Surgeons and other health care professionals have been working to reduce and prevent health care-associated infections (HAIs), including surgical site infections (SSIs); however, individual efforts alone can only go so far. The hospitals where these surgeons and physicians work must address the problem with a strategic, system-wide program. An updated HAI compendium provides practical recommendations to assist hospitals in implementing and prioritizing their efforts regarding this issue with a multidisciplinary approach.
A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals is a free guide from The Joint Commission and several other partners, including the Society for Healthcare Epidemiology of America (SHEA), which has been updated to accelerate the adoption of important evidence-based practices known to be effective at addressing HAIs and SSIs.
The role of surgeons
According to the updated compendium, a vital element of preventing HAIs is for surgeons and health care professionals to be accountable, as accountability provides the necessary translational link between science and implementation. Without clear accountability, scientifically determined implementation strategies will be used in an inconsistent or fragmented way, decreasing their effectiveness in preventing HAIs.*
Surgeons and health care professionals can improve their accountability for SSI prevention efforts by:
- Complying with appropriate antimicrobial prescribing practices before and after surgery
- Following protocols for hair removal, preoperative skin disinfection, and control of blood glucose levels in cardiac patients
- Using a checklist based on the World Health Organization’s specifications to ensure compliance with best practices to improve surgical patient safety
- Complying with hand hygiene practices, both individually and by observing and correcting the hand hygiene practices among other members of the operating room team
- Implementing postoperative surveillance by reviewing microbiology reports, patient medical records, surgeon and patient surveys, and by screening for readmissions or returns to the operating room
- Educating patients about SSIs and their role in the prevention of this type of infection through SHEA’s related patient guide.
Surgeons should also be provided with regular continuing education opportunities directed at minimizing SSIs. Routine auditing and confidential feedback on SSI rates and adherence to process measures should be provided to individual surgeons as well as to the surgical division, department chiefs, and hospital leadership.
Recommended implementation strategies
The updated compendium includes a new implementation section with examples of strategies that may be used to reduce and prevent SSIs. These strategies reference SSI resources from The Joint Commission, including the Joint Commission Center for Transforming Healthcare’s Surgical Site Infections project† and The Joint Commission’s Implementation Guide for NPSG.07.05.01 on Surgical Site Infections: The SSI Change Project.‡
The recommended implementation strategies may be applied in specific locations or patient populations, or they may be carried out hospital-wide, depending on the outcome data, risk assessment, and/or local requirements. The strategies are organized into four stages based on key concepts: engagement, education, execution, and evaluation, the details of which follow:
- Engagement phase: Clear and effective communication as to the reasons why SSI implementation strategies are important for patient care are disseminated
- Education phase: Education pertaining to practices to prevent SSIs is essential for senior leadership, physicians, nurses, patients, and their families
- Execution phase: Deployment of quality improvement methodology, information technologies, and recommendations on the use of preoperative/postoperative order sets
- Evaluation phase: The focus in this phase is on the use of measurement and evaluation tools to determine the effectiveness of implementation strategies in the prevention of SSIs. Performance improvement tools, observations of evidence-based practices, and longitudinal evaluations of SSI rates and compliance rates are completed
Together, surgeons can work with their hospitals to implement a HAI program that engages and educates surgeons, while also incorporating recommended strategies to best reduce and prevent SSIs.
Access the updated compendium.
For more information on SSIs, visit The Joint Commission’s HAI portal.
*Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. Accessed October 1, 2014.
†The Joint Commission.Joint Commission Center for Transforming Healthcare: Reducing Colorectal Surgical Site Infections. May 1, 2013. Available at www.centerfortransforminghealthcare.org/assets/4/6/SSI_storyboard.pdf. Accessed October 1, 2014.
‡The Joint Commission.The Joint Commission’s Implementation Guide for NPSG.07.05.01 on Surgical Site Infections: The SSI Change Project. December 3, 2013. Available at www.jointcommission.org/implementation_guide_for_npsg070501_ssi_change_project/. Accessed October 1, 2014.