The final National Patient Safety Goal (NPSG) that deals with a specific infection is NPSG.07.05.01, concerning surgical site infections (SSI). As with NPSG.07.03.01 and NPSG.07.04.01, accredited facilities must meet specific requirements at certain points throughout the year.
As with the previous two NPSGs, the first milestone expected by The Joint Commission was for a facility's leadership to assign a person to oversee and coordinate the development, testing, and implementation of this NPSG by April 1, 2009. In most facilities, leaders will assign this responsibility to the infection preventionist (IP), epidemiologist, or an infection control (IC) consultant.
By July, this designated person should have a defined work plan in place that identifies resources, accountability, and a timeline for fully implementing this plan. The hospital must pilot test this plan in one clinical unit by October 1 and fully implement it across the facility by January 1, 2010. Hospital leaders should make the person who manages the SSI program responsible for ensuring that the facility implements an active program for identifying SSIs, analyzes data about them, and regularly provides information to those people who can use the information to improve the quality of care. The person must also see that the hospital incorporates evidence-based practices into the program.
Evidence-based guidelines that hospitals should implement in their SSI program include:
- Perioperative glucose control (with cardiac procedures)
- Preoperative showering
- Surgical skin antisepsis
- Judicious use of implants
- Flash sterilization
- Aseptic technique
- Surgical technique
- Postop dressing
IPs can find advice on preventing SSIs in APIC's Guide to the Elimination of Mediastinitis Surgical Site Infections. Key points for preventing these infections-recommended in this guide and by other industry leaders-that you may want to consider for other major surgeries as well include:
- Flash sterilization. Hospitals should avoid instrument flashing, and staff members should close the containers used for flashing to prevent contamination, regardless of the proximity of the autoclave to the operating room (OR).
- Postoperative dressings. Staff members should leave dressings intact for a minimum of one to two days to promote healing and prevent contamination and disruption of the moist healing environment.
- Blood glucose control. Postop blood glucose levels should be below 200mg/dL by 6 a.m. on postop day one and 6 a.m. on postop day two.
- Preoperative hair removal. Staff members should remove hair by clippers as close to the time of surgery as possible, but not in the OR suite, where there is a risk of carrying skin and hair cells onto the sterile field via air currents. Also, if hair is not removed and staff members use an alcohol-based skin preparation, the OR staff must ensure that the alcohol absorbed by the hair shaft has time to dissipate prior to draping the patient to avoid the possibility of a fire.
Source: Briefings on Infection Control, September 1, 2009, published by HCPro, Inc.