OR Manager - April 2020 - 27

AMBULATORY
SURGERY CENTERS
Mobley, Leapfrog's vice president of
administration.
Barbara J.
Holder, BSN,
RN, CAPA,
CAIP
Andrews Institute Ambulatory
Surgery Center in
Gulf Breeze, Florida, an
ASC that participated in
the Leapfrog survey,
has been using HSAG's
checklist as a guide.
ASCs may not use antibiotics
as frequently as
hospitals do, but they
still administer certain
types, which usually include cefazolin,
clindamycin, and vancomycin, says Barbara
J. Holder, BSN, RN, CAPA, CAIP,
the center's QI/IC safety/regulatory officer.
As part of its stewardship efforts,
Andrews audits charts for each surgeon
and type of surgery performed, as well
as antibiotics administered during the
preoperative, intraoperative, and postoperative
phases. This provides the
center with a baseline metric on antibiotic
usage, she explains.
Holder says the facility has adopted
more prudent antibiotic prescribing and
infection control practices. As an example,
hand surgeons order intravenous
antibiotics (IV ATB) for some, but not
all, procedures. Total joint surgeons are
no longer ordering home health care
with IV ATB administration.
Leapfrog also recommends 200 observed
hand washings per hospital unit/
ASC facility. At Andrews, every department
has gotten on board with this recommendation.
Each employee is responsible
for observing three hand washings
per month. Overall, " our employees'
adoption of this program has helped to
improve our safety culture, " Holder says.
Engaging staff
SurgeryDirect decided to engage its
physicians and partnering pharmacies
in conversations about the necessity
of antibiotics before and after surgery.
What were the criteria for doing so
after an implant, for instance, or a
www.ormanager.com
Antimicrobial stewardship adoption rates
The Leapfrog Group and other entities have encouraged ambulatory surgery centers
(ASCs) to adopt an antimicrobial stewardship program to promote judicious use of
antibiotics and other antimicrobials, thus reducing microbial resistance and spread of
infections while improving patient outcomes. In a 2019 survey of 321 ASCs, Leapfrog
discovered that just one in five (58) had adopted a program.
" In stark contrast to similar data from
ASCs, the vast majority (93%) of hospitals
are in compliance, " Leapfrog stated.
The 2020 Leapfrog survey, launching on
April 1, invites ASCs across the country to
participate. Similar to its hospital survey,
" we will be reporting results by individual
brick and mortar facilities " this year, says
Erica Mobley, Leapfrog's vice president of
administration.
DO YOU HAVE AN
ANTIMICROBIAL
STEWARDSHIP PROGRAM?
18%
Yes
Source: Adapted from Same Day Surgery
in the US: Findings of Two Inaugural
Leapfrog Surveys. The Leapfrog Group.
2019. https://www.leapfroggroup.org/
SameDaySurgery. Used with permission.
procedure around the bone and joint?
Delving deeper, they expanded their
stewardship efforts to staff, educating
them on the basics of infection prevention.
Hand hygiene was the number
one target, Kirchner says.
The facility already had a sound record
on infection control; no wound infections
have occurred in the past 3
years. This is a solid achievement for
an institution that does some very highrisk
procedures such as neurosurgery,
deep brain stems, and generator packs
(batteries connected to the stems in
the brain), in addition to orthopedics
and implants, Kirchner notes-adding
that education on stewardship is
needed nonetheless.
SurgeryDirect took other steps to
strengthen its infection controls:
* reviewed policies and procedures
on SSIs
* reviewed and incorporated CDC and
APIC data on antimicrobial stewardship
82%
No
*
rewrote its infection control plan to
include antibiotic stewardship.
" We've been working with our surgeons
to develop education for them
and our staff so they understand what
it means to give antibiotics, " explains
Kirchner. They must ask: Does this
patient really need this antibiotic order?
The general consensus is no, they
don't need it. Being treated in an ASC
is very different than in a nursing home,
for example, where risk of infection is
much higher. A patient who goes home
after an outpatient procedure and
comes into contact with normal flora in
the home may not need an antibiotic.
SurgeryDirect's initiative began last
fall, with a full rollout anticipated in the
spring. " We're not where we want to
be yet, " Kirchner says. Physicians have
insisted that the center complete its
research and come back with recommendations
based on patient health
issues in the ASC.
Continued on page 29
OR Manager | April 2020
27
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OR Manager - April 2020

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