Studies show that standardization of surgical processes and protocols improves quality and patient outcomes, yet healthcare organizations often find it difficult to implement these changes systemwide.
During a 3M-sponsored virtual roundtable on May 19, as part of Becker's Hospital Review 11th Annual Meeting, Amy Law, vice president of global health economics, outcomes research and market access at 3M Medical Solutions Division, led a discussion about how standardization can prevent complications in the operating room. Several health system leaders participating in this roundtable offered their perspectives.
Four insights:
- Nasal decolonization reduces surgical site infections. To reduce Staphylococcus aureus infections, the CDC recommends the use of chlorhexidine gluconate wipes, as well as the application of Mupirocin twice daily to the nose five days prior to surgery or two applications of at least 5 percent nasal iodophor (povidone-iodine) within two hours before surgery. The Association of Perioperative Registered Nurses has also added nasal iodophor to their guidelines.
Despite the effectiveness of these protocols, not all health systems have adopted nasal decolonization practices. An infection preventionist from a major medical center in the Midwest noted, "This has been a hot topic during our SSI drilldowns. We provide nasal decolonization only for certain cases, but there's a push to do it on all cases. It's something that old-school infection preventionists don't support as widely."
- Although the benefits of maintaining perioperative normothermia are well known, patient pre-warming practices are inconsistent. For surgeries longer than 60 minutes, inadvertent perioperative hypothermia will occur in a significant percentage of patients, unless preventative measures are taken. One participant noted that their institution uses the 3M Bair Hugger system for some patients in the preoperative and intraoperative areas. Hypothermia monitoring still remains a challenge, however, with the anesthesia department. This isn't uncommon. "At 3M, we recently looked at 12 different auditresults and found pre-warming practices are still very low — 44 percent of organizations indicated they aren't doing patient pre-warming," Ms. Law said.
- Within the OR, antimicrobial incision drapes reduce contamination. Two recent randomized controlled trial studies on knee surgeries (Clinical Orthopaedics and Related Research and The Journal of Arthroplasty) looked at the reduction in contamination when antimicrobial incision drapes are used versus bare skin. In both studies, antimicrobial drapes reduced contamination. The senior medical director of a healthcare provider and insurer on the east coast commented, "When I was working as a surgeon, I found that the impregnated drapes were thinner and more adherent. They preserved the sterile field better than anything else."
- Closed incision negative pressure wound therapy improves outcomes for high-risk patients. World Health Organization guidelines indicate that closed incision negative pressure wound therapy may be helpful for preventing SSIs with high-risk wounds. The FDA has also granted a de novo indication that this type of medical device reduces the incidence of seroma, and in patients at high risk for postoperative infections, it can reduce the incidence of superficial SSIs. A study conducted at Durham, N.C.-based Duke University (Journal of Surgical Research) found that the SSI rate for closed groin incisions after vascular surgery among high-risk patients was 7 percent when closed incision negative pressure wound therapy was used, compared to 20 percent when the standard of care was used.
To learn more about the event, click here.