scholarly journals Targeting Zero-Preventing Surgical Site Infections by Reducing Immediate-Use Steam Sterilization (IUSS)

2020 ◽  
Vol 41 (S1) ◽  
pp. s402-s402
Author(s):  
Jill Holdsworh ◽  
Zach Juno ◽  
Patty Rider ◽  
Taviana McClendon ◽  
Billy Key

Objective: To reduce the number of immediate-use steam sterilization (IUSS) cycles performed to below 2% to increase patient safety and decrease surgical site infections (SSIs). Methods: The facility decide to make a “hard stop” date at which IUSS cycles were no longer going to be allowed without operating room (OR) and Sterile Processing Department (SPD) leadership approval, based on standardized indications for IUSS cycles. Before the start date, extensive education was given to surgeons, OR clinical teams, and SPD team members to ensure understanding of the process and risk of infection due to IUSS. The facility also recognized that workflow was a large part of why instruments were being sent through IUSS cycles, due to a backup of sets in the department and because some items could not be processed before the next day. Many items were purchased to increase workflow capabilities: such as a new washer, sonic, adding a pass-through window, a low-temperature sterilizer, Also, 3 sterilizers were replaced with newer, more efficient models. The facility also purchased a large number of instruments to create new and additional trays to accommodate the surgical volume. The SPD also underwent LEAN Kaizen events on both the clean and dirty sides to improve workflow and efficiency to prevent further IUSS. Project Results: The facility saw immediately results in reduction of IUSS cycles being performed and were the department was able to drop below the goal of 2% after the first month of using the new process. The rate has continued to be <2% for >5 months. Communication and partnership between the OR, infection prevention staff, and SPD were beneficial and will continue to move the facility forward in a shared decision-making model as improvement continues in the future.Funding: NoneDisclosures: None

2018 ◽  
Vol 5 (12) ◽  
pp. 3951
Author(s):  
Jay M. Makadia ◽  
Manoj A. Vasava

Background: The objective of present study is find out various patient factor including demographic data as well as operative data on occurrence of surgical site infection in patients of cholecyctectomy.Methods: A Prospective observational study of 273 patients of cholecystitis undergoing cholecystectomies for Surveillance of surgical site infections was conducted in the Department of General Surgery at the SSG hospital and Medical College Baroda during a period from 1st December 2013 to 30th November 2015. All patients operated for cholecystectomy are included irrespective of technique. Data collected from each patient were: Case start date and time, case end date and time, discharge date & time, case length, postoperative length of stay in hospital, patients characteristics (age, sex, ASA score), operative characteristics like, pathological diagnosis report of specimen, microorganism isolated based on culture report and antibiotic resistance pattern from infected wounds, antibiotic prophylaxis given perioperatively and antibiotics administered to treat SSI`s, intra operative spillage and bleeding, date of infection, urgent/elective procedure.Results: During the period of 24 months total 273 patient were undergone cholecystectomy out of which 12 (4.3%) patients were developed SSI. SSI rate is affected by various factors which are statistically significant are sex of patients, age, type of procedure, ASA score >3.Conclusions: The overall incidence of SSIs in the present study was 4.3%. The rates of SSI were more in patient with higher age, with male sex, emergency procedure and higher ASA score.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 235-235
Author(s):  
Emily Johengen ◽  
Arielle Davidson ◽  
Kathleen W. Beekman ◽  
Kelly Hecht ◽  
Emily R. Mackler

235 Background: Use of oral anticancer agents (OAAs) for cancer treatment continues to grow and creates a need for oncology practices to adapt their ambulatory infusion model of care to one that supports patients taking anti-cancer treatment at home. Historically, our practice has had success with care managers supporting infusion treatment patients. A recently published randomized trial has shown considerable benefits of dedicated pharmacist follow-up for patients taking OAAs. As a result, our practice added a dedicated oncology pharmacist to provide education and follow-up for our OAA patients. Methods: This is a single-center, retrospective evaluation of time to first follow up for patients taking OAAs pre-intervention (11/1/20 - 2/28/21) versus post-intervention (3/1/21 - 4/30/21). The intervention consists of structured symptom and adherence monitoring by a dedicated oncology pharmacist as part of our care management team for all patients prescribed an OAA. In the pre-intervention group, OAA monitoring was divided between care team members without a dedicated OAA program. The population consists of 139 patients newly started on OAAs over the 6-month period. “On-time” follow up defined by our practice is follow up that is <10 days from the OAA start date. There were 20 patients (10 per group) excluded from data analysis due to being deceased before follow-up could be assessed (n= 3), transferring oncology care elsewhere (n= 5), or never starting the OAA (n= 12). Results: Pre-intervention, initial follow up occurred via pharmacist or nurse care manager visit (n=47), provider visit (n=29), or unplanned admission (n=3). Post-intervention, all but two initial follow up visits were performed by the designated oncology pharmacist, and there were no unplanned admissions prior to first follow up. The median time to first follow up visit was 8 days (range 2 to 31 days) in the pre-intervention group (n=79) and 7 days (range 3 to 15 days) in the post-intervention group (n=40). Follow up visits occurred within 10 days of OAA initiation for 67.1% of patients in the pre-intervention group and 95% of patients in the post-intervention group (p=<0.001). Follow up occurred within 14 days of initiation for 82.3% of pre-intervention patients and 97.5% of post-intervention patients (p=0.018). Conclusions: Post-intervention assessment showed improvement in the time to follow up for patients taking OAAs. Future analyses will include outcomes, such as interventions at the time of follow-up, length on therapy, and unplanned admissions.


2020 ◽  
Vol 41 (S1) ◽  
pp. s111-s111
Author(s):  
Kathleen McMullen ◽  
Gaylene Dunn ◽  
Sheri McDuffie ◽  
Bradley Freeman

Background: Surgical site infections (SSI) related to colorectal procedures are detrimental to patients and publicly reportable events. Our institution implemented a successful bundle of interventions to decrease SSI rates in 2014. In 2018, compliance started to wane, with a concurrent increase in infections. In an effort to enhance compliance and incorporate up-to-date information, we convened a multidisciplinary team to streamline this process. Methods: Our team evaluated published studies on successful bundle components and updates to professional guidelines for SSI prevention to determine adjustments. Modifications included allowing surgeon preference for (rather than mandating) wound protector use and simplification of clean closure protocol (determined by intraoperative contamination, leading to more efficient closure time). In addition, measures were added to achieve perioperative patient optimization (maintenance of normothermia, prevention of intraoperative hypoxia, tighter glucose control and postoperative bathing). The bundle was implemented in stages starting January 2019. SSI rates were monitored throughout the process using NHSN definitions, and rates were compared using χ2 analysis (Epi Info, CDC). Results: From 2015 to 2017, bundle compliance was 90%, and 8 SSIs (rate, 3.8 per 100 procedures) were detected (Table 1). In 2018, compliance was 82%, with 4 SSIs (rate, 6.6 per 100 procedures). From January through September 2019, SSI rates decreased to a rate of 4.8 per 100 procedures, with notable increase in superficial SSI, with zero cases of deep or organ-space infections. Feedback from operating-room personnel indicated their commitment to bundle compliance and perceived intraoperative time savings. Conclusions: Revamping an existing colorectal SSI bundle, including relaxation of time-intensive and expensive intraoperative measures and increased focus on evidence-based guidelines, resulted in decreased deep-organ space SSI rates, as well as increased satisfaction from procedural team members. Successful implementation of care pathways to prevent infections is an iterative process and requires the engagement of practitioners.Funding: NoneDisclosures: None


Surgical site infection is one of the most common health-related infections, which can cause problems for health care providers by increasing morbidity and mortality, length of hospital stay, and costs. Undoubtedly, one of the most efficient and cost-effective ways to fight infection is to prevent it. An essential measure in infection control is the disinfection of the surgical team members to remove fat and contamination, eliminate transient microorganisms, and prevent the growth and proliferation of resident microorganisms on the skin. This study aimed to introduce different types of soap and alcohol disinfectant solutions for surgical scrub and describe the advantages and disadvantages of each by reviewing several recent research studies. This study is a brief overview of the recently conducted articles as searched in library resources, the Google Scholar Search Engine, Pubmed, UpToDate, Cochran, and Scopus databases using the English keywords of "hand hygiene", "infection control", "hand disinfection/methods", "hand disinfection/standards", and "Surgical Procedures, Operative" as well as the Persian keywords of "surgical scrub", "Povidone-iodine", "alcohol", and "hand disinfection". After reviewing 76 articles and eliminating the duplicate sources, 43 studies published from 2007 to 2019 were fully reviewed. Finally, 26 sources were selected as eligible with substantial relevance to the subject matter and subsequently reviewed. Based on the review of articles, it can be concluded that alcoholic solutions are often effective alternatives to soap scrub solutions due to their high disinfecting properties, safety, rapid effectiveness, and greater compliance with instructions.


2020 ◽  
pp. 153567602091963
Author(s):  
Jan Schinköthe ◽  
Benjamin Bartram-Sitzius ◽  
Jens-Peter Teifke ◽  
Ute Pfitzner ◽  
Sven Reiche

Introduction: The complete inactivation of infectious tissues of large animal carcasses is one of the most challenging tasks in high-containment facilities. Steam sterilization is a method frequently in use to achieve biological inactivation of liquid and solid waste. Objective: This study aims to highlight parameters most effective in creating reproducible cycles for steam sterilization of pig and calf carcasses. Methods: Two pigs or 1 calf were sterilized by running a liquid cycle (n = 3) at 121°C for at least 120 minutes in a pass-through autoclave. To assess the physical and biological parameters, temperature data loggers and biological indicators (BIs) with spores of Geobacillus stearothermophilus (ATCC 7953) were placed at defined positions within animal carcasses. After completion of each cycle, data loggers were analyzed and BIs were incubated for 7 days at 60°C. Results: Initial testing with an undissected pig carcass resulted in suboptimal temperatures at the tissue level with growth on 1 BI. After modifications of the used stainless-steel boxes and by placing the reference probe of the autoclave in the animal carcass, reproducible cycles could be created. A complete inactivation of BIs and a temperature profile of >121°C for at least 20 minutes could be achieved in almost all probed tissues. Conclusion: Only minor modifications in carcass preparation and the used sterilization equipment resulted in effective and reproducible cycles to inactivate large animal carcasses by using a steam autoclave.


Author(s):  
Hillary Carey ◽  
Jonathan Cagan ◽  
Craig M. Vogel ◽  
Laurie R. Weingart

A model of strategic planning for product development is introduced which captures corporate decision making from the earliest planning stages to final product success, measured by cost-control and revenue generation stemming from a strong emotional response in customers. The model was created based on observation and interviews ranging from top executives to design team members from all major disciplines at a large automobile company. By mapping an approach to part differentiation based on part complexity and lifestyle (i.e., value) impact onto the decision making model, those decisions most critical to different aspects of the product are identified and more heavily emphasized. Many companies tend to drive the entire process based on cost and technology objectives as a means to maximize profit, rather than by understanding the true impact of customer response to the product as well. In bringing Design strategy decisions into the earliest phases, companies set a strategy that fulfills customer expectations while reducing conflict, delays, added costs, and improving quality. The model helps companies recognize how to structure decisions and allocate resources to appropriately balance costs and customer’s emotional response.


Author(s):  
Janine Sanders Jones ◽  
John R. Olson ◽  
Peter Southard

This paper describes how the Operations and Supply Chain Management Department at the University of St. Thomas uses kaizen events as a vehicle to integrate undergraduate and professional programs with local area organizations. A unique business collaboration was created where the faculty members led an actual lean kaizen event at a local organization. Project team members included lead and support faculty, undergraduate students, professional certification students, and company representatives. In a one-week intensive experience, teams addressed real issues at a local organization and implemented changes that had positive impacts on the student learning experience and the bottom lines of the participating organizations. This paper discusses how to conduct a kaizen event student project as well as challenges and benefits related to this approach.


Author(s):  
Mustafa Demir ◽  
Nathan J. McNeese ◽  
Nancy J. Cooke ◽  
David A. Grimm ◽  
Jamie C. Gorman

Project overview Team resilience is an interactive and dynamic process that develops over time while a team maintains performance. This study aims to empirically investigate systems-level resilience in a Remotely Piloted Aircraft (RPA) System simulated task environment by examining team interaction during novel events. The approach used in the current study to measure systems-level resilience was developed by Hoffman & Hancock (2017). In their conceptual study, resilience was considered a key feature of success in emerging complex sociotechnical systems; in our case, that is applied to Human-Autonomy Teams (HATs). Hoffman and Hancock conceptualized a resilience measure dynamically by means of several components, such as the time it took the system to recognize and characterize anomalies, and the time taken to specify and achieve new goals. In their framework, there were two main sub-events which expressed resilience via time-based measures, and upon which we designed ours in this study: (1) time taken to design a new process and (2) time required to implement it (Hoffman & Hancock, 2017). Design In this current research, there were three heterogeneous team members who used a text-based system to communicate and successfully photograph target waypoints: (1) navigator – provided information regarding a flight plan with speed and altitude restrictions of each waypoint; (2) pilot – controlled the RPA by adjusting its altitude and airspeed through negotiating with the photographer in order to take a good photo of the target waypoints; and (3) photographer – screened camera settings and sent feedback to the other team members regarding the status of target’s photograph. This study followed the Wizard of Oz paradigm wherein the navigator and photographer were seated together in one room and were told that the pilot was a synthetic agent. In actuality, the pilot was a well-trained experimenter who was working from a separate room. This ‘synthetic’ pilot used restricted vocabulary to simulate that of a computer. The main manipulations in this study consisted of three degraded conditions: (1) automation failure - role-level display failures while processing specific targets, (2) autonomy failure - autonomous agent behaved abnormally while processing specific targets (i.e., it provided misinformation to other team members or demonstrated incorrect actions), and (3) malicious cyber-attacks - the hijacking of the synthetic agent, which led to the synthetic agent providing false, detrimental information to the team about the RPA destination. Because the malicious cyber-attack only occurred once (during the final mission), we will focus on the automation and autonomy failures for this study. Each failure was imposed at a selected target waypoint and the teams had to find a solution in a limited amount of time. The time limit for each failure was related to the difficulty of the failure. Each failure was introduced at a pre-selected target waypoint for each team. Method In this experiment, there were 22 teams, with only two participants randomly assigned to the navigator and photographer roles for each team, because the pilot was a highly-trained experimenter. The current task was comprised of ten 40-minute missions in which teams needed to take as many “good” photos as possible of ground targets while avoiding alarms and rule violations. For this study, using the RPAS paradigm, we calculated two team resilience scores (1) time taken to design a new process and (2) time required to implement it (Hoffman & Hancock, 2017). For the calculations, we used the message sent time (in seconds) for each role to express resilience in terms of the proportion of total task time (2400 seconds). As an outcome measure, we used target processing efficiency as a coordination and time-based performance score, which was based on how quickly teams were able to take a good photo of each target. Results and discussion We found that teams were more resilient during automation failures and progressed toward targets more successfully than during autonomy failures. We see three possible explanations for this: (1) automation failures were more explicit than autonomy failures, since at least one team member interacted with other teammates; (2) autonomy failures took more time for human teammates to identify the failure, because the autonomous agent’s abnormal behavior was not as straight forward; and 3) human teammates overtrusted to the autonomous agent and lack confidence in themselves and let the failure go on. Acknowledgements This research is supported by ONR Award N000141712382 (Program Managers: Marc Steinberg, Micah Clark). We also acknowledge the assistance of Steven M. Shope of Sandia Research Corporation, who integrated the synthetic agent and the testbed.


2015 ◽  
Vol 21 (7/8) ◽  
pp. 361-385 ◽  
Author(s):  
Wen-Hsing Liu ◽  
Sarah Asio ◽  
Jennifer Cross ◽  
Wiljeana J. Glover ◽  
Eileen Van Aken

Purpose – The purpose of this study is to identify inhibitors and enablers of Kaizen event effectiveness, as perceived by participants, and categorize them into shared mental models to understand the factors participants believe to be affecting Kaizen event success. The findings are also interpreted using the lens of attribution bias and previous studies of Kaizen event effectiveness. Design/methodology/approach – A qualitative approach involving coding responses from participants was adopted. The identified significant inhibitors and enablers were then assigned to shared mental model types using a mapping and categorization approach. Findings – The results are largely consistent with previous studies and show that job/task and technology/equipment mental models dominate participant views of inhibitors, while enablers were primarily drawn from team and team interaction mental models. This also suggests that attribution bias is present. Research limitations/implications – The methods used to measure shared mental models in this study are cross-sectional and exploratory in nature. Future research could involve the intensive study of a smaller number of Kaizen events over time. Practical implications – The findings in this study can be used by organizations to identify training needs for Kaizen event teams by identifying areas of potential attribution bias, by divergence of perceptions between facilitators and team members and by underestimated factor effects. Originality/value – This investigation offers understanding of the Kaizen event team shared mental models with respect to inhibitors and enablers of event success. Organizations can harness common perceptions among continuous process improvement teams to increases chances of Kaizen event success.


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