Improving Patient Care: Pre-Surgical Skin Antisepsis Standardization

Healthcare acquired infections cause 271 patient deaths per day and result in $3 billion in costs each year. These are alarming figures, particularly in a time that is zeroing in on value-based care.

"There are less healthcare dollars out there for us to waste," said Sharon Butler, MSN, RN, clinical nurse IV, at Stanford (Calif.) University Hospital and Clinics. During a CareFusion webinar on Sept. 24, Ms. Butler, also the chairperson of the hospital's Perioperative Research Council, shared how Stanford University Hospital built and implemented a standardized pre-surgical skin antisepsis protocol.

Stanford University Hospital is a 500-bed academic medical center. Of the hospital's patients, 75 to 85 percent are surgical patients. "Medicare is not reimbursing us for HAIs, and other insurance companies are getting onboard," says Ms. Butler.

By standardizing the pre-surgical skin antisepsis process, healthcare providers can decrease waste and lessen the chance of errors. Pre-surgical skin antisepsis is a controllable factor that can support quality initiatives and lessen the burden on healthcare spending.

One of the most often heard buzzwords in healthcare is a "culture of safety" and behind this catchy phrase is a principle that serves as the basis for any successful standardized protocol. "Whenever you implement any project, whether it is standardized antisepsis or something else, you need to have the right stakeholders that the table," says Ms. Butler. At Stanford University Hospital, the team began with the Surgical Quality Group, Infection Control Practitioners and the nursing leadership in the perioperative environment.

During the process of building the program, Ms. Butler and her team of perioperative nurses turned to literature to find the evidence needed to support the implementation of the process and provide education needed to get the job done.

Following the change in process, Ms. Butler and her team found that CHG/alcohol single-use products became their first choice due to its rapid and long-lasting properties. Once the decision had been made, the process of removing old agents that would no longer be used began. "Over one weekend, our orderly staff came in and removed non-compliant supplies and replaced them with single-dose packs of approved products," said Ms. Butler. "We had an 'Aha!' moment when we saw that we were using large multiple dose containers. We had the perfect opportunity to switch to single-dose containers for all of our prepping agents."

In order to make the switch, the hospital's nurses needed to review physician preference cards. The switches were made in all custom and basic kits. Through standardization, the manpower needed to stock supplies and the space needed for storage were reduced. Once the process is in place, reinforced compliance ensures its success.

"Continue to look at the process. Make sure surgeons are on board. The ones that practice at Stanford were really involved. The challenge was connecting with surgeons that are in and out," says Ms. Butler.

As with any healthcare facility, it is difficult to get everyone in one place at once. Staff meetings are an excellent place to reinforce the necessary steps for the standardized protocol, but it is important to provide reinforcement outside of meetings. Ms. Butler suggested placing posters with the relevant information in places staff, nurses, physicians and anesthesiologists can see them. Easily visible information, such as near the scrub sinks, keeps everyone in the facility updated on how to follow the protocol.

Tracking the standardized protocol is an important step. At Stanford University Hospital, the process of tracking was simplified through EHR use. For years, the information reported through tracking the pre-surgical skin antisepsis process has been required, but Ms. Butler emphasized how easy access to that information has become through EHR.

Though most of creating and implementing a standardized pre-surgical skin antisepsis process is done within the four walls of healthcare facility, it is important to involve those outside as well. Ms. Butler explained that healthcare providers work with physician offices to ensure patients receive the necessary literature and pre-surgical instructions, such as the use of CHG in the days prior to surgery.

There are so many variables at play in a healthcare facility that it is difficult to attribute the implementation of a new standardized pre-surgical skin antisepsis protocol to lowered infection rates. Though this may be true, there is still reason to standardize. "Standardization is the name of the game. It's all about having not a lot of choices, but the right choices for your patients," says Ms. Butler.

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