Data and best practices prevent SSIs
Therese Antony, RN, CIC
Weiss Memorial Hospital/Vanguard Health System
Therese Antony facilitated a remarkable reduction in surgical site infections (SSIs) – and a dramatic increase in infection prevention acumen – in her facility’s orthopedics unit by leveraging data, best-practice education and “engineered” work practices.
Weiss Memorial Hospital is a destination center for total joint replacements, performing 5,000 orthodedic procedures annually. Many of these procedures are complex revision surgeries and limb salvage. An SSI in a joint can be devastating, particularly among patients with already compromised joint or limb health.
When Antony joined Weiss Memorial in 2010, the orthopedics unit did not have an SSI prevention program in place; this gave her the opportunity to create a program from the ground up. “It was a double-edged sword,” she said. “Because there had been no surveillance, the early data we gathered challenged some surgeons’ perceptions that there were no infections. It was a shock for them.”
So much of a shock, in fact, that they initially questioned the data’s validity. “It required much patience and education,” said Antony. “NHSN helped me tremendously by validating that we were classifying cases appropriately. Once the surgeons began to trust the data and realized that I was on their side, they became highly motivated.”
Antony created an SSI prevention program incorporating best practices from APIC, Association of periOperative Registered Nurses, and American Academy of Orthopaedic Surgeons, including MRSA screening, nasal decolonization, chlorhexidine gluconate bathing, antibiotic selection, and weight-based dosing. She also worked with staff to engineer practices across patient care, making it difficult to deviate from best practice. Over the past 18 months, Weiss Memorial orthopedic unit has recorded zero MRSA-associated SSIs.
“Team work and convincing staff you are on their side is key in any infection prevention initiative,” said Antony. “Provide good data and let that drive the decisions.”
Antony sees increasing acknowledgement of the value of infection prevention. “Doctors used to say, ‘We can prevent some infections, but they’ll never be zero.’ That attitude is really changing.”