10 Essentials for an Infection Control Program at Spine Centers

Valerie Maxam-Moore, RN, MN, Vice President, ASC Operations & Quality at Laser Spine Institute, discusses 10 critical components of strong infection prevention programs at spine centers.

1. Follow AORN and AAMI standards and the APIC Guidelines.
The best way to begin building a foundation for good infection control and prevention programs at spine centers is by applying the Association of periOperative Registered Nurses and Association for Advancement of Medical Instrumentation standards and the guidelines put out by the Association of Professionals in Infection Control. "These programs outline very clearly the best practice recommendations for all surgical centers," says Ms. Maxam-Moore. "You can meet your state’s minimum requirements, but if you want a superior infection prevention program, you need to commit yourself to industry best practices, particularly given the inherent risk associated with spine surgery."

A few examples of best practices outlined in the AORN standards include the use of an antimicrobial soap with CHG for patient preop showers, meticulous skin preparation measures, hair clipping versus shaving, and all OR personnel going through a hand scrub in the morning instead of just the surgeons and surgical technologists.

2. Document each case well. Clear and thorough documentation of each case is extremely important in case you need to track back to find the potential source of a surgical site infection and track potential trends in how patients are acquiring infections at your center. For every case, the center should record serial numbers on equipment, lot numbers of the materials used during the case, tray identification numbers and the names of all the medical professionals who were in the room and/or worked perioperatively with that patient. "Keeping good records is essential because if you do have an infection, you can track everything back for a surgical site infection workup," says Ms. Maxam-Moore. The staff, supplies or surgical equipment used could all be a potential source of a patient's infection.

For example, if the center experiences multiple instances of surgical site infection, staff members can trace back the patients' steps and potentially isolate the source of the problem, which could be as simple as the way a staff member performs a dressing change postoperatively. "If you are documenting everything along the way with the cases, when you do have a surgical site infection you can have all the information to go back through," she says.

3. Empower an infection prevention resource person. An RN at the surgery center should serve as the leader of the infection prevention program and point person for quality-related issues. This person undergoes additional infection prevention education from an outside source, such as APIC. The infection prevention resource person also coordinates internal audits, performs assessments, arranges training for other staff members and ensures audit results are reported clearly to the staff, Patient Safety and Quality Assurance/Performance Improvement teams.

"This person needs to be able to say 'we looked lousy [or great] in our handwashing audits'," says Ms. Maxam-Moore. "They should be given the resources to implement the infection control program and make recommendations based on the audits and assessments."

4. Have committed leadership. The most effective infection prevention programs have a leadership team committed to infection prevention. "It's expensive to follow infection prevention best practices, and there has to be an expectation of excellence and a goal of approaching an infection rate of zero," says Ms. Maxam-Moore. "If that doesn't start at the top, it won't trickle down."

The administration needs to stand behind the staff members working on the infection prevention program to optimize its resources. If the infection prevention team identifies a more expensive biological indicator for monitoring effective sterilization, or a more frequent use of a BI as a best practice, even though it isn't required, committed administrators will understand the importance of the recommendation and be willing to foot the bill.

5. Regularly assess and audit the QI program. A strong quality and infection control program should include regular audits and assessments to make sure staff members are following protocol. These assessments could include appointing someone to watch staff members while they complete their handwashing routine to see who is following the rules and who isn't. The center should also complete audits on the night cleaning crew. Create a checklist for the night staff so they know their part in your center's infection prevention program. Complete surgery center annual assessments are also necessary and can help you identify new and different problems at the center.

"Take a look around and make sure there aren't any issues with facility design or flaws in the process and protocols that contribute to infection," says Ms. Maxam-Moore. Once the audits are complete, share them with the staff. "You can't just do the audits and assessments and keep them to yourself. You have to report the results to the leadership team and staff, and challenge them to improve."

6. Frequent checks on instrument sterilization practices.
Ms. Maxam-Moore believes, for example, that it's important for spine centers to identify the best biological indicators for monitoring sterilization and to use them more than the minimum requirement. If the minimum requirement for a particular monitor is daily, but AORN and AAMI suggest best practice is to run the indicator with each load, the center should opt to follow the more intensive, best practice.

7. Incentivize best practices and improvements.
You can create friendly competition among employees or multiple surgery centers to promote quality improvement and adherence to best infection prevention practices and protocols. Laser Spine Institute challenges each of its four surgery centers to outperform the others in quality assessments. "We see who is doing better in which areas and look at ways to award those with the best results," says Ms. Maxam-Moore. "Sometimes, friendly competition is a good thing."

8. Build in constant reminders of best practices.
It's important to keep constant reminders around the surgery center detailing the best practices for infection control. Hanging posters, such as those from the Centers for Disease Control's "One and Only Campaign," around the center can keep staff members on their toes. Laser Spine Institute is considering a program where all staff wear buttons that say "Ask me if I washed my hands."

Internally, Laser Spine Institute publishes a monthly infection prevention newsletter and holds infection prevention meetings to keep quality issues at the forefront of their staff members' focus. The newsletters include tips and reminders, such as "no hoodies in the OR," and field anonymous staff questions about infection control. A typical question might be, "How long can you have a room open before the case," and the newsletter can run the answer without reprisal to the inquirer.

9. Involve everyone in licensure and accreditation efforts.
Whether your surgery center is pursuing accreditation or facing re-licensure or re-accreditation, proving you have a strong infection prevention program is essential. Laser Spine Institute recently went through a licensure survey at one of their centers and the surveyor was very impressed by the specificity and detail in their case documentation and the SSI work-up they did for the one SSI they had in the prior year. This is also a good time for you to review any updates that may be needed in your infection prevention best practices.

"Reviewing the best practice requirements and guidelines for infection control is important because they change so often," says Ms. Maxam-Moore. "Overhaul the infection prevention protocol in your policy and procedure manuals so it matches the best practices updates. When you make the changes, alert staff members so they know changes have taken place."

10. Hold yourself to highest standards.
Even if your surgery center isn't planning on seeking accreditation or Medicare-deemed status, your center should still refer to those standards when building its infection prevention programs. "Licensure bodies will often follow what CMS and the accrediting organizations are doing," says Ms. Maxam-Moore. "so it's better to be prepared."

Related Articles on Laser Spine Institute:

6 Points on the Laser Spine Institute Fellowship Program
4 Tips for Employee Loyalty at Spine Centers

Challenges in Spine Practice Management: Q&A With Laser Spine Institute Executive Director Lester Morales

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