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SSI: FYI

How Mary Greeley is working to prevent surgical site infections … and what patients can do to protect themselves.

Your surgery went great.

You recovered for a  few days in the hospital and then returned home relieved that everything went as you hoped. Then the site of your incision started feeling odd. It was red and warm to the touch. You consult your post-surgery instructions and promptly call your primary care physician. At a follow-up appointment it is determined that you, unfortunately, have a surgical site infection.

According to the Centers for Disease Control (CDC), a surgical site infection, or SSI, is defined as an infection that occurs after surgery in the part of the body where the surgery took place. It can result in a simple treatment to address the infection, or, in rare cases, readmission to the hospital and possibly another surgery.

Most surgical patients do not develop SSIs, but there is always a chance of infection with surgery. Infections can develop in the OR, the patient’s hospital room or, in most cases, the patient’s home. Mary Greeley is taking strides to help prevent SSIs. There are also several steps that patients can do to protect themselves. 

Leann Hillier, MPH, BSN, RN, infection preventionist at Mary Greeley, is one of several members of a medical center task force created to help prevent SSIs.

“Surgical site infections can cause several issues for the patient,” says Hillier. “The most obvious one is pain and discomfort at the surgical site. Depending upon the severity of the infection, sometimes a patient can be readmitted to the hospital."

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Dr. Benjamin Schlicher, McFarland Clinic general surgeon, is part of a task force put in place by Mary Greeley to help prevent surgical site infections.

“Surgical site infections are something that can happen with any surgery and with any patient,” Schlicher notes. “There are several things that a patient can do pre-operatively to help prevent surgical site infections. There are also a couple of risk factors that often patients have and if we are able to improve those risk factors, we can decrease their risk of surgical site infection.”

NO PLACE LIKE HOME

Colon surgeries typically have a higher rate of surgical site infections, specifically colon resections.

“When a person undergoes colon surgery of any sort, you’re dealing with an area of the body that includes fecal matter,” Hillier says “We know that material carries bacteria so we have to be especially careful during those surgeries to ensure an infection doesn’t occur.”

Due to the fact that the risk of an SSI is higher with colon surgeries, Mary Greeley’s Home Health Services now offers home visits to patients undergoing those surgeries, both before and after the surgery. For example, a Home Health aide may help a patient prepare for surgery the night before, including showering and making sure there are clean linens on the bed.

A Home Health nurse can visit a patient after being discharged to make sure the patient understands their discharge instructions, medications, and signs and symptoms of any post-op complications. The post-op visit is provided to patients free of charge.

The visits are not mandatory, but since being implemented in October 2016, more than 70 percent of colon surgery patients have utilized the service and the rate of SSIs among those patients has decreased. 

One such patient was Gilbert resident, Leticia Linhares, who had a colon resection late last year. She was visited by a Home Health nurse after her surgery.

“I was so glad when she came,” Linhares recalls of the home health nurse. “I was actually a bit worried about my incision and one of the first things the nurse did when she got there was check it. She assured me that everything was fine, which made me feel much better.”

Linhares also remembers the nurse helping manage her pain. “I was taking some pretty powerful pain medication that was causing me to not feel well. The nurse helped me create a schedule using just Tylenol so that I could feel better, but stay on top of the pain as well,” she says.

The same nurse called Linhares after that initial appointment to make sure everything was going okay. “I so appreciated that call. It made me feel like she genuinely cared about my well-being.”

Les White, MPA, BSN, RN, Home Health clinical services manager, noted that while the visit is offered to every-one, there are various factors at play in regards to whether or not a patient takes them up on the visit. 

Some leave the area to stay with family, some are health care providers themselves, some we are unable to reach after they’ve been discharged, and some patients simply decline,” White says. “The important thing though is that this service is available and the patients who are taking advantage are seeing the benefit.

White notes that the post or pre-surgical home visit can result in additional services being offered if staff identifies issues within the patient’s home. Potential issues may include:

  • Various safety concerns, specifically in regards to moving about or bathing
  • Risk of falling
  • Inability to manage medications
  • Inability to manage incisional/wound care
  • Difficulty performing basic personal hygiene

A STERILE ENVIRONMENT

It’s no surprise that the operating room is one of the main focuses for SSI prevention. Several steps are done before the surgery, or pre-operatively (pre-op) and during the surgery, or intra-operatively (intra-op).

“If you are a surgical patient, 30 to 60 minutes before your incision is made, you will be given an antibiotic,” explains Hillier. “Research shows that this helps decrease the chance of infection. That antibiotic will be stopped within 24 hours of the surgery so that we don’t create an antibiotic resistance.”

Other pre-op steps include keeping the patient warm, which promotes healing; clipping hair around the surgical site instead of shaving prevents nicks in the skin which can increase the risk of infection; and the use of CHG bathing.

“CHG stands for chlorhexidine gluconate and is essentially a special chemical found in soap that kills germs,” notes Hillier. “Surgical patients are given CHG soap and encouraged to use it in the shower the night before their surgery and then after the surgery as well.”

Hillier added that the CHG in the soap kills germs that may be living on the surface of the skin, thus helping decrease the risk of infection.

Intra-operatively patients are also kept warm and their antibiotic is continued. One of the things that has been implemented at Mary Greeley is something referred to as the “closing corner.”

“With the closing corner, we’re essentially using two different sets  of instruments and drapes,” says Margaret Liston, MPA, BSN, RN, director of Surgical Services at Mary Greeley. “We use one tray of instruments and drapes at the beginning
of the surgery and during the surgery, but before we close the incision we change gloves, and, if necessary, gowns. Then we redrape and use a new sterile instrument tray.”

This technique ensures that there is no cross-contamination.

Liston also outlined what is expected of OR staff in regards to maintaining a sterile environment.

“Our staff must wear a jacket, and their hair and ears must be covered. We also do not allow cell phones in the OR,” she says.

As an added safety feature all scrubs at Mary Greeley are laundered by Midwest Healthcare Textile Services (MHTS). This is significant because MHTS has been accredited by the Healthcare Laundry Accreditation Council (HLAC), which ensures that anything laundered by them remains hygienically clean. 

HOMEWARD BOUND

Appropriate post-surgical care at home is important, and in most cases the responsibility of patients and their caregivers. 

“Every surgery, and surgeon, for that matter has different discharge instructions,” said Nicole Stupp, BSN, RN, Mary Greeley medical/surgical clinical resource nurse. “Regardless, we’ll come in and go over the instructions and patient education with you. We’ll let you know how often you should change your dressing, talk about hand hygiene and anything else that’s been noted by your doctor. We want you to feel comfortable and
confident when you go home.” 

SSI Prevention: What Can Patients Do?

“It’s important to note that patients play a role in helping prevent surgical site infections as well,” says LeAnn Hillier, infection preventionist at Mary Greeley.

“There are a number of things that patients can do both pre-operatively and post-operatively to help lower their chances of getting an infection.”

Hillier suggests that surgical patients do the following for the night before a procedure:

  • If indicated by your physician, bathe using the CHG soap kit
  • Make sure the towel you dry off with is a clean towel and has not been used for previous showers.
  • Put on clean pajamas and have clean linens on your bed.

There are other lifestyle factors that can help prevent the occurrence of surgical site infections: 

  • If you are diabetic, make sure your blood sugar is in check. Stable levels help your tissues to heal more quickly.
  • Practice good nutrition. It can improve healing.
  • If you smoke, quit. Not smoking can also improve healing.

Lastly, if not feeling well prior to surgery, make sure you tell your physician.
“Patients sometimes don’t want to put off their surgery, so even if they aren’t feeling well, they may not let their doctor know,“ explains Hillier. “What many don’t realize is that by doing this, you are increasing your risk of infection. Surgery puts stress on your body and if you are already sick prior to it, you run the risk of ending up even more sick.“
The following steps should be done post-op:

  • Before leaving the hospital, make sure you know how to change your dressing and how often to change it. Make sure anyone helping you at home knows this information as well.
  • Practice good hand hygiene at home, especially when changing your dressing. Make sure anyone helping you at home does the same thing.
  • Watch for signs of infection which can include: redness around the incision, sore or hot to the touch, pus or drain-age from the incision site, fever/chills or an odor coming from the incision.