Infection Prevention Experts Issue Call-to-Action to Reduce SSIs

A team of infection prevention experts has released a whitepaper, "Educate, Empower, Engage: A Collaborative Interdisciplinary Call-to-Action for Reducing Surgical Site Infections," outlining potential solutions for preventing surgical site infections (SSIs) at healthcare facilities. Co-authored by recognized experts in infection prevention, epidemiology, the operating room and sterile processing, the call-to-action focuses on breaking down barriers and improving collaborative teamwork and communication across each hospital function to improve patient safety and outcomes. Information and recommendations in the call-to-action resulted from the fourth annual Infection Prevention Leadership Summit (IPLS) held in October 2011 and presented by 3M.

 
According to the Centers for Disease Control (CDC), as many as 500,000 SSIs are estimated to occur annually, a rate representing as much as 22 percent of total healthcare-associated infections (HAIs). New 3M research gathered from IPLS attendees showed the barriers to reducing the number of infections may reside within a healthcare facility's workplace culture. Responses from professional healthcare organizations and industry experts indicate healthcare facilities face challenges related to teamwork, communication and collaboration, process improvements and compliance with infection prevention recommended practices on site: 
- More than 50 percent of those surveyed cited teamwork and collaboration as a top challenge, with 40 percent identifying it as a barrier.
- Only 43 percent of surgical staffs receive SSI hospital report cards/dashboards.
- Process improvements were a challenge among 31 percent of facilities.

The impact of these barriers is costly; it has been estimated that SSIs may result in as many as 3.7 million additional hospitalization days and an annual overall cost of $1.6 billion in the United States.

To drive reductions in these statistics, the "Educate, Empower, Engage" call-to-action identifies three areas that, if put into practice, would increase a healthcare facility's ability to reduce SSIs:

 
- Educate: Because healthcare institutions are complex and multi-faceted, personnel training must focus on understanding interactions and relationships across departments, demonstrating personal competency, reporting data and outcomes and utilizing electronic medical records.

 
- Empower: Healthcare institutions must adopt a culture that delineates responsibility and increases accountability among all personnel, not solely leadership.

 
- Engage: Employees should be encouraged to make a psychological investment in patient care, with all disciplines performing their jobs with a level of pride beyond simply achieving formal indicators of success.

 
"If facilities put all three of these disciplines into practice, it would produce positive change toward the goal of preventing SSIs in every patient, every time," says E. Patchen Dellinger, MD, professor, vice chair and chief of the Division of General Surgery at the University of Washington Medical Center. "In the area of infection prevention, we believe we must find ways to implement the 'Educate, Empower and Engage' concepts consistently and universally across functions, so that all disciplines are integrated, horizontally and vertically, toward the goal of eliminating SSIs."

The "Educate, Empower and Engage" call-to-action was the result of a three-day summit focused specifically on reducing HAIs and SSIs. The summit, "All for None: Eliminating HAIs through Knowledge, Collaboration and Leadership," brought together 80 professionals representing infection prevention, surgery, sterile processing and epidemiology. 3M and its partners convened the group to share ideas, network and generate dialogue about possible interdisciplinary steps that can be taken toward the reduction of HAIs, with special focus on SSIs. Expert faculty members presented the latest challenges and emerging trends in the fields of epidemiology, infection prevention, sterile processing and operating room procedures. (The "Educate, Empower, Engage" call-to-action can be viewed at http://bit.ly/ipls_wp)

"The summit and call-to-action helped us outline how best we can work together. It is clear there are opportunities to improve information sharing and processes across teams," says Kathleen Kohut, RN, director of infection prevention for NCH Healthcare System. "Teams must work proactively across departments, share in finding solutions and feel empowered to point out when something needs to be improved."

 
"This is the fourth year we've convened a cross-functional summit of infection prevention experts, and we are proud of work they have produced," says Debra Rectenwald, president and general manager of 3M's Infection Prevention Division. "We challenge healthcare facilities to use these concepts in their strategic planning moving forward."

 
The summit and call-to-action is a collaborative effort supported by an educational grant from 3M and its partners Sage Products, Belimed and Rochester Medical and with participation by the following professional associations: Association of periOperative Registered Nurses (AORN)' Association for Professionals in Infection Control and Epidemiology (APIC), International Association of Healthcare Central Service Material Management (IAHCSMM), National Patient Safety Foundation (NPSF), Society for Healthcare Epidemiology of America (SHEA)' and Surgical Infection Society (SIS).
The "Educate, Empower, Engage" campaign seeks to unite all stakeholders, from the C-suite to hospital staff to patients, while also leveraging the power of unity among societies, such that all are working and communicating collaboratively.

The "Educate, Empower, Engage"  whitepaper emphasizes that, "Comprehensive application of E3 as a guiding discipline can produce positive change toward the goal of preventing SSIs in every patient, every time. This is what patients should expect as they enter the 'surgical home,' and accordingly, what surgical institutional leadership and healthcare professionals and supporting staff must provide. Similar in concept to the medical home, the surgical home is a patient-centric model recognizing that every patient requiring surgery enters a continuum of care that begins at diagnosis and concludes with the return to normal activities."

 
The following is an overview of how the E3 discipline can be applied:

- Educate: Going beyond required didactic courses and certifications. Because healthcare institutions are complex and multi-faceted, training must also focus on understanding interactions and relationships across departments, demonstrating personal competency, reporting data and outcomes, and utilizing electronic medical records. Moreover, institutional leadership must provide the resources and establish a culture that makes this a priority.

- Empower: Adopting a culture that delineates responsibility and increases accountability. In an institution at the top of its game, every discipline and every person within the surgical home feel empowered to carry out their duties, work effectively across teams, and make important contributions. In the healthiest organizations, empowerment also allows a person to speak up without fear of retribution when something is wrong, missed, or when a process can be improved.

- Engage: Making a psychological investment in patient care with all disciplines performing their jobs with a level of pride beyond simply achieving formal indicators of success. This translates to optimum execution getting it right with every patient, every time.

The whitepaper also asks several probing questions to help institutional surgical home leadership, teams and individuals take a hard look at current practices and how to take effective next steps. For those who shoulder leadership and/or direct patient care responsibilities, these questions allow some potentially uncomfortable self-assessments that should result in investments of time and money well worth the outcomes that could be realized.

Overall, based on the SSI challenge still ahead, the authors of the whitepaper emphasize:
- We cannot continue to be satisfied with the current status quo that has not improved HAIs and SSIs specifically over the last 10-plus years.
- We must look at our delivery of care differently and optimally coordinate treatment for the patient from the office to their home.
- We must be more collaborative with each other and break down any remaining silos that have the potential to cause patients harm.
- We must invest in education and collaboration activities and tools (e.g., electronic media records) to strengthen the team approach across the patient's continuum of care.
- Are there also broader mandates that should be considered and supported by all relevant professional and patient organizations including AORN, APIC, SHEA, IAHCSMM, NPSF, SIS and others? What additional collaborative opportunities exist to develop bundles of policies and procedures going beyond required courses and certifications?

As the authors of the whitepaper note further, "Collectively, we must find ways to implement the E3 educate, empower, and engage discipline consistently and universally across functions so that the surgical home represents a place where all disciplines are integrated, horizontally and vertically, to eliminate SSIs. Under circumstances of unwavering support from leadership and committed cross-team communication and collaboration, we may have this opportunity to create the optimum patient experience that indeed does get it right with every patient, every time."

Reference: Educate, Dellinger EP, Dutton RP, Gordon S, Guglielmi CL, Huber LS and Kohut K. Educate, Empower, Engage: A Collaborative Interdisciplinary Call-to-Action for Reducing Surgical Site Infections. Proceedings from the fourth annual Infection Prevention Leadership Summit sponsored by 3M Infection Prevention.

Breaking Down the Barriers to SSI Reduction

ICT spoke with Silvia M. Perez, global business vice president of 3M Infection Prevention Division, about how the "Educate, Empower, Engage concept can improve organizational culture to boost SSI prevention efforts.

Q: What have been some of the most challenging aspects of SSI prevention that hospitals are facing and why?
A: What we have heard from our customers, and specifically from the attendees of the Infection Prevention Leadership Summit, is barriers and challenges to reducing SSIs may reside within a healthcare facilitys workplace culture. Hospitals face challenges related to teamwork, communication and collaboration across disciplines, process improvements and compliance with infection prevention recommended practices on site. There are many reasons why these barriers and challenges exist ranging from lack of education, to accountability or resources. 
3M strengths flow from our unique culture and sense of purpose that enables us to harness the power of collaboration internally and with customers. Our natural curiosity is complemented by our trust in each other and our ability to share ideas freely; we collaborate like no other company. And we extend this collaboration to our customers and their professional associations to create an environment of continuous change to improve patient safety. We became involved in this specific initiative because we heard from our customers that some fundamentals may be overlooked in HAI reduction initiatives.  We are committed to helping break down these barriers and to reducing the risk of infection.  This initiative is just another example of 3Ms commitment to improving patient safety and providing innovative solutions for healthcare professionals across all functions.

Q: How can the Educate, Empower, Engage concept help address these challenges in a time of shrinking budgets, resources and staff?
A: Much of what the E3 discipline encourages facilities to do does not cost more or require additional staff, its more about utilizing your team and resources to get it right with every patient, every time.  Leadership must foster a culture that believes in accountability and transparency with the data and outcomes. Everyone within the organization needs to be committed to personal competency, no matter how large or small their role is. And, its critical to utilize technology and tools to improve and monitor performance.
For many facilities, optimizing the E3 concept to reduce SSIs will save them money and maximize their resources more efficiently if re-admissions or extended stays caused by infections are eliminated.

Q: How can infection preventionists assist OR personnel in SSI prevention efforts?
A: We have heard a few examples and ideas on how infection preventionists can assist various teams with SSI prevention efforts. One example mentioned in the Educate, Empower, Engage whitepaper is to implement interdisciplinary team meeting before and after each procedure. This ensures that all team members connected to the surgery understand all aspects of their individual and cross-functional roles as well as the overall case. They utilize checklists and scorecards to monitor performance which has helped the facility increase education, engage all the key personnel, and empower everyone to perform at their highest level. SSIs have been reduced overall and patient safety has improved.