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A 75% return rate on any survey is terrific, but when this is the average return rate for a monthly survey that goes to surgeons, you wonder why the physicians take the time to complete them.
"Our physicians have seen the importance of monitoring surgical site infection rates," says Farrin A. Manian, MD, MPH, chief of infectious disease division at St. John’s Mercy Medical Center in St. Louis. Monthly reports that show overall rates and incidence of surgical site infection as well as twice a year confidential reports that display surgeon-specific information have been well received by the medical staff, he says.
The surgery department at St. John’s handles inpatient and outpatient surgery in the same operating rooms, but more than 60% of the procedures are outpatient, says Manian. While the infection rate for inpatient surgery at the facility between 1988 and 1985 was 1.4% and the rate for the same period of time for same-day surgery was only 0.13%, or one-tenth of the inpatient rate, it is critical that same-day surgery programs have some way to measure surgical site infections, he says.
A monitoring program gives a same-day surgery staff an opportunity to be proactive when controlling infections, says Manian. With more complicated surgeries, such as cholecystectomies and herniorraphies, moving into the same-day surgery program, there are greater risks of infection, he explains. "A good monitoring program gives you a chance to investigate potential problems before they become big problems," he adds.
Once a month, St. John’s 300 surgeons receive a list of patients who have undergone surgery during the previous one to two months, says Manian. The only question the surgeon must answer for each patient is, "Did you observe a surgical site infection?"
If the answer is no, the infection control staff takes no further action. If the answer is yes, a member of the staff calls the surgeon to obtain more details, he says. "In addition to talking with the surgeon or his staff, we pull the patient’s medical chart and review lab reports, operative notes, and any other documentation that give us information on what happened while the patient was with us," adds Manian.
Specific items that are evaluated include the type of procedure, any lab reports on the infection, antibiotics used during and after surgery, and any risk factors identified by the surgeon or anesthesiologist prior to surgery, says Manian. The infection control staff prepare monthly reports that show overall infection rates and discuss any problems identified during the month. These reports are shared with surgery staff and physicians in regular staff meetings, he says.
The monitoring program at St. Alexius Same Day Surgery Center in Bismarck, ND, is run differently. "We send a questionnaire for each patient to the surgeon’s office the day after surgery," says Sandy Berreth, RN, director of the surgery center. "The questionnaire is placed on the patient’s chart, and the physician completes it during the patient’s first post-op visit," she explains.
Five questions are asked on the form:
If the physician answers yes to any question, there is a place for further explanation, says Berreth. The surgeon’s office staff mail the forms back to the surgery center. Since she receives the questionnaires, Berreth handles any follow-up questions with the physician.
A simple process is necessary, says Berreth. "We have a high rate of return for our questionnaires; in fact, we have many months with 100% return," she says. A simple form and the surgeons’ desire to make sure their patients are at low risk for infection when they come in for surgery are the main reasons for the successful return, she explains. "Our physicians are just as interested in infection control as my staff, and they know that monitoring infection rates gives us a chance to identify and solve problems early," she adds.
One reason for the success of his monitoring program is his own visibility, says Manian. He is an epidemiologist, but even if you don’t have a physician who specializes infectious diseases, a physician should head up the program, he says. "The physician should be visible and demonstrate respect for the confidentiality of the data and a commitment to providing good patient care," he says. Many of Manian’s conversations with surgeons occur informally as he runs into them in the surgery department or physician’s lounge.
"It is important that the surgeons see me and know that I understand what they are doing," he adds. "This accessibility and visibility has built a trust between surgeons and the monitoring program," Manian adds.
For more information about staff involvement with infection control, contact:
• Sandy Berreth, RN, Director, St. Alexius Same Day Surgery Center, P.O. Box 4046, 810 E. Rosser Ave., Bismarck, ND 58502-4046. Telephone: (888) 495-5005 or (701) 530-5049.
• Sherron Kurtz, RN, MSA, CNOR, CNAA, Director of Perioperative Services, Henry Medical Center, 1133 Eagles Landing Parkway, Stockbridge, GA 30281. Telephone: (770) 389-2355 or 2357. Fax: (770) 389-2158. E-mail: Skurtz@hmc-ga.org.