What is the OR's role in SSI surveillance?
Under the Joint Commission's National Patient Safety Goal 07.05.01 on preventing surgical site infections (SSIs), organizations are required to measure their SSI rates. They also need to provide process and outcome measures, such as SSI rates, to key stakeholders; for example, surgeons and senior administrators. Perioperative nurses play an important…
A Lean process for OR technology
With tighter budgets and long lists of technology requests, organizations need a fair and systematic way to set priorities. At Virginia Mason Medical Center (VMMC) in Seattle, where Lean manufacturing principles are part of the culture, it was natural to apply Lean to the review of new surgical supplies and…
A plan for fixing sterile reprocessing
Every morning when the central service (CS) staff arrived for work, they were greeted by a jumble of unprocessed sets left from the previous day. There were service problems with the OR, and morale was low. “When the first shift came in, there was a never-ending pile of sets. They…
Sepsis, pneumonia after surgery take heavy toll in lives and costs
Two common hospital-acquired conditions, sepsis and pneumonia, killed 48,000 patients and cost $8.1 billion in 2006 alone, according to a large national study. In a separate analysis of outcomes associated with surgery, the researchers found that nearly 20% of patients who developed sepsis after surgery died as a result. Patients…
Total joints: Toward zero infections
The Hospital for Special Surgery (HSS) in New York City has one of the highest volumes of total joint replacements in the world. It also has one of the lowest surgical site infection (SSI) rates. The hospital, which performs about 8,000 joint replacements a year, was recently commended by the…
Keynote: What would Florence do?
When did the health care crisis get to be a crisis? Was it last year with the capital crunch and reimbursement cutbacks? Was it the evolution of managed care and corporate medicine? Does it go back to when Medicare was established? What would Florence Nightingale say about the health care…
CMS anesthesia rules are stiffened
A guest column on regulatory standards. In mid-December, the Centers for Medicare and Medicaid Services (CMS) issued an 18-page Survey and Certification memorandum that clarifies and adds new requirements and interpretive guidelines for anesthesia services in Medicare-certified hospitals. Given the Joint Commission's requirement to mirror CMS regulation, we should anticipate…
With checklist, Michigan ICUs hold infections down for 3 years
The state of Michigan, which used a 5-step checklist to virtually eliminate central-line bloodstream infections in ICUs, has been able to keep the number near zero for 3 years. Peter Pronovost, MD, PhD, a patient safety expert at Johns Hopkins University School of Medicine who developed the checklist, says the…
Preventing S aureus infections: What's needed for screening?
A new study in the New England Journal of Medicine finds that treating patients who are Staphylococcus aureus nasal carriers with mupirocin nasal ointment and chlorhexidine gluconate soap for 5 days reduces hospital-associated postoperative S aureus infection by 60%. "This well-designed, well-executed study contributes more to our knowledge that screening…
SSI prevention: How's your practice?
Preventing surgical infections is what perioperative nursing is all about. From the moment they don a scrub suit and cap, they engage in well-practiced steps to protect patients from harmful micro-organisms. Surgical site infections (SSIs) are a well-known cause of suffering and death. An estimated 500,000 SSIs occur each year.…
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