limiting traffic movement in the OR.
Ms. Luna and her team will formally roll out a comprehensive colorectal SSI bundling program on Oct. 1, but continue to improve their infection prevention program — a total joint SSI bundle is next, with bundles for additional procedures to follow. "Over the past year we have decreased our total joint infection rates as well as our colorectal infection rates and continue to constantly improve on our processes to decrease any potentials that could lead to SSIs," says Ms. Luna. OSM
Other SSI prevention initiatives at UPMC Pinnacle: A Surgical Optimization Clinic for high-risk patients screens them for smoking, obesity, diabetes and COPD; if there are risky conditions, letters are sent to both the surgeon and PCP, asking them to consider sending the patient to the clinic for optimization. To limit foot traffic in the ORs, "do not enter" signs are placed on doors during surgeries. "Every single person has a responsibility to prevent SSIs," says Ms. Winston. "Even one infection is too many."
— Joe Paone
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