Continuous Environmental Disinfection in the OR: A Case Study - - PowerPoint PPT Presentation

Continuous Environmental Disinfection in the OR: A Case Study

Objectives

Discuss our TJR SSI prevention journey Discuss risk factor mitigation strategies:

• Patient Related
• Pre-operative
• Intra-operative
• Post-operative
• Post Acute

Discuss our experience with continuous disinfection technology

Maury Regional Medical Center

• a 255-bed facility serving more than 200,000 people in

southern Middle Tennessee

• Part of a three hospital system that includes outpatient surgery

centers, numerous physician practices, and additional facilities across southern Middle TN

• Performs more than 900 TJR each year
• Goal of zero surgical site infections

Background

It has been well documented that surgical site infection (SSI) after lower extremity total joint replacement (TJR) produces devastating complications that can take months to heal. The combination of the length and complexity of the surgery along with the presence of an implant puts these patients at high risk for SSI. Even with improvements in surgical techniques and implant designs, periprosthetic joint infection (PJI) continues to remain a major cause

• f implant failure and need for revision.

Around 1 million TJR performed each year Infection rate of the implant is appx. 1% Maradit Kremers H, et al. Prevalence of total hip (THA) and total knee (TKA) arthroplasty in the United States. Presentation at: American Academy of Orthopaedic Surgeons Annual Meeting; 2014; New Orleans, La.

Our Surgery Program according to Carechex

Why does one infection matter?

SSI involving implants are often not adequately treated with a single procedure.

• Requiring multiple operations and antibiotics.
• It is difficult to eradicate a pathogen within a prosthetic device.

Risk Factors – Patient Related

• Comorbidities such as:
• Diabetes
• Immunocompromised status
• Obesity
• Cigarette Smoking
• Personal Hygiene
• Home Environment

Pre-operative Infection Prevention

• Test for intranasal MRSA/MSSA
• Home chlorhexidine (CHG) applications
• Nasal decolonization
• Blood glucose control
• Cessation of tobacco use
• TJR Education

Pre-surgery:

• Clippers for hair removal – prior to OR
• CHG application

Pre-op/Intraoperative Infection Prevention

• Antimicrobial prophylaxis
• Correct antibiotic and dose for

weight ü Attention to local resistance

• Infusion timed for maximum tissue

saturation at time of cut

• Vancomycin for MRSA + patient
• CHG prep – appropriate amount, let

dry

• Redose if appropriate according to

antibiotic half life

• Attention to temperature and glucose

Intraoperative Infection Prevention

• Surgical environment
• Restricted areas - foot traffic, doors

being opened when case opens

• Room ventilation – positive pressure;

air exchanges

• Surgical attire – scrubs, warm-up

jacket, masks, hoods, caps

• In between case and terminal cleaning

process revamp to standardized work

• Quality checks with fluorescent

marker and UV flashlight

Postoperative Infection Prevention

• Silver technology dressing applied in OR
• Dressing not changed unless drainage

mandates

• Necessary dressing changes done using sterile

technique

• Patient education regarding leaving dressing

intact

Post Acute Infection Prevention

• Home Health and Skilled Nurse Facility

Education

• Do not remove dressing unless

drainage mandates

• Call surgeon for any issues with

incision in the first 7 days

• Ensure SNF, HH has orders for how

and when to change dressings

• Ensure SNF, HH stocks silver

technology dressing for changes in first 7 days

What more can we do?

Review of data regarding air quality and contamination

• Staph aureus is common pathogen

for SSI

• Staph aureus is common pathogen
• n healthcare workers hair and skin.
• 10 million skin particles are shed

from skin every day

• The act of walking releases 1,000

skin particles per minute

• approximately 10% of skin cells

carry viable microorganisms that can pose a threat of SSI to perioperative patients

Partnership with Indigo-Clean

• UV light for disinfection has

been used for years in other applications

• Automated disinfection

technology

• Does not require additional

staff to operate

• Continuous disinfection when

unoccupied and occupied

• Not harmful to healthcare

workers

• ~500 sq. ft.
• Primarily used for
• rthopaedic applications
• Sampling conducted over

30 day period in two rooms

• 15 days prior to

installation

• 15 days after installation
• Contact agar (BPA)

media used

• Sampling performed on

M, W, F of each week

• 50 samples per room per

sampling day

Study Design

Installation

View at 5am

Lights are on a motion detector and timer. When the room is unoccupied for 30 minutes, the lights automatically switch from mixed white disinfection mode to Indigo disinfection mode

Study Design

Samples taken after terminal clean and before first biomed entry of the day 25 sites per OR, 2 culture plates per site combination of high touch and static sites

Surface pictures and description of high touch areas *highest colony counts Door Handle* Front of Anesthesia Screen* Boom Light* Control Nurses chair* Top of Computer*

Surface pictures and description of culture areas Front of Bovie Machine Mouse Keyboard Inside phone handle Door handle To gloves Anesthesia Chair arms L & R Anesthesia desk Top of IV warmer Lower corners of Anesthesia machine Top of syringe bin Handle of fluid Collection machine

Study Results

100 200 300 400 500 600 700 800 900 4-Oct 5-Oct 6-Oct 7-Oct 8-Oct 9-Oct 10-Oct 11-Oct 12-Oct 13-Oct 14-Oct 15-Oct 16-Oct 17-Oct 18-Oct 19-Oct 20-Oct 21-Oct 22-Oct 23-Oct 24-Oct 25-Oct 26-Oct 27-Oct 28-Oct 29-Oct 30-Oct 31-Oct Total Colony Count OR1 OR2 Linear (OR1) Linear (OR2)

Lights installed

Clinical Results for Indigo-Clean

“Compared to the baseline, we saw an average, daily reduction

• f 88% in the
• perating room

where Indigo- Clean was installed despite the fact that the room was used 54% more than in the baseline period.”

• Lynnelle

Murrell, Director, Infection Prevention, Maury Regional Hospital

Conclusion

• SSI prevention requires multiple activities throughout

the entire perioperative and postoperative time.

• We have to keep asking “What more can we

do?”

• Indigo-Clean lights provide another means of

protection for our patients by continuously reducing bacteria in the OR environment

• Continuous disinfection may provide greater benefit in
• utcomes when paired with a robust SSI prevention

program

• Further study needed regarding outcomes, and
• ngoing degrees of contamination and disinfection

during OR use.

For More Information Contact Lynnelle Murrell @ lymurrell@mauryregional.com