3M Sterile U Webinar 2.17.11
Welcome! Thank you for attending today’s meeting, it will begin shortly. How do I get a CE Certificate? Next week, all of today’s meeting participants will be sent an email containing instructions for obtaining a CE Certificate for today’s meeting. The email will be sent to the email address you provided when you logged-in to today’s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate email to them. 1
© 3M 2011. All Rights Reserved.
3M™ Sterile U Web Meeting February 17, 2011
© 3M 2011. All Rights Reserved.
Welcome! Topic:
Your OR Customer: What They Need from Your CSSD
Facilitators:
Susan Flynn, 3M Dianne Koch, 3M
Speaker:
Kim Bamburg RN, MEd, CNOR, CSPDT
Housekeeping •
Questions • Mute feature (*7 = unmute; *6 = mute) • “Chat” feature
• • •
Technical difficulties CE Credits Post session follow-up
3
For more information: www.3M.com/AttestSterileUOnline © 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Disclosure Statement Kim Bamburg RN, MEd, CNOR, CSPDT Field Technical Service 3M Infection Prevention
[email protected]
4
© 3M 2011. All Rights Reserved.
Learning Objectives Discuss the concepts of Sterile Field, Aseptic Technique, and Surgical Conscience Describe the roles and responsibilities of surgical team members Discuss various OR metrics and how incomplete or unavailable sets impact patient care and OR turnover
5
© 3M 2011. All Rights Reserved.
Brief History • Early 19th Century Surgeon operated in a Prince Albert coat and used the same sponges for every patient treated • Mid 19th Century protection of the surgical wound
6
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Key Concepts • Sterile Field: An area immediately around a patient that has been prepared for a surgical procedure. The area includes all furniture covered with sterile drapes and all personnel who are in sterile attire. • Aseptic Technique: The methods by which microbial contamination is prevented in the environment • Sterile Technique: “Methods by which contamination with microorganisms is prevented to maintain sterility throughout the surgical procedure.” 7
Ref: AORN 2010: RP on Maintaining a Sterile Field, Glossary © 3M 2011. All Rights Reserved.
Maintaining a Sterile Field • “Scrubbed persons should function within a sterile field” (Recommendation I) • “Sterile drapes should be used to establish a sterile field” (Recommendation II) • “Items used within the sterile field should be sterile” (Recommendation III)
8
Association of periOperative Registered Nurses (AORN), Perioperative Standards and Recommended Practices 2010, RP on Maintaining a Sterile Field © 3M 2011. All Rights Reserved.
Maintaining a Sterile Field (cont’d) • “All items introduced to a sterile field should be opened, dispensed, and transferred by methods that maintain item sterility and integrity” (Recommendation IV) • All personnel moving within or around a sterile field should do so in a manner that maintains the sterile field. (Recommendation VI)
Association of periOperative Registered Nurses (AORN), Perioperative Standards and Recommended Practices 2010, RP on Maintaining a Sterile Field 9
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
10
© 3M 2011. All Rights Reserved.
Key Concepts • Surgical Conscience: The basis for practice of strict adherence to sterile technique by all surgical team members; It involves a level of honesty and moral integrity that must be upheld
Ref:2008 Surgical Technology for the Surgical Technologist: A positive Care Approach 3rd edition 11
© 3M 2011. All Rights Reserved.
Developing the Surgical Conscience • Is this best practice? • Do I have everything necessary for the procedure? • Have I done all I can to provide a safe, therapeutic environment for the patient?
12
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Key Influencers
13
© 3M 2011. All Rights Reserved.
Sterilization Focus
14
© 3M 2011. All Rights Reserved.
AORN • Recommended Practices for Sterilization in the Perioperative Practice Setting • “The creation and maintenance of an aseptic environment has a direct influence on patient outcomes.” • Minimizing patient’s risk of Surgical Site Infection (SSI) is a major responsibility of perioperative RN • Surgical items free of contamination at time of use is important measure to prevent SSI • “Sterilization provides the highest level of assurance that surgical items are free of viable microorganisms”
15
Ref: AORN 2010 Perioperative Standards and Recommended Practices, Recommended Practices for Sterilization in the Perioperative Practice Setting, Purpose © 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Objective Two Describe the roles and responsibilities of surgical team members 16
© 3M 2011. All Rights Reserved.
Surgical Team Members • • • •
Circulator Scrub Nurse Surgical Technologist Physician’s Assistant
• Surgeon • Anesthesiologist • Support
17
© 3M 2011. All Rights Reserved.
Circulator • • • • •
RN Goal of Perioperative Nursing Practice Patient Safety Time Out and Sterilization Patient Advocate
18
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Scrubbed Team Members • • • •
Surgical Technologist (ST,CST) Scrub Nurse (RN,LPN,PN) Surgeon (MD,DO) Physician’s Assistant (PA)
19
© 3M 2011. All Rights Reserved.
Team Members • • • • • • •
Not scrubbed into the case X-Ray Technicians Manufacturer Representatives Turn over teams Anesthesia Technicians Anesthesiologist MD,DO or CRNAs Central Sterile Processing Technicians
20
© 3M 2011. All Rights Reserved.
AORN Comprehensive Surgical Checklist 21
http://www.aorn.org/PracticeResources/ToolKits/CorrectSiteSurgeryToolKit/Comprehensivechecklist/
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Objective Three OR Metrics
22
© 3M 2011. All Rights Reserved.
Turnaround (Turnover) Times • Defined differently by Surgical Team members • Nurses/Scrub Techs • Anesthesia Providers • Surgeons
23 © 3M 2010. All Rights Reserved.
© 3M 2011. All Rights Reserved.
Why all the concern over turnover time? • Lost Revenue • Directors/Manager Responsibility • Patient Safety
24 © 3M 2010. All Rights Reserved.
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Hypothetical Business Impact Hospital
Total Knee T.O. time
CABG
Total Hip
Lap Chole
Hospital A
48 minutes
39 minutes
56 minutes
41 minutes
Benchmark
35 minutes
25
25
22 minutes
Improvement
13 minutes
14
31 minutes
19 minutes
Annual Case volume
525
490
600
1200
Increase case volume
625
620
900
1400
Impact
$$
$$
$$
$$
25
© 3M 2011. All Rights Reserved.
Incomplete Instrument Sets
• Specialty Sets: Ortho. neuro, cysto, Minimally Invasive sets, cardiothoracic, vascular • Drills, batteries • Implants: plates, screws, wires
26 © 3M 2010. All Rights Reserved.
© 3M 2011. All Rights Reserved.
Unavailable sets • • • • •
Loaners Late arrivals to O.R. Holes in wrapper Prior cases Missing/failing CI
27 © 3M 2010. All Rights Reserved.
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Quality Metric: Surgical Site Infection Rate • No implant: Infection occurs within 30 days after the operative procedure • Implant: Infection occurs within 1 year if implant is in place and the infection appears to be related to the operative procedure
Horan, Andrus, and Dudeck 2008, CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting, Am J Infect Control 2008;36:309-32. 28
© 3M 2011. All Rights Reserved.
Thanks! • Thanks for all your hard work in CSSD! • It is critical to successful patient outcomes in the OR.
29
© 3M 2011. All Rights Reserved.
Key Learnings • Sterile surgical instruments are a key requirement of the sterile field • Many team members collaborate in the OR to deliver optimal patient outcomes • Your partners in the OR rely on CSSD to provide complete, terminally sterilized instrument sets, on time.
30
© 3M 2011. All Rights Reserved.
3M Sterile U Webinar 2.17.11
Thank you! Next 3M™ Sterile U Web Meeting:
• March 10, 2011 • Immediate-use Steam Sterilization
Register at www.3m.com/AttestSterileU/WebMeetings 31
© 3M 2011. All Rights Reserved.
References • Association of periOperative Registered Nurses (AORN) Perioperative Standards and Recommended Practices (2010) Recommended Practices for Sterilization in Perioperative Practice Setting Recommended Practice for Maintaining a Sterile Field
32
© 3M 2011. All Rights Reserved.
