By Don Sadler
Numerous medical advancements that have been made in recent years are truly astounding. This makes it ironic that thousands of patients still die in hospitals each year from the simplest of causes: healthcare-associated infections, or HAIs.
The most recent statistics with regard to HAIs are sobering. Each day, one in 25 hospital patients suffers from an HAI, according to the Centers for Disease Control (CDC). Worse yet, 75,000 patients with HAIs died during their hospital stays in 2014.
The Financial Cost of HAIs
Hospitals also pay a heavy financial cost due to infections.
“This is especially true in light of new penalties associated with CMS reimbursement,” says Judith Seltzer, MS, BSN, RN, CNOR, the Surgical Clinical Director, National Accounts for Mölnlycke Health Care.
According to Seltzer, payment adjustments of up to one percent are imposed on hospitals ranking in the lowest quartile with respect to the Healthcare-Associated Conditions Reduction program.
“Also, patients suffering from a surgical site infection (SSI) will likely have hospital stays 7 to 11 days longer than patients without SSIs,” Seltzer says. “In addition, they suffer mortality rates up to 11 times higher than patients without SSIs.”
“HAIs have been shown to increase patient morbidity and mortality, increase the patient’s length of stay in the hospital, and increase overall health care costs,” adds Amber Wood, MSN, RN, CNOR, CIC, FAPIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN).
In addition, patients with HAIs are 60 percent more likely to be admitted to the ICU, thus incurring additional health and economic burdens. Seltzer points to a CDC study that determined that each hospital-acquired SSI costs hospitals up to $34,670 in direct costs.
“This figure has the potential to rise when indirect costs such as increased litigation, decreased referrals, unreimbursed expenses and a patient’s lost wages and potential morbidity are included,” says Seltzer.
Meanwhile, the intangible costs to the patient – like pain and suffering, psychological issues, loss of social functioning and curtailment of daily activities – are difficult to calculate.
A Silver Lining
If there’s any good news when it comes to HAIs and SSIs, it’s that awareness of the problem among OR personnel is increasing.
“Almost every professional program or meeting I attend is addressing this concern,” says Stephen M. Kovach, the director of education for Healthmark Industries in Fraser, Michigan.
“We have definitely seen an increase in infection prevention awareness in the operating room environment,” she says. “Hospitals are increasing their focus on reduction of HAIs, in part due to the significant financial impact at stake as a result of healthcare reform.”
According to Seltzer, 35 states now require hospitals to publically report their infection rates.
“Many hospitals are instituting formal initiatives aimed at reducing particular infections or implementation of preventative protocols,” she says.
Another reason awareness is increasing is because patients are better informed about HAIs due to public reporting, says Wood. “Patients are questioning the infection rates of their providers and health care facilities,” she says. “Also, there has been more emphasis on prevention and monitoring of HAIs due to accreditation and regulatory oversight.”
SSIs and HAIs
According to the CDC, SSIs are the most common cause of HAIs, causing nearly one-third of all infections. Somewhere between 160,000 and 300,000 SSIs occur each year, affecting between 2 percent and 5 percent of all inpatient surgical patients in the U.S.
Wood says that SSIs can be caused by multiple factors. “This makes it difficult to determine the exact cause,” she says.
“Many SSI prevention efforts are focused on bundling multiple interventions,” Wood adds. “These may include antibiotic prophylaxis, screening and decolonization of Staphylococcus aureus, maintaining patient normothermia, maintaining glycemic control, and increased oxygenation of the patient to improve wound healing.”
However, the experts are unanimous when it comes to the most effective steps to infection prevention.
“It should go without saying: Wash your hands and follow aseptic technique,” says Kovach.
“Perioperative team members can help prevent HAIs by performing excellent hand hygiene and providing the patient with a clean OR environment,” Wood adds. Other infection prevention steps she lists include:
- Adhere to best practices for sterile technique, disinfection and sterilization.
- Wear clean surgical attire.
- Minimize OR traffic and door openings.
- Monitor OR temperature, humidity and positive pressure.
“In many situations, infection prevention comes down to addressing the basics,” says Seltzer. “For example, there are crucial guidelines in the AORN Guidelines for Perioperative Practice that should be reviewed and followed. Among these are perioperative patient skin antisepsis, sterile technique and sharps safety.”
Wood lists the following specific AORN Guidelines that address prevention of HAIs:
- Guideline for the Prevention of Transmissible Infections
- Guideline for Environmental Cleaning
- Guideline for Hand Hygiene
- Guideline for Preoperative Patient Skin Antisepsis
- Guideline for Sterile Technique
- Guideline for Surgical Attire
- Guideline for Safe Environment of Care Part 2
- Guideline for Sterilization
In addition to practicing proper hand hygiene, Seltzer stresses the importance of thorough environmental cleaning and proper sterilization of all instruments. “It’s also important to screen patients for disease-causing germs and isolate those with contagious conditions,” she adds.
New Product Solutions
One positive development in the fight against costly infections is the introduction of new product solutions that can help prevent HAIs.
“Healthcare organizations and the healthcare industry continue to innovate in the area of providing new and improved products and methodologies to assist in the prevention and reduction of infections in the OR,” says Seltzer.
For example, Hibiclens from Mölnlycke Health Care is a patient compliance bundle that helps educate patients about the pre-operative showering process.
“Proper education has the potential to improve compliance prior to patients entering the surgical facility,” says Seltzer.
Another example is the Biogel Puncture Indication System, which provides a visual alert to the wearer when a glove perforation occurs.
“Studies indicate that nearly 90 percent of glove perforations go unnoticed during procedures,” says Seltzer.
Kovach says that OR personnel can now test medical devices for organic soils like protein and hemoglobin using HemoCheck and ProCheckII.
“This helps ensure that a device is clean before sterilization takes place,” he says.
Clorox Healthcare has several options to help with HAI and SSI prevention, including nasal antiseptic swabs and a line of disinfectants.
Ultraviolent technology is a growing aspect of disinfection for many health care facilities with products offered by several companies, including Clorox, Spectra, STERIS, Tru-D and Xenex.
The Role of CSP
The role of Central Sterile Processing (CSP) cannot be overemphasized when it comes to infection prevention in the OR.
“It is essential for the CSP staff to build a strong relationship with OR staff,” says Seltzer.
“Although CSP maintains the integrity of instrument sterility, it is the OR staff who can give feedback if they believe, for example, that the parameters of sterility were not met,” she adds. “Building a collaborative relationship will ensure that both areas recognize any opportunities for improvement.”
“It’s all about teamwork,” says Kovach. “Each area needs to understand each other and each department’s processes. Both areas have a direct impact on reducing SSIs and HAIs.”
“In the perioperative setting, we must function as a team with the patient and our colleagues,” says Wood. “We should speak up for patient safety and hold each other accountable on our mission to keep patients infection-free.”
Seltzer says that historically, HAIs were considered to be “bad luck” and were bound to eventually happen.
“Now we can safely say that this attitude has and continues to change,” she says.
“Not all HAIs can be prevented, but many can,” Seltzer adds. “So what we do today in our infection prevention measures matters in terms of what tomorrow’s health care environment will become.”