Apr 17, 2018

Understanding Transmission-Based Precautions and recommended practices

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Patients in isolation are among the most infectious, and the most vulnerable. By understanding the different types of isolation precautions and when to apply them, we can help improve patient safety and outcomes.

Standard Precautions prevent the transmission of infection from patient to patient as well as patient to healthcare providers.  Standard Precautions include hand hygiene, use of gloves, gown, mask, eye protection and safe injection practices.1

In addition to Standard Precautions, Transmission-Based Precautions can be implemented when Standard Precautions won’t interrupt the route of transmission.  Usually, a patient is placed in Transmission-Based Precautions when there is a known infection or if the patient is colonized.2

There are three main transmission based precautions: contact, droplet and airborne.2  Each precaution has recommendations for healthcare settings to follow.  It is important to note that more than one Transmission-Based Precaution may be used on one patient and all of these precautions are in addition to Standard Precautions.2

Contact Precautions:

Contact Precautions are implemented when the infectious agent is spread by direct or indirect contact with the patient or the patient’s environment.2  The CDC recommends placing the patient in a single room, and health care providers entering the room should wear a gown and gloves for all interactions.2  Examples of conditions requiring contact precautions are Clostridium Difficile (C diff), Vancomycin-resistant Enterococci (VRE), Respiratory Syncytial Virus (RSV), and Methicillin-Resistant Staphylococcus Aureus (MRSA).  For contact precautions, the CDC strongly recommends using disposable noncritical patient-care equipment or implement patient-dedicated equipment.2  Other organizations including the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) created a summary of strategies to prevent Healthcare associated infections (HAIs) including Clostridium difficile (CDI) and MRSA.  These summaries state that “dedicated equipment should be readily available for healthcare providers (e.g., stethoscopes)” and to use “dedicated patient care equipment and items.” 3,4

Droplet Precautions:

When the infectious agent is spread by contact through close respiratory or mucous membrane contact with respiratory secretions, Droplet Precautions are implemented.2  Placing the patient in a single room and having visitors and healthcare providers wear a mask are recommended practices for Droplet Precautions.2  Common conditions requiring Droplet Precautions include the influenza virus, pertussis, and mumps.

Airborne Precautions

Airborne Precautions are implemented when the infectious agent is small enough to remain suspended in the air.2  Patients should be placed in a single room with negative air flow and healthcare providers should wear respirators when caring for these patients.2  Tuberculosis, measles and chickenpox are examples of conditions requiring airborne precautions.2

It is important to note that the CDC states “In all healthcare settings, providing patients who are on Transmission-Based Precautions with dedicated non-critical medical equipment (e.g., stethoscope, blood pressure cuff, electronic thermometer) has been beneficial for preventing transmission.”2

It is the responsibility of the entire healthcare delivery team to provide appropriate resources to follow these recommended practices to keep patients and healthcare providers safe.

Mar 23, 2018

Join 3M to fight SSIs from every angle during the 2018 AORN Global Surgical Conference & Expo

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Fight SSIs from Every Angle. Visit booth #2829

It’s looking like 2018 AORN Surgical Conference in New Orleans, La. will be another exceptional event for perioperative nurses. The agenda is packed March 24-28, 2018 with more than 200 contact hours available in an array of learning formats—there will be plenty to learn!

If you’re registered for the Executive Leadership Summit, don’t miss the presentation by Kathleen Kohut, MS, RN, BSN, CIC, on “Reduce Skin and Nasal Bacteria to Lower the Risk of SSIs.” That’s the lunch session on Monday, March 26 from 12:30-1:45 p.m.

When you are Parading the Hall, make sure to visit 3M booth 2829! We want to help you “Embrace Action” and take your fight against SSIs to the next level: 3M Surgical Safety Solutions is a comprehensive initiative to help give you a path to progress in your fight against SSIs. You can earn 100 Parade the Hall points by participating in a demonstration activity with 3M™ Skin & Nasal Antiseptic for preoperative nasal decolonization.

In-booth education is back – come earn credit! Kathleen Kohut, Director of Infection Prevention at Cape Cod Healthcare in Hyannis, MA, and Kim Prinsen, Technical Service Specialist for 3M, will review the topic, “Reducing the Risk of SSIs – What are we missing?”

Objectives:

  1. Describe interventions in preparation of the patient for surgery that will reduce the risk of  SSI.
  2. Identify relevant clinical studies that support these measures.
  3. Describe guidelines and recommended practices that support each intervention.

Education sessions include a 30-minute live presentations plus additional self-study activity.

Finally, all international visitors and new members are welcome on Saturday, March 24 from 5:00 to 6:00 pm (rooms 276-277) at the 3M sponsored International and New Members Reception and, throughout the conference, at the 3M sponsored International Lounge (rooms 276-277), a place for international guests to relax, recharge and network, open according to the following schedule:

More information will be available in at 3M booth #2829. We look forward in seeing you in New Orleans!

Nov 3, 2017

4 Quick Questions on Cleaning Verification Monitoring with ATP

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Clean Trace

Q: We just started using ATP in endoscope reprocessing. Is it normal to see a number of failures when using ATP?

A: It is not unusual to see failing results when beginning a cleaning monitoring program with any type of cleaning indicator. A failing ATP result is signaling where to focus additional efforts to achieve effective cleaning practices. Initially every endoscope should be tested multiple times to achieve a baseline assessment of the effectiveness of the current cleaning process, followed by taking steps to improve the process and decrease failure rates.

Q: Some of our endoscopes always pass the ATP test, but others don’t. What’s happening?

A: It is somewhat typical to discover that a particular endoscope type has higher average ATP values. Upper GI flexible endoscopes (e.g., gastroscopes and duodenoscopes) have been shown in clinical studies to be more contaminated than lower GI flexible endoscopes1,2 (e.g., colonoscopes). Upper GI endoscopes are also more difficult to clean.

Another common finding is that specific scopes (i.e., a particular serial no.) routinely result in higher ATP values after cleaning. When multiple rounds of manual cleaning are required to obtain a passing ATP result, this can be a sign that this particular scope may be damaged and need servicing. ATP is an effective means to help identify endoscopes nearing “end of life” or needing repair.

Q: How are the Pass/Fail numbers determined?

A: The pass/fail thresholds for ATP testing are not arbitrary. They are based on validation with results provided in published clinical studies3,4.

Q: We do a manual clean then process in the AER. We were told to do our ATP check before AER processing. Wouldn’t that provide a false record of how clean our scopes are since they haven’t been through AER yet?

A: Clean and disinfected/sterilized are not the same thing. ATP is a cleaning verification method, used to verify that the cleaning process was effective for removal of clinical soil and that the appropriate level of cleanliness was achieved prior to sterilization or disinfection. ATP testing is not an appropriate tool for measuring disinfection or sterilization, and therefore should not be used to measure the success of the high-level disinfection (HLD) process. Ensuring that an endoscope is clean enough prior to HLD is critical – after all, HLD can’t be effective if the endoscope isn’t clean going in.

Have more questions? 3M is happy to answer any further questions about ATP cleaning verification monitoring – you can contact your local representative, call the 3M Health Care Helpline 1-800-228-3957 or visit go.3M.com/cleantrace.

References:

  1. Ofstead CL, et al. Assessing residual contamination and damage inside flexible endoscopes over time. 2016. Am J of Infect Control. 44: 1675-7.
  2. Ofstead CL, et al. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes. 2017. Am J of Infect Control. 45: e26-e33.
  3. Alfa MJ, Fatima I, Olson N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. 2013. Am J Infect Control. 41: 245-8.
  4. Alfa MH, Fatima I, Olson N. The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels. 2013. Am J Infect Control. 41: 249-53.
Oct 25, 2017

Are you ready for the ASC-13 normothermia measure?

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In an effort to create a health care system that results in better care, smarter spending, and healthier people, the Centers for Medicare & Medicaid Services (CMS) implemented the Ambulatory Surgical Center Quality Reporting (ASCQR) Program in 2012. The ASCQR Program is a pay-for-reporting, quality data program requiring ambulatory surgery centers report on specific quality metrics in return for a full annual update to their annual payment rate.1

Earlier this year, CMS announced new measures will be added to the ASCQR payment determinations in 2020. ASC-13: Normothermia Outcome is one of the new measures and will require data to be submitted directly to CMS via the www.QualityNet.org website. Data collection begins on Jan. 1, 2018. Reporting will be required in 2019 impacting payment determination for 2020.1

ASC-13 timeline

ASC-13: Normothermia Outcome

ASC-13: Normothermia Outcome assesses the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the post-anesthesia care unit (PACU).1 Data reporting is required for all patients that meet the measure criteria, as defined below.

ASC-13 definition

A reasonable goal for this measure is a normothermia rate in the 95%-100% range.2

Develop Your Warming Strategy

With data collection starting in a matter of months, how do you prepare for the ASC-13 measure? Consider the following as you develop a patient warming strategy.

Conduct a temperature review. Determine how many of your patients currently are normothermic upon arrival at PACU. How you choose to measure and monitor patient temperature is an important consideration. Obtaining an accurate and reliable core body temperature reading becomes vital when determining the success of your warming protocol. 3M can help you take this key first step with a temperature review.

Determine a process for accurately documenting patient temperatures. A simple temperature tracking form can encourage data recording habits consistent with the measure. CMS offers a form template on its website.

Actively prewarm patients. One of the greatest contributors to surgical hypothermia is the physiological effects of anesthesia itself, which disrupts the body’s ability to regulate temperature.3 Prewarming, or increasing the total heat content of the periphery before surgery, can help offset the significant drop in temperature brought on by anesthesia induction, essentially stopping hypothermia before it might otherwise begin.4 Multiple clinical guidelines now recommend the use of prewarming to maintain normothermia.5-9

Expand the use of intraoperative warming. Selecting a warming system that can cover your entire range of needs while effectively serving your most difficult-to-warm patients can help your facility successfully meet the ASC-13 normothermia outcomes measure. The 3M™ Bair Hugger™ normothermia system’s expansive portfolio of products is cost-effective and designed to optimize clinical performance and ease of use.

Look to effective, proven normothermia solutions. Unintended perioperative hypothermia is a frequent, yet preventable, complication of surgery. It can increase the rate of wound infection (SSI)10-12, extend recovery time13, extend length of stay10 and increase mortality rates.14 The Bair Hugger system is the most clinically researched and proven portfolio of warming solutions on the market today, offering a wide range of patient warming products to help maintain normothermia throughout the surgical journey.

As the leaders in forced-air warming, 3M can help you meet your ASC-13 warming goals. We will work with you to understand your warming needs, identify your clinical challenges and evaluate your practice requirements so we can recommend proven, cost-effective solutions.

Visit go.3m.com/ASC to learn how we can help your ASC prepare for the new normothermia quality measure and your overall quality improvement program for SSI prevention.

References:

  1. CY 2017 OPPS/ASC. 81 FR 79562. CMS-1656-FC.
  2. ASC Quality Measures Implementation Guide. Version 3.1. ASC Quality Collaboration, ascquality.org.
  3. Sessler, DI. Current Concepts: Mild Perioperative Hypothermia. N Engl J Med, 336(24): 1730-1737; 1997.
  4. Sessler DI, Schroeder M, Merrifi eld B, Matsukawa T, Cheng C. Optimal Duration and Temperature of Prewarming. Anesthesiology. Mar 1995:82(3)674-681.
  5. Nelson G, Altman AD, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations – Part I. Gynecologic Oncology. 2016;140:313-322.
  6. American Society of PeriAnesthesia Nurses. Clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16:305-314.
  7. Guideline for prevention of unplanned patient hypothermia. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2017:567-590.
  8. Anderson DJ, Podgorny K, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. 2014;35(6).
  9. Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KMF, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg 2017;224:59-74.
  10. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209–1215.
  11. Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006;83(5):1090–1104, 1107-1113.
  12. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomized controlled trial. Lancet. 2001;358:876-880.
  13. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87(6):1318–1323.
  14. Bush HL Jr, Hydo LJ, et al. Hypothermia during elective abdominal aortic aneurysm repair: the high price of avoidable morbidity. J Vasc Surg. 1995;21: 392–400; discussion 400–392.
Sep 13, 2017

FDA: Keep using patient warming devices, including forced-air technology

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Bair Hugger Multi-Position Blanket Supine Shoulder

The 3M Bair Hugger forced-air warming system

The U.S. Food and Drug Administration recently issued a letter reminding healthcare providers that it continues to recommend patients be warmed during surgery when clinically warranted.

The FDA specifically mentioned that its recommendation includes the continued use of forced-air warming devices. The 3M™ Bair Hugger™ warming system is the world’s leading forced-air warming product.

The FDA said it recently became aware that some providers and patients are foregoing the use of forced-air warming because of concerns about a possible increased risk of surgical site infections. Those concerns have been driven by a 3M competitor and a group of plaintiffs’ attorneys, who are promoting a theory that forced-air warming devices such as the Bair Hugger system lead to an increased risk of surgical site infections.

The FDA, which regulates medical devices, said it has thoroughly reviewed available data and “has been unable to identify a consistently reported association between the use of forced air thermal regulating systems and surgical site infection.”

You can read the letter here.

You can read an update from the Minneapolis Star Tribune here.

Download the 3M™ Bair Hugger™ Research Compendium here.