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Same-day surgery programs need a thorough screening mechanism for tracking infections because procedures such as breast surgeries and orthopedic surgeries are prone to wound infections, accreditation surveyors suggest.
"Know how many infections you’re having, and what types of surgeries they’re coming from," advises Sheryl Walker, MD, medical director of The SurgiCenter of Baltimore, and a surveyor for the Skokie, IL-based Accreditation Association for Ambulatory Health Care (AAAHC).
The SurgiCenter sends a monthly letter to its physicians along with a list of the patients they’ve treated that month and the procedures they underwent. (See sample letter, p. 63.) The physicians list any wound infections and complications associated with those cases.
While AAAHC standards don’t require the use of this tool, they do require a process for monitoring infection control, Walker emphasizes. "Only with that type of tracking mechanism can you evaluate whether you have a problem." Don’t rely on the surgeons to volunteer the information without any prompting from the same-day surgery program, she warns. "They’re busy, and they don’t always tell you there’s a problem."
At the SurgiCenter, every infection is monitored with a quality improvement (QI) tool. (See Investi-gation of Wound Infections form, inserted in this issue.) The staff evaluates the patient’s chart and the process used during the procedure to determine whether there were any predisposing factors to infection. The QI tool is used to document the classification of the wound, whether a culture was done intraoperatively, whether there was a break in sterile technique, etc. Corrective measures include steps such as re-educating staff and surgeons on sterile techniques, Walker says.
Monitoring infections isn’t the only problem for same-day surgery programs. Hospital-based programs often struggle with taking action to prevent or reduce risk of nosocomial infection, says Ann Kobs, MS, RN, former director of the department of standards and current sentinel event specialist for the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. Between January and June 1998, 6.2% of facilities surveyed received a score of 3, 4, or 5 for IC.4: Action to prevent or reduce risk of nosocomial infection.
"We look to see that you’ve decreased the nosocomial infections over time, and also that you’ve got one activity aimed at preventing nosocomial that might go from patient to employee," Kobs says. If your program has complied with the Hepatitis B plan from the Occupational Health and Safety Administration, you’re in compliance with the Joint Commission standard, she says.
Another important piece of the Joint Commission standards for hospital-based programs is to have someone qualified as an infection control practitioner and have a way of supporting that person in their initiatives, Kobs says. Infection control practitioners often wear several hats, she points out.
"We’re looking at things in terms of software for computers so that you can do your job in a more efficient manner," she says.
[Do you have an accreditation tip you’d like to share or a question for the surveyors? Contact: Joy Daughtery Dickinson, P.O. Box 740056, Atlanta, GA 30374. Fax: (404) 262-5447. E-mail: firstname.lastname@example.org.]