5 Best Practices for Appointing an Infection Prevention Nurse at an ASC

Surgery centers are placing a greater emphasis on infection prevention as the healthcare industry turns an eye to quality measures and their future ties to reimbursement. Jean Day, RN, CNOR, director of clinical education for Pinnacle III, discusses five things to know about appointing, training and overseeing an infection prevention nurse in a surgery center.

1. Choose a staff member who volunteers for the position. Ms. Day indicates selecting a staff member for the position of infection preventionist can be "a bit of a challenge." Surgery center leaders are often forced to choose from a cadre of nurses who may not want to branch out into infection control, she says. "Most staff nurses like being staff nurses," she comments. "They like the direct patient care, and they are not inclined to seek a job that asks more in terms of job responsibilities. If they were so inclined, they would likely already be climbing the career ladder in search of a leadership position."

She recommends asking for volunteers among ASC staff. Ms. Day maintains, "If nurses are forced into the infection prevention role, they tend to not perform well." She recommends supporting the staff member by providing funds for professional development and education, such as attendance at infection prevention conferences. The surgery center should also set clear expectations about the amount of time spent on infection prevention duties — Ms. Day estimates around 10 percent of total work time is required to effectively accomplish the related tasks.

2. Hold the infection preventionist responsible for evaluation of policy. The infection prevention nurse should be held responsible for evaluating the surgery center's policies to determine the center's level of compliance, Ms. Day suggests. "That doesn't mean authoring them, but being granted an authoritative voice when it comes to enforcing those policies," Ms. Day asserts.

For example, if the IP nurse observes a coworker using his or her personal protective equipment incorrectly, intervention and correction with that colleague must occur. Every staff member should understand that the infection prevention nurse is responsible for reviewing and enforcing policy to create a sense of trust and respect. "A teachable moment is lost when the IP nurse feels they have responsibility but not authority," says Ms. Day.

3. Assign the IP nurse to provide staff education. Ms. Day believes the IP nurse should also be held responsible for providing staff education on a quarterly basis at minimum. For example, the IP nurse can sit down with staff members and provide an overview of hand hygiene policies. "On a quarterly basis, we do expect some kind of staff education, even if that's just reporting the quarterly infection rates to the staff," she states.

Education doesn't have to involve a sit-down lesson, either; the IP nurse can pull a current article out of print material and place it in an educational notebook for personnel to read. Asking the IP nurse to provide staff education helps connect the staff member to the remainder of the ASC’s employees. Colleagues will be more likely to listen to and respect the IP professional if they receive education about the center's progress on a regular basis.

4. Go over statistics basics with your new IP professional. IP nurses will have to use statistics to track infection rates and uncover trends in patient safety issues — a potential problem because ASC staff members may not have recent experience with statistics. "Some nurses have never been asked to collect and report data, and they may not know how to calculate infection rates based on total population or by specialty," Ms. Day says. The IP nurse at a surgery center may need a refresher course in statistics, or an overview of how to track and record adverse events in the surgery center's computer system, Ms. Day adds.  

5. Expect ASC surveillance on a regular basis. Most of the IP nurse's responsibilities should center on surgery center surveillance, Ms. Day emphasizes. She indicates the nurse may spend up to eight hours a month conducting concurrent surveillance for surgical site infections. When SSI are reported by the attending surgeon, the IP nurse is required to conduct an investigation to determine if the infection is attributed to breaches of best practices. Ongoing surveillance includes observing direct patient care and determining whether staff members are in compliance with infection control policies. For example, the IP nurse may conduct hand-washing surveillance to determine how many staff members are washing their hands (a significant concern since national hand-washing compliance falls around 50 percent, according to Ms. Day). Verifying consistent use of personal protective equipment, which minimizes an employee's risk exposure, is an additional surveillance activity that ought to be conducted on a routine basis.

Ms. Day expects IP nurses to conduct a "walkabout" throughout the work environment on a monthly basis. She notes Pinnacle III provides a surveillance checklist to ensure every IP nurse reviews the same set of criteria.  Surveillance may include reprocessing of surgical instruments, medication storage, medication administration, donning and removal of gloves and direct patient care, she adds.

Learn more about Pinnacle III.

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