A Collaborative Approach to Preventing SSIs in Ambulatory Surgery Centers
The following article was originally published in Preventing Infection in Ambulatory Care, the quarterly e-publication from the Association for Professionals in Infection Control and Epidemiology (APIC). To learn more about receiving this resource and joining APIC, visit www.apic.org/ambulatorynewsletter. To learn more about APIC, visit www.apic.org.
During July 2010, the San Francisco Bay Area (SFBA) APIC chapter discussed the growing need of local ambulatory surgery centers (ASC) for support in preventing surgical site infections (SSIs). This is especially challenging for ASCs because most do not have a dedicated infection preventionist (IP). Centers for Medicare and Medicaid Services (CMS) ASC site visits began in October 2010, focusing in part on SSI prevention efforts and outcomes. IPs within the SFBA chapter who work at hospitals with associated ASCs indicated that they were providing progressively increased levels of consultation and support. The chapter proposed extending an invitation to the local Association of periOperative Registered Nurses (AORN) chapter to partner in developing a method of supporting ASCs in SSI risk reduction. A work group comprised of six IPs was convened and an invitation was extended to two perioperative nurses from the San Francisco/Marin chapter of AORN, who accepted.
Plan of Action
First, the work group established a regular meeting day and time for teleconferences through the end of 2011. A work plan was then developed and a timeline was established. The first teleconference was held in August 2010 and monthly teleconferences are conducted each month. The work plan includes:
1. Development of a toolkit/library comprised of documents and website listings designed to support ASCs in preventing SSIs and preparing for or responding to CMS site surveys.
2. Development of a local email ListServ of ASC directors and IPs to facilitate networking.
3. Structured, voluntary site visits for any ASC by voluntary consultative team (one perioperative nurse, one IP).
4. Virtual or face-to-face group meetings for local ASC directors.
5. An SSI prevention presentation to the group of ASC directors, once convened.
In September 2010, as news of our work group spread, AORN contacted the ASC work group with an invitation to present a session on the project during the 2011 AORN congress in Philadelphia. Sue Barnes (an IP) and Kris Anderson (a perioperative nurse) accepted the invitation and co-presented at the conference.
A collection of documents and websites was compiled and posted on the APIC SFBA website for easy access. The website includes the CMS ASC survey tool, checklists for department assessments relative to infection prevention, and SSI prevention guidelines.
The toolkit link is shared with ASC directors when they are each contacted by the work group, and a hard copy is provided during site visits. The toolkit/library contents are posted here: http://www.aboutinfectioncontrol.com/SubWebs/APIC/MAIN_Toolkits.htm
Voluntary Consultative Visits
The first (pilot) site visit was performed on December 14, 2010 at Seton ASC in Daly City, California. The site visit was structured as follows:
1. In-office consultation with local perioperative nurse manager and infection prevention manager
- Review of toolkit contents
- Discussion of SSI prevention measures in place: Pre-operative, Intra-operative, Post-operative
- Review of CMS survey tool
- Review of ASC SSI surveillance plan
2. Walk through of the ASC and the sterile processing (SP) department. SP was deferred due to time constraints and is planned for future site visits.
3. Post-walk through debrief
- Best practices identified
- Opportunity areas identified
- Evaluation of site visit
During the post-site visit evaluation, the ASC director stated that it had been very helpful in preparing for the pending Joint Commission site visit. More importantly, it provided an opportunity for knowledge sharing between the survey team and the onsite team.
The work group continues to respond to requests for site visits by an IP/perioperative team. The site visits provide knowledge sharing opportunities and help refine the process. Best practice tools and documents are added to the dynamic online library. The group plans to continue outreach to ASC directors and will ultimately offer to help establish a regular ASC directors meeting group to facilitate networking.
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