How wireless environmental monitoring minimizes surgical site infection risk

In spite of innovations in patient care technology, healthcare-acquired infections (HAIs) such as wound sepsis are continuing to rise, and hospitals are paying the price.

One of the most recent studies, a two-year longitudinal examination published in 2014, revealed the average patient with a surgical site infection (SSI) stays 10 extra days in the hospital.1

While clinicians and hospital executives may believe they are doing all they can to reduce infection, the reality is that there is a disconnect between knowledge and practice — largely due to an ineffective use of technology.

As we move into an era of greater healthcare-provider competition and transparency in patient outcomes, it is becoming clearer that reducing HAIs such as wound sepsis can be influenced by the use of sophisticated technology support tools such as wireless environmental monitoring solutions. In fact, wireless environmental monitoring has already proven to be a significant advantage in reducing infection incidents and associated length of stays at hospitals around the country.

Wound sepsis prevention: addressing challenges in healthcare environments

Sepsis constitutes one of the most all-encompassing healthcare problems, clinically and economically. As recently as 2011, the United States spent $20.3 billion on hospital care for patients with sepsis.2

Within the sepsis subcategory, surgical wound infections (SSIs) account for one of the highest contributors to surgical morbidity and mortality.

While numerous reasons exist for these trends, one of the biggest challenges in controlling SSIs is managing the environmental conditions of a healthcare setting. Even at the correct temperature, humidity, and pressure, air contains microorganisms that can contaminate surgical wounds and cause sepsis. This can be particularly dangerous in the operating room when bacteria attach themselves to air from vents or respiratory droplets.

To make matters worse, established guidelines for adhering to regulatory requirements are often lacking or outdated. It is still not unusual, for example, for a hospital inspector to check for proper differential air pressure by placing a tissue at a door threshold, instead of conducting a more comprehensive review of specific temperature/differential air pressure ranges and environmental controls.

Also, while hospitals are equipped with technology to change differential air pressure, humidity, and temperature, most equipment lacks real-time alerts when environmental measures approach dangerous thresholds. Real-time alerts are responsible for dispatching critical information at the point of care, and thus support perioperative workflows by enabling the correction of environmental conditions as they begin to approach set parameters and unsafe ranges.

Clinicians being able to respond more promptly can lead to clinical and financial benefits. The risk that wound sepsis will occur is drastically reduced, which has an immediate effect on patient outcomes. When a hospital's infection control program improves, it helps keep a hospital financially solvent by ensuring an adequate volume of elective surgeries.

On the other hand, a hospital with a high rate of HAIs could find itself the subject of unfavorable press and a worsened reputation, which could reduce the number of patients seeking elective surgeries. As the last two years have shown, through CMS' Hospital Acquired Condition Reduction Program, there are steep financial penalties for facilities that rank in the lowest quartile with HAIs.

Finding the right environmental monitoring solution

Over the last couple of years, a number of technology solutions for wireless monitoring have emerged, some of which are based on real-time location system, or RTLS, technologies. RTLS takes environmental monitoring a step further by addressing the need for locating important assets immediately as well as their condition, thus reducing risk and improving safety in the operating room.

For hospital leaders who are looking for new ways to reduce sepsis, this is good news.

However, not all solutions are the same. The most important differentiators that hospitals should consider include:

1. Accuracy: Alerts must be targeted and timely, to ensure clinicians can respond to changes in environmental conditions. A hospital should determine how it can ensure a technology's vendor measurements are reliable, and if the system dispatches alerts in a timely manner.

2. User Support: A healthcare organization should inquire about the extent to which a vendor will offer support if issues arise during launch and post implementation.

3. Operational Issues: Is the solution provider available to walk through potential workflow or situational challenges and discuss concerns? If a problem arises with systems integration or functionality, how would the vendor respond? These are important questions, as a vendor's relationship with a hospital should be ongoing.

4. Clinical Issues: Educating clinicians on a real-time alert system is crucial for obtaining buy-in, but also to encourage proper operation and rapid response times. A solutions provider should describe its clinician education and training process.

5. Technical Issues: A hospital should determine if the technology is NIST-certified or how else it complies with industry standards. How the system monitors battery life is also important.

Organizations need to also consider other factors such as patient outcome targets, environmental visibility improvement, and ease of compliance reporting. A number of vendors address some, but not all of these concerns, so looking at the big picture is key.

Wireless environmental monitoring technology is here today and has already made a significant positive clinical impact for many hospitals in reducing wound sepsis and other HAI incidents. Hospitals that truly hope to nudge the needle towards decreasing events for surgical patients while supporting regulatory compliance should consider the potential of this technology when moving forward.

About the author:
Lorn Clancey is the Director of Environmental Monitoring Solutions for CenTrak

http://www.journalofhospitalinfection.com/article/S0195-6701(13)00344-7/abstract
2 http://blogs.cdc.gov/safehealthcare/2015/09/08/the-cost-of-sepsis/

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