The fight to eliminate SSIs — Why OR optimization is essential for better infection control

Healthcare-associated infections place a considerable burden on hospitals and health systems by way of patient morbidity and care costs. Surgical site infections, one of the most prevalent HAIs, often originate in the operating room, making the OR an important point of focus for hospital infection control efforts.

This content is sponsored by Advance Medical Designs, Inc.

According to CDC estimates, 157,500 inpatient SSIs occurred in American acute care hospitals in 2011. This accounted for more than 21 percent of all the estimated HAIs in the nation that year.

Although hospitals have made improvements in HAI reduction in recent years, reductions in SSIs appear to be occurring at a slower pace. While central line-associated bloodstream infections declined 50 percent between 2008 and 2014, SSIs experienced a 17 percent decline over the same time period, with SSIs related to colon surgery dropping by just 2 percent.

SSIs can lead to increased morbidity, longer hospitalizations, higher readmission rates and greater healthcare costs. The infections carry a mortality rate of 3 percent, and three-quarters of SSI-associated deaths can be directly attributed to the infection, according to a study published in the journal Surgical Infections.

These data suggest SSIs are a prime target for HAI-reduction initiatives. However, it's important that these efforts also support OR efficiency, which is associated with greater patient satisfaction, fewer post-operative complications and improved outcomes, according to a study published in the Journal of Postgraduate Medicine.

To help prevent SSIs while keeping OR turnover time low, hospitals can look to infection control systems that protect and prolong the life of OR equipment, minimize cross contamination and ensure each patient receives high-quality care in a controlled, standardized setting.

Improving infection control techniques in the OR
To mitigate the risk of SSIs, hospitals must employ a variety of preventive measures that help neutralize the threat of contamination posed by operative staff and the OR environment.

Although few studies have evaluated the role of surface contamination in the OR, a growing base of evidence shows the OR's inanimate environment can become contaminated with harmful pathogens. An OR's walls, tables, floors and equipment surfaces are susceptible to these pathogens even with standard environmental cleaning processes, a study published in Surgical Infections found.

Pathogens in the OR environment can then be transmitted to providers' hands and to patients, increasing the likelihood of an SSI.

Advance Medical Designs, a manufacturer of disposable infection control products used in ORs, continues to innovate the Advance Room Turnover Infection Control System Program to help hospitals improve infection control technique and promote better patient outcomes.

To protect OR equipment, the Advance Room Turnover system uses impervious table linens, sturdy lift sheets, arm board and headrest covers, various bags and single-use mops. Each product is disposable and replaced after a one-time use.

"These products enhance infection control procedures by minimizing the potential for cross contamination in the operating room," said Anthony J. Cottone, President and CEO of Advance Medical Designs.

Hospitals with the Advance Room Turnover system in place also have access to the Value Added Goods Program, which includes gel positioners, hampers, mop handles and storage containers that support the components in the system's kits.

The table linens included in the room turnover kits are impervious to blood and viral penetration. Fluid from the procedure or the patient does not get onto the OR mattresses, meaning staff will not have to clean the mattresses as vigorously as they would when using reusable linens.

The chemicals required for rigorous cleaning processes in hospitals that do not use the Advance Room Turnover system break down mattresses overtime, meaning these facilities may have to spend more on replacements. Additionally, the room turnover kit's absorbent table cover helps minimize the likelihood that fluid will leak into the controls of the OR bed itself.

Beyond the room turnover kits, Advance Medical Designs offers hospitals an OR audit program that assesses OR cleaning procedures while providing onsite training on proper cleaning protocols. The program also offers hospitals analysis of infection control processes to ensure progress toward infection control goals and that patient rooms are cleaned in accordance with recommendations set by the Association of periOperative Registered Nurses.

Decreasing OR turnover time
The OR is one of the most critical and sensitive areas of a hospital's operation. It contributes to staff workload and hospital revenue while presenting numerous challenges to maintaining high quality patient care and preventing dangerous infections.

For an OR to be efficient, hospitals must juggle case scheduling, staff allocation, equipment use, surgery performance and preparation of the area for the next patient. If hospitals are unable to efficiently manage the OR, patients may face long waiting lists or case cancellations.

An OR's overall efficiency can be significantly burdened by minor delays in starting a case and lengthy turnover times. Turnovers are not the same as delays. Turnovers are less than one hour while delays exceed an hour.

Long turnover times in the OR can lead to dissatisfied surgeons, who often see turnovers as time during which they could complete other OR cases. As a result, many hospitals focus on reducing turnover time to improve OR efficiency.

By providing disposable OR products and addressing existing infection control protocols and turnaround times, the Advance Room Turnover program helped Alamance Regional Medical Center, a 238-bed hospital in Burlington, N.C., decrease OR turnover times while increasing surgeon and patient satisfaction.

Alamance Regional Medical Center chose to implement Advance Room Turnover to boost patient safety efforts and efficiently dispose of each OR product, said Tracey Chaney, BSN, RN, assistant director of operative services at the hospital.

Since hospital staff can more efficiently dispose of OR products included in the room turnover kit, the facility saw decreases in turnover time, Ms. Chaney said. "The biggest positive change we've seen from using the kits is that our turnover times decreased from 30 minutes to right at 15 to 20 minutes," she said.

Additionally, having OR equipment such as disposable table covers, string mops and drawtape bags in one room turnover kit helped OR staff spend less time finding and gathering items, thereby helping to minimize inefficiency during room turnover.

"Having everything contained in one kit has been the best thing for our OR," Ms. Chaney said. "Staff do not have to locate the linen and trash bags or mop head, because they're all contained in one readily available bag."

Prolonging OR equipment life while ensuring standardized care
ORs are one of the most expensive areas of hospital operations. With healthcare organizations facing a growing number of financial pressures related to declining reimbursement and other factors, hospital leaders should reexamine OR operations to identify possible avoidable costs.

To determine the cost of one minute of OR time as well as what contributes to this cost, a recent study published in JAMA Surgery looked at financial disclosures from comparable shortterm general and specialty care hospitals in California.

The researchers found the mean cost of OR time in fiscal year 2014 for the acute care hospitals included in the study was $36 to $37 per minute; $20 to $21 of this amount was associated with direct cost, with $13 to $14 attributable to wages and benefits and $2.50 to $3.50 attributable to surgical supplies.

Not every OR will cost $37 per minute, but hospitals can look to incorporate products that help reduce costs by prolonging the life of their OR equipment.

For Alamance Regional Medical Center, the disposable products included in the Advance Room Turnover system cut costs on various OR items, including linens. Furthermore, by using a system of disposable, one-time use items, hospitals can better protect and preserve operating tables and mattresses.

"The system helped us limit the number of linens we have to purchase, decreasing our expenses for these items," Ms. Chaney said.

By using products that can be discarded after each patient use and better protecting OR equipment, hospital staff can ensure all patients are receiving the same standard of care, helping to minimize their risk of contracting harmful infections during their hospital stay.

The fight to eliminate SSIs
Infection control products focused on room turnover can help reduce OR turnover time, save money on costly equipment replacements, extend the life of the OR beds and ensure every patient receives high-quality care in a standard, controlled setting.

For hospital leaders, being aware of the potential consequences of SSIs on patient health and care costs and continually working to improve OR practices is critical to ensuring their facility is controlling infections and generating the best patient outcomes they possibly can.

For more information on the Advance Room Turnover program, visit

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