Archive September 2017 XVIII, No. 9

SSI Prevention: A Bridge Between Infection Prevention and the OR

A late career switch stamping out surgical site infections.

Dan O

Dan O'Connor, Editor-in-Chief


2017 OR Excellence Award: SSI Prevention
peel pouches PICKIES Advocate Christ Medical Center stores an inventory of peel pouches ("pickies") in the ORs for those single instruments that are likely to be flash-sterilized.

After working the 3:00 to 11:30 p.m. off shift in the operating room at Advocate Christ Medical Center in Oak Lawn, Ill., for 32 years, Tracy Haberkorn, RN, BSN, MS, CNOR, went part-time and got a new title 6 years ago: epidemiology coordinator of surgical services. That's a fancy way of saying she's the liaison between infection prevention and the OR at a Level 1 Trauma Center with 28 surgical suites servicing various specialties — such as adult and pediatric cardiovascular services, heart, kidney and lung transplantation, neuro, orthopedics, vascular, thoracic, general, gynecology, urology, robotic, plastic, ENT, ophthalmology and trauma services — that last year performed more than 24,000 surgeries.

The reason for her newly created, 3-days-a-week position? "The hospital was so busy that they wanted to have more collaboration with infection control," says Ms. Haberkorn, winner of the OR Excellence Award for SSI Prevention for her persistence and enthusiasm in driving down infections. Ms. Haberkorn performs surveillance for infections within the surgical division and incorporates the latest standards, according to evidenced-based literature, identifying potential barriers in infection control practices. She rounds in all areas, including day surgery, holding, OR and PACU, to identify potentially unsafe practices and improve them. She reviews departmental policies and updates and educates staff about infection control practices. Among her many accomplishments:

Reduced immediate-use steam sterilization. Ms. Haberkorn began tracking Advocate Christ's flashing rates, which were very high — ranging from the high teens to the low 20s, but nobody paid much attention. "I would do these reports, but they weren't embraced by everybody," she says. Ms. Haberkorn now meets monthly with various hospital leaders, including the business director, sterile processing director, surgical director and the VP of surgical services, to review the IUSS logs and to track trays that were flashed. As a result, the OR purchased more instruments and trays, and stores an inventory of peel pouches ("pickies") in the ORs for those single instruments that may be missing or contaminated, including tissue forceps, scissors, clamps and retractors. All vendor trays or outside instruments are required to go directly to the sterile processing department for reprocessing. Finally, the intraoperative staff begins the cleaning of instruments by making sure all instruments are free from blood, tissue, and bone during each operative procedure, as well as spraying all with an enzymatic foam to help decrease bioburden and biofilm from developing before transport to the Sterile Processing Department (SPD). The IUSS rate is now between 1% to 2% and has consistently been below 3% in 2017. "That might sound high, but for the volume of surgery our hospital does, we're very proud," says Ms. Haberkorn.

Sponsored by BD

Perfect trays. Another key role in the prevention of SSIs is the "March to Zero" collaboration with the SPD to provide sterile trays with zero defects every time for every surgical case. To ensure success with this initiative, all SPD techs are certified and presently attending CIS (certified instrument specialist) training for a deeper understanding of how to clean instruments.

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