infection prevention
infection prevention
By Jill E . Holdsworth , MS , CIC , FAPIC , NREMT , CRCST
July 1 : What is the Significance in Infection Prevention ?
Every year , July 1 comes around and , if you work in healthcare , you either love it or you dread it . Why ? A new class of residents and fellows start in our facilities , and the trained , experienced physician trainees leave . There will always be those who feel July 1 means more medical errors and mistakes with less-experienced trainees ; however , I have learned to take a different perspective — this is an incredibly exciting time where we can catch this new class when they first come in , teach them good habits right out of the gate so they will teach other residents that come after them correctly , thus creating a cascade effect of proper technique and practice . July 1 should be viewed as a significant opportunity in all areas of healthcare — especially infection prevention !
It ’ s easier to dread July 1 than to see
It ’ s easier to dread July 1 than to see the silver lining , but why not try ? Having new , bright minds ready to soak up every ounce of training and knowledge they can is such a powerful time .” the silver lining , but why not try ? Having new , bright minds ready to soak up every ounce of training and knowledge they can is such a powerful time . Residents want to do the right thing and they absolutely want to be taught correctly . When asked , many senior residents will tell you they were taught certain skills by the resident prior to them — thus the need to ensure all residents and fellows are taught basic infection prevention skills and knowledge correctly . How does this fit in with infection prevention ? There are many ways infection preventionists ( IPs ) can impact how residents are learning , and thus help prevent infections .
One of my favorite memories of working with our teaching Head & Neck surgical team is when a resident came up to me before a case started in the operating room ( OR ) and held up a chemical indicator from a surgical drill tray that he had opened to prepare for the case and said , “ I am not comfortable with how this indicator turned . I am going to send it back to the sterile processing department ( SPD ).” This was an incredible moment for our entire team and showed that we had come full circle in what we had talked about , learned and now were able to put it into action to keep our patients safe . But how did we get here ?
You must put the time in as an IP — “ Go to the Gemba ,” as they say . This means to go where the work is done . When it comes to surgical teams , this may look different than your typical rounding with your nursing units , checking for isolation compliance and hand hygiene . To educate surgical teams , you first must understand their workflow , and to do this you must
live it . I am the first to admit that this is not easy , and it means getting up very early and spending a lot of time with the team simply observing and learning . The first step is always spending time with the teams you are working with , getting to know their work , their barriers , and their work . When you gain their trust , they will learn from you as much as you learn from them .
When does the surgical team round ? Who does the rounding ? Who does the surgical prep in the OR ? What is the resident ’ s role in the OR ? Who marks the patients for clipping in pre-op ? Do residents see the patients in pre-op ? These questions will get you started with where you can make an impact with surgical site infection ( SSI ) protocols with your surgical team . In the past , we have surveyed a service line ’ s residents at the beginning of the year for general knowledge in skin-prep application techniques such as dry time , application time , as well as sterile processing practices such as checking blue wrap for holes , verifying sterility on chemical indicators , and asking questions about who taught them this information in the past . We spent the next year of their training teaching and emphasizing proper technique and protocols and then we surveyed them again at the end of the year and saw a significant difference in overall attitude and knowledge toward infection prevention processes .
When I spent time educating the surgical residents , I followed up on observing their cases alongside them , being in pre-op with them and tagging along during surgical rounds in the morning . Essentially , I became part of their team , too . As an IP , we can either be a teammate or an auditor . I guarantee you that a teammate will get farther every time . When I observe cases and attend surgical rounds , I don ’ t bring a clipboard or even a notebook ; I put my hands up and let them know I am here to learn , listen and observe .
Teaching services also will have education sessions during their week — find when these sessions are and put yourself on the schedule . You can emphasize the educational topics you need to cover , show pictures of things you saw during rounds , ask questions about how you can help them , etc . When you become part of the solution , you become a teammate , and everyone begins working together .
Everyone in the OR should know how to check for sterility of instruments , perform an appropriate skin prep , and check an instrument wrap for a hole . When we partner with our physician trainees who may be doing these tasks , we can ensure not only that they are doing these tasks correctly and understand the importance , but that they pass down the correct information to the next class of trainees .
Jill E . Holdsworth , MS , CIC , FAPIC , NREMT , CRCST , is manager of the Infection Prevention Department at Emory University Hospital Midtown in Atlanta .
10 september 2023 • www . healthcarehygienemagazine . com