But that is not an easy task and comes with its own set of challenges.
Four panelists discussed the biggest infection control challenges for 2016 and how to overcome them at the Becker’s ASC Review 22nd Annual Meeting in Chicago.
Panelists were Michael Sengmanivong, administrator at Doctors Outpatient Center for Surgery in Beverly Hills, Calif.; Chandler Shirer, administrator at Franciscan Surgery Center in Indianapolis; Barb Struthers, RN, MSN, administrator at Rush SurgiCenter in Chicago; and Sandra Jones, senior vice president and COO of ASD Management.
Responses are edited for clarity and space.
Question: What infection control issues are most concerning you today and looking into next year?
Chandler Shirer: I think some of our biggest concerns that we encounter is patient compliance. And obviously on the follow-up side, [patients] have to comply with things. If they’re not taking care of those things it’s difficult to control the infections. It’s not so much in-house, our worries. The superbugs that continue to be out there, how they’re continuing to morph and how we can stay ahead of the game is [an issue] for the industry in general.
Michael Sengmanivong: We’re small, a two [operating room] facility, so we have people that do a lot of different things — two or three hats per person. I think the biggest concern or issue is accountability, and then the best thing to do is recordkeeping. I think that’s important.
Barb Struthers: We have four ORs, but we do probably 50 percent orthopedics. It may seem like it shouldn’t be top priority, but we [had] a routine audit on our hand hygiene and found that it’s not happening. And I don’t know that we’ll ever get to the numbers that we really need to get because we are human, but we’ve circled back and are really pushing hand hygiene … We’re a small place — you have limited resources, everybody wears a lot of hats. If the flu hits the center and my staff is down, that’s going to be a problem. We at this point are not mandating the flu shot, although our mothership does.
Sandra Jones: My concern is still with [employees’ feeling of], “We’ve always done it that way. Why do I have to change?” And it’s hard sometimes to overcome. There’s always some new directives, there’s a lot of education to always do, whether it’s your patient compliance education or it’s your staff education, to actually determine what they’re doing and what they should be doing.
Q: How do you win over staff members in those situations, especially with the compliance issues, where it’s not really your choice to update and do things differently, but it just has to be that way?
SJ: Most of what I’ve seen is that the staff are trained by somebody who trained them, who trained them, so some of those bad habits got carried forward and trying to get them to step back and look at manufacturers’ instructions for use and determining how they have to do it differently. Additionally, it’s being able to speak up when a surgeon wants a new instrument and they find out that instrument requires 15 minutes processing and every other instrument on [their] tray is 10 minutes. They need the confidence to speak up and say, “We need to do it right, here’s why we need to do it right,” and not be afraid to tell the administrator or the physician of why that might be a little slower turnaround of instruments.
Q: How do you make sure that staff members feel comfortable doing that in a setting where they may not be top dog?
MS: We have one person controlling the training portion of infection control, so [staff] will be getting the same information from the same person all the time. If you pass it along, it gets lost in translation. If you just have one person focusing on infection control training-wise, then they get the same message hopefully.
Q: What preemptive measures are you taking to prevent infections next year? Any issues coming up that weren’t necessarily considered in the past?
BS: Make sure you have a good prescreening process. Make sure you’re asking the right questions of the patients so that you’re not letting in what you don’t want to have there. Things can be done to prepare the patient so that we’re not spreading it within the environment. I think it’s really important you establish a just culture that it’s not the person, it’s the process, and that people can feel comfortable and supported when they do speak up.
Along with that comes some education, maybe some role playing with the staff. I think education, communication, just culture and certainly tracking and trending and responding accordingly. When you’ve got that infection and three months later you have another one from the same doc, are you looking back at who was in the room, what equipment was used, trying to find the common denominator to determine is this isolated or is it something we may have a problem with moving forward?
Q: Obviously centers don’t want to have infection issues and have any complications, but when something does happen what is the typical process you use in order to drill down and figure out what’s going on and make that change so it doesn’t happen again?
SJ: Sometimes you can’t figure out why the infection occurred, so tracking who was in the room, what instrument trays they used. Some of that means you have to track your instrument choices as they go through the process and then trying to determine is it patient education? Educate your patients on their own hygiene when they go home. So many pieces go into this puzzle that it’s very hard to determine what caused the infection.
Q: There are a lot of different ways you can form your infection control committee, depending on the size of the surgery center and who’s really taking ownership of making sure those initiatives get done. Who is in charge of infection control at your centers and what really makes a strong leader?
SJ: Mostly I think that it’s the personality. You really need a Type-A person, and you need someone who can coach so they share their information. They’re very diligent about getting information and then they’re sharing their information and teaching all the staff things to do and how to do them. They can say to someone in a non-threatening way, “You didn’t wash your hands,” whatever the catch phrase of the day is. Something you can do to keep staff totally aware without calling attention and singling it out so much.
BS: Infection control isn’t about the person who’s leading it. It’s about everybody and getting everybody engaged. We all have a responsibility. However, you do have to have somebody wearing that hat to help you make sure everything is being done as it should be? The first challenge is obviously who’s it going to be? You have limited resources, so it may be a challenge to find somebody who’s willing to step up to the plate.
That being said, for me, I’m going to look for somebody who has a little [obsessive-compulsive disorder] in them, Type-A personality. I kind of like it if they’re a little bit of a germaphobe. I think it kind of sets the tone. It’s most important that they walk the walk, that they are actually acting and doing what needs to be done.
CS: Tap into your resources. Yes, you have to sacrifice a little bit, but you have to put the right people in place. It’s hard. It takes time. If it’s important, which it should be, you have to do that.
Q: In your experience, how can you successfully audit the center for infection control issues?
SJ: I really like to get the employees involved, so while I’m doing a survey [or] onsite visit and an audit of my centers, I can help give them ideas about what they can do once I leave. And I think the hardest part is thinking about how you can do observation audits and break it down into smaller components so that it’s not so overwhelming and figure out how to tie it in to your quality assessment performance improvement.
