Q: How do you get people to take hand hygiene more seriously?
Lou Ann Bruno-Murtha — It requires persistence, continuous monitoring and feedback. After some initial failures, we instituted greater accountability by having our hand hygiene champions enter into a database the name of the person being observed. Compliant staff members get an automated e-mail thanking them for preventing infections and keeping our patients safe. Non-compliant staff and their managers get a series of e-mails, depending on how many instances of non-compliance are observed. The first clarifies policy and expectations and invites their input. The second includes a PowerPoint training module and an invitation to meet for further education. The third, if necessary, is a discussion with their manager or chief about developing a performance improvement plan. Fortunately, to date, no one has received the third notification. The approach worked. We've been able to achieve and sustain our goal of greater than 90% compliance.
Q: Should you screen every patient for Staphylococcus aureus?
Lou Ann Bruno-Murtha — It's burdensome to do it on every patient, so use a targeted approach by screening patients who are most vulnerable — the ones for whom an infection would be a nightmare. For us, those are patients having prosthetic joint surgery and vascular patients receiving implants. We also encourage surgeons to consider screening other patients based on their health histories or risk factors. Screening OR staff shouldn't be routine, but if you identify an increase in S. aureus infections due to a strain with a similar antibiotic susceptibility profile, you must consider the possibility that a team member could be a carrier. If that happens, you may need to screen staff.
Q: How important is prophylactic antibiotic therapy?
Lou Ann Bruno-Murtha — This can be very effective in the fight to reduce SSIs, but there are a lot of variables that need to be understood. Re-dosing and weight-based dosing can be especially challenging, particularly when you're dealing with obese patients. Also, it makes sense to find out whether patients are really allergic to penicillin. Avoiding antibiotics is a disservice to patients who don't have anaphylactic penicillin allergies, since alternative therapy may be less efficacious. Also, vancomycin is often used as an alternative for cefazolin in penicillin-allergic patients, but vancomycin needs to be infused slowly, which can delay patient throughput.
Q: Do you advocate pre-op bathing?
Lou Ann Bruno-Murtha — The evidence supporting universal adoption is still lacking, provider practices vary greatly and there's no standard set of directions for patients. No wonder healthcare providers are confused. But there's sufficient rationale to use chlorhexidine-impregnated cloths both the night before and morning of surgery. The cloths are key because most people who use the soap immediately rinse it off. Tell patients how to use the cloths, and emphasize that they should wipe their entire bodies from the chin down, not just the surgical site, because it's easy to transfer bacteria from one location on the body to another.
Q: What's an example of the kind of SSI threat people don't always think about?
Lou Ann Bruno-Murtha — It's easy to overlook, but you need to have a policy in place when it comes to receiving, cleaning and sterilizing loaner equipment. We've had to tell many vendors that the items we were getting from them were unacceptable. No equipment should come into your facility dirty or pose a risk for transmission of bloodborne pathogens to your sterile processing staff. Containers for loaner equipment should also be inspected for cleanliness.