This article will appear in the upcoming July-August print issue of Surgical Products.
Dr. Scott Ellner, Vice Chairman of Surgery and the Director of Surgical Quality at Saint Francis Hospital and Medical Center, recently spoke to Surgical Products and gave his take on the healthcare industry’s fight against surgical-site infections.
SP: In your opinion, why are surgical-site infections still a major problem for the healthcare industry?
Dr. Ellner: One of the main reasons is culture and standardizing the certain guidelines that are out there to help teach behavior so we can better prepare our patients and optimize them for surgery. That includes surgical-site infection prevention. It’s one of the most common hospital-acquired infections that we see in our practice and most surgical practices, and it’s costly – up to $10 million per year. In order to affect change, you really have to get not only your surgeons to buy in to certain evidence-based guidelines, but your front line staff as well. This includes your preop nurses, your OR scrub technologists, anesthesia, and people who work in other ancillary services. Even at home, family members can support the patient.
SP: What are the besy ways clinicians can combat surgical-site infections?
Dr. Ellner: There are global initiatives like the surgical unit-based safety program, that really started out of Johns Hopkins, which helps to address that culture and to bring teams together with education about putting together a clinical guideline for SSI prevention. You bring together a multi-disciplinary group to sit down and review the literature and some of the data that’s out there. Tools that are available are then used by the teams to go out and educate the front-line staff and the patients. What we do is not only teach proper handwashing to our staff and patients, but also how to maintain a clean, hygienic environment. One of the things we’ve done, and I think we’ve been very good at in our organization, is we’ve helped to educate the patient on preoperative cleansing prior to surgery. In particular, we’ve looked at colorectal surgery. Colorectal surgery has a much higher risk of the patient developing a surgical-site infection compared to other procedures. It’s about 2-7 percent for any other surgery, but with colorectal surgery the risk is from 4.5 percent all the way up to 20 percent. What we want from our patients is to go home and shower with a CHG skin-cleansing agent. They do this in the evening the day before surgery and then the morning of the procedure. The goal is to reduce the bacterial burden in the skin flora on the abdominal wall, particularly for the colorectal surgery. There is evidence out that by reducing that burden, your rate of surgical-site infection goes down. Patients come in the day of surgery. They’ve done the evening shower and they’ve done the morning shower, and a nurse assesses them in the preop area and asks them if they’ve gone through the cleansing. Most of them say they have, and if not, we’ll have them go through one. One of the dirtiest areas of the abdominal wall is the belly button. For many reasons, patients may be debilitated or they just can’t clean themselves adequately. I truly believe that one of the most important factors of preventing an SSI is proper hygiene.
SP: Is the healthcare industry making strides in the fight against surgical-site infections?
Dr. Ellner: About a year ago, I would have probably said that this is a problem on the rise. But with the recognition that surgical-site infections are not going to be reimbursed as part of value-based reimbursement through CMS/Medicare/Medicaid, I think organizations, hospitals, and private practitioners are taking notice and are assuming much more responsibility for ensuring that their patients don’t end up being readmitted with an infection. In our organization, we found that 30 percent of our patients who developed a surgical-site infection were readmitted. We’re not going to get paid for those. So it has sort of plateaued, to answer your question. It’s not necessarily on the rise, but it’s definitely recognized as a problem. Now we’re kind of holding some of the patients accountable by asking them to participate (in the fight against surgical-site infections) and cleanse themselves before surgery.
SP: Is there anything you wanted to emphasize in terms of where you think things are headed in the future?
Dr. Ellner: One of the things I do emphasize with any organization that is going to be doing surgery is measure your results. You’ve got to track your outcomes. What’s really important is that you know how well you are performing, either internally or externally, with nationally-recognized benchmarks. Take that information, bring it to the right stakeholders, and then partner with people (whether they are in the C-suite, on the front line, or even in industry) and come up with a recognized standard or clinical guideline that will help you achieve improved results.
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