Preventing Surgical Site Infection in the OR: A Comprehensive Approach to Point-of-Use Instrument Care

Lisa Pawlowski, DNP, MSN-Ed, RN, CRMST, presents a poster at the HSPA COnference, 2024, in Las Vegas, NV.

Surgical site infections (SSIs) pose a serious threat to patients and healthcare systems and can be very expensive to treat. One potential cause of SSIs is contaminated surgical instruments. Reprocessing reusable medical devices (RMDs) is a complex, highly regulated process that involves multiple steps and must be carried out in a controlled environment by specially trained technicians. Any error or oversight during the reprocessing of RMDs can put patients at risk of harm.

In some cases, specific steps of the medical instrument reprocessing process are carried out in the operating room (OR), near the point-of-use and the medical instrument storage area. The problem is that clinical staff may need help understanding these reprocessing steps and the standards, recommendations, and instructions from different sources, which can often be conflicting.

To look at this concerning situation, Lisa Pawlowski, DNP, MSN-Ed, RN, CRMST, from the Cheyenne Veterans Administration Healthcare System, presented a poster titled “Implementing an Evidence-Based Bundle for Point-of-Use Instrument Care to Reduce Surgical Site Infection Rates in Operating Room Patients” at the Healthcare Sterile Processing Association (HSPA) Annual Conference in Las Vegas, Nevada, from April 20 to April 23, 2024.

“The purpose of this project was to implement an evidence-based bundle for post-use care of instruments and instrument storage that considered standards, recommendations, and evidence-based practices,” Pawlowski wrote. The purpose is to ensure staff tasked with these instrument reprocessing use critical thinking to make decisions in daily practice with instrument safety in mind.”

The project was successful: After monitoring the clinical site for 8 weeks, no surgical site infections (SSIs) were recorded. The SSI rate for the previous quarter was 0.3%.

How was it done: OR staff participated in a concept-based education course to focus on reprocessing RND used in the OR. This project used the Switch Change Methodology to “ensure logical, emotional, and environmental components were addressed,” the author wrote.

The OR staff followed the reprocessing of RMD from point-of-use through the reprocessing stages. These included pretreatment, decontamination, cleaning, inspection, packaging, sterilization, and storage. They also participated in each step under the supervision of a certified sterile processing technician.

“The methodology of this project was selected with an emphasis on the sustainability of the improvement as OR staff at the clinical site typically discuss point-of-use instrument care annually during competency evaluation,” the author explained. “The methodology was also derived from the Switch Change Framework, which focused on process, environmental, and human factors. While previously point-of-use instrument education focused solely on the process, the addition of addressing the human and environmental factors may have improved the sustainability of the intervention.”

Pawlowski conducted this study to examine whether developing and implementing a practice bundle based on evidence for SSI prevention can reduce the incidence of SSIs in adult veteran surgical patients over 8 weeks. After the study was concluded, the nonconformities with post-use instrument care and storage decreased. Following implementation training, the OR staff could communicate the requirements for instrument care at the point of use during post-assessment.

The author wrote, “The sustainability of this project is promising. However, this will depend on the ongoing commitment to patient safety and high reliability.”

Find other coverage from HSPA 2024 and previous years here.