3. NEBH SSI Rates 2003 – 2010 (outpatient and inpatient infections)

6. Team Intent: Zero Healthcare-associated Infections The teams: SSI, VAP, CLABSI, UTI, MRSA, C.difficile Books: Power Versus Force – David Hawkins, MD 48 Laws of Power – Robert Greene

20. Patient Risk Factors

26. AORN Journal –Nov 2008 Vol 88, Nov. pages 818-820 “ Dealing with Antibiotic Resistant Organisms”

33. Sample of Chlorhexidine Products for Healthcare Use BSI = bloodstream infection; CHG = chlorhexidine gluconate; ICU = intensive care unit; SSI = surgical site infection Product Format CHG Concentration Healthcare Uses Topical solution Sponge applicators Swab sticks Ampules 2% or 3.15% With 70% isopropyl alcohol Skin preparation for surgery, invasive procedures, central lines to prevent SSI and BSI Scrub solution Liquid detergent (sudsing base) 2% or 4% aqueous Preoperative showering/bathing General skin cleansing Washcloth Impregnated single-use washcloth/wipe 2% aqueous Daily bathing in ICU patients Dental solution Oral rinse 0.12% Decontaminate oral cavity (ventilator-associated pneumonia prevention protocols) Gauze dressing Cotton-weave gauze dressing 0.5% with paraffin Wounds or burns Catheter dressing CHG pad or integrated with semi-permeable transparent dressing 2% gel pad or foam disk Peripherally inserted central catheters Central line dressings Hand rub Waterless antiseptic hand gel 1% alcohol based with emollients Hand sanitizer for healthcare personnel (nonsoiled hands)

37. OR Air Current Contamination In teaching hospitals: Surgeon leaves room Resident, Physician Assistant or Nurse Practitioner work on incision Circulating Nurse counts sponges and starts room breakdown Scrub Technician starts breaking down tables and preparing instruments for Central Processing Anesthesia move in and out of room Instrument representative might leave room Visitors may leave room

38. Suture with Staphylococcus colonies Air settling plates in the operating room at the last hour of a total joint case Potential for Contamination of Sutures at End of Case

49. INCISIONAL SKIN ADHESIVE TO PREVENT EXOGENOUS CONTAMINATION TO INCISION DURIN G POST-OP PERIOD

50. Skin Issues in Orthopedics Anterior fusion with tape burns Posterior fusion with contaminated steri-strips Contaminated steri-strips

51. We Do Not Recommend Incisions opened to air with contaminated steristrips Bacteria feed off blood (and sugar) Incisions are in exudative stage of wound healing first few post-op days Sent home on day 3- 4 with incision and underlying tissues starting proliferative stage of wound healing Wounds are susceptible to dehiscence

56. Incisional Adhesive on Total Knee Incision

57. Incisionial Adhesive and AMD Dressing Knee : Sealed with Dermabond, covered with antimicrobial Telfa and a transparent dressing Hip: Sealed with Dermabond, covered with antimicrobial gauze and transparent dressing Healed incision

60. 2008 Standardization: Antimicrobial Dressing (AMD) By Nursing Staff AMD secured with MeFix tape for protection from exogenous contamination and prevention of tape burn Allow skin/incision to create proper temperature beneath dressing to enhance wound healing Protect the incision from exogenous contamination until discharge Protect the incision from trauma Incision protected until discharge and then 48 hrs post-op

61. Knee Dressings with Ace Ace bandage one day post-op with blood strikethrough after drain removed – nurses told to “reinforce” – another reason to have antimicrobial gauze beneath the ace bandage. Initial post-op dressing is usually an ace wrap for compression. AMD gauze are in post-op dressing kits to offer protection to the incision in first two days

62. Spine Service and Shoulders AMD sealed with Tegaderm left on until discharge AMD Island dressing – left on until discharge Rotator cuff (and total shoulders) – Dermabond is being used or an AMD gauze covered by tegaderm – left on until discharge

63. Practices with Limited Supporting Data

67. Our Experience and Evidence

68. OR Cleanup Bundle Approach to Reducing SSI

69. NEBH SSI Rates 2003 – 2010 (outpatient and inpatient infections)

70. Creative and Fun Hand Hygiene Educational Programs Infection Control - $7000.00/year budget

72. Alcohol Foam, Liquid and Hand Wipes All patients receive package of alcohol wipes in admission kit – encourage them to sanitize hands Foam or liquid sanitizer In each patient room, outside rooms, cafeteria and other areas Wash hands often – before eating, before leaving work, after contamination

76. Creative and Interactive Glo-Germ “Bug Beat” Fair Contact Plates

78. 2007

79. 2007

80. 2008

82. Hand Hygiene Observations

84. Thank You