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Prevention of Healthcare Associated Infections

  1. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (Public Health Agency of Canada, 2012).

Detailed information relative to routine practices and additional precautions are available from the Public Health Agency of Canada.

Prevention of Surgical Site Infections

Safer Healthcare Now! (2014) Four Key Components of Reliable Perioperative Care:

  1. Antimicrobial Coverage Peri-Operatively:
    • Appropriate use of prophylactic antibiotics; and
    • Antiseptic prophylaxis.
  2. Appropriate Hair Removal.
  3. Maintenance of Perioperative Glucose Control.
  4. Perioperative Normothermia.

Detailed information relative to the four key components above is available in the Safer Healthcare Now! Surgical Site Infection Getting Started Kit (2014).

Prevention of Central Line Associated-Bloodstream Infections

Safer Healthcare Now! Central Line Insertion Bundle (2012)

  1. Hand Hygiene.
  2. Maximal Barrier Precautions.
  3. Chlorhexidine Skin Antisepsis.
  4. Optimal Catheter Type and Site Selection:
    • Avoid the femoral vein in adults; subclavian preferred to minimize infection risk.
    • Optimal catheter type and site selection in children is more complex with the internal jugular vein or femoral vein most commonly used. Site preference in children needs to be individualized.

Safer Healthcare Now! Central Line Care Bundle (2012)

  1. Daily Review of Line Necessity, with Prompt Removal of Unnecessary Lines.
  2. Aseptic lumen Access.
  3. Catheter Site and Tubing Care.

Detailed information relative to the bundle components above is available in the Safer Healthcare Now! Central Line Associated-Bloodstream Infection Getting Started Kit (2012).

Prevention of Surgical Site Infection for Hip and Knee Arthroplasty

(IHI, 2012; Anderson, 2014; Safer Healthcare Now! SSI, 2014)

Three Evidence-Based Interventions for Preventing SSI for Hip and Knee Arthroplasty:

  1. Use an alcohol-containing antiseptic agent for preoperative skin preparation.
  2. Instruct patients to bathe or shower with chlorhexidine gluconate (CHG) soap the night before and morning of surgery.
  3. Screening for S. aureus and decolonizing surgical patients with an antistaphylococcal agent in the preoperative setting for high-risk procedures, including some orthopedic and cardiothoracic procedures has been proposed and supported by the Society for Healthcare Epidemiology of America (SHEA). Mupirocin nasal ointment along with chlorhexidine soap has the ability to nearly suppress S. aureus from the nasal sites.

For more information regarding preventative practice for periprosthetic joint infections refer to the Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection (Parvizi, Gehrke, Chen, 2013).

Prevention of Infective Endocarditis

Prevention and Management of Open Surgical Wounds

(Orsted et al., 2010)

Cause:

  • Complete a holistic assessment to identify factors that may affect surgical wound healing in the pre-operative, intra-operative and post-operative phases.
  • Create a treatment plan to eliminate or reduce factors that may affect surgical wound healing in the pre-operative, intra-operative and post-operative phases of care.

Patient-centered concerns:

  • Include the patient, family and/or caregiver as members of the team when developing care plans.
  • Educate the patient, family and/or caregiver to optimize surgical wound healing.
  • Assess the surgical wound and document findings using a standardized approach.
  • Debride the surgical wound of necrotic tissue.
  • Rule out or treat a surgical site infection.
  • Provide optimal local wound moisture balance to promote healing by choosing an appropriate dressing for the acute and chronic phases of surgical wound healing.

Re-evaluation:

  • Determine the effectiveness of interventions and reassess if healing is not occurring at the expected rate. Assess the wound edge and rate of healing to determine if the treatment approach is optimal.
  • Consider the use of adjunctive therapies and biologically active dressings.

Organizational concerns:

  • Recognize that surgical wound healing requires a team approach.
  • Implement a surgical site surveillance program that crosses clinical setting boundaries.

Conduct Clinical and System Reviews (see details below)

Given the broad range of potential causes of this clinical group, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.

Clinical and System Reviews, Incident Analyses

Occurrences of harm are often complex with many contributing factors. Organizations need to:

  1. Measure and monitor the types and frequency of these occurrences.

  2. Use appropriate analytical methods to understand the contributing factors.

  3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.

  4. Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for analysis methods are included in Resources for Conducting Incident and/or Prospective Analyses section of the Introduction to the Hospital Harm Improvement Resource.

Chart audits are recommended as a means to develop a more in-depth understanding of the care delivered to patients identified by the HHI. Chart audits help identify quality improvement opportunities.

Useful resources for conducting clinical and system reviews: