SDS Hand Hygiene Compliance rates

Late last year a hand hygiene audit was done in the SDS by a Master's student in Epidemiology. Her study included Pre-and Post InService data.

Here are the results. Good Job!!!

Hand hygiene compliance rates among RNs

	HH performed	HH opportunities	HH compliance
1st moment	3	52	6%
2nd moment	1	34	3%
3rd moment	8	21	38%
4th moment	19	63	30%
Overall compliance	31	170	18%

Post intervention - hand hygiene compliance rates among RNs

	HH performed	HH opportunities	HH compliance
1st moment	25	63	40%
2nd moment	10	27	37%
3rd moment	16	24	67%
4th moment	33	62	53%
Overall compliance	84	176	48%

Hand hygiene compliance rates among Anesthesiologists

	HH performed	HH opportunities	HH compliance
1st moment	2	7	29%
2nd moment	4	18	22%
3rd moment	2	2	100%
4th moment	2	10	20%
Overall compliance	10	37	27%

Post intervention hand hygiene compliance rates among Anesthesiologists

	HH performed	HH opportunities	HH compliance
1st moment	4	9	44%
2nd moment	1	8	13%
3rd moment	2	2	100%
4th moment	2	10	20%
Overall compliance	9	29	31%

The Day Surgery Unit demonstrated an overall HH compliance rate of 19% (220/41). By HCW, the HH compliance rate among the nurses was 18% (170/31) with the lowest compliance during the 1^st and 2^nd moment at 6% (52/3) and 3% (34/1), respectively. Among the anesthesiologists, the compliance rate was 27% (37/10), with lowest compliance during the 4^th moment at 20% (10/2). Post intervention, the compliance rate, among nurses, increased substantially. Within this group, HH compliance increased from 18% (170/31) to 48% (176/84). This increase in compliance was significant (p<0.001). With regards to the anesthesiologists, with whom the intervention was not performed, results indicated that HH compliance went from 27% (37/10) to 31% (29/9). This was shown to not be significant (p=0.768).

*** Please note that the intervention was only carried out with the nurses.

Surgical Site Infection

It has come to the attention at the Surgical Site Infection committee for General Surgery, that many patients are showing up for surgery and they have shaved the area where they think they are going to be operated on, at home.
The CDC Guidlelines recommends that patients are clipped (not shaved) just prior to going into the OR. This helps to prevent Surgical Site Infections (SSI’s).
The following guidelines were found in this article: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/SSI.pdf


2. Operative Characteristics: Preoperative Issues
a. Preoperative antiseptic showering
A preoperative antiseptic shower or bath decreases
skin microbial colony counts. In a study of >700 patients
who received two preoperative antiseptic showers,
chlorhexidine reduced bacterial colony counts ninefold
(2.83102 to 0.3), while povidone-iodine or triclocarbanmedicated
soap reduced colony counts by 1.3- and 1.9-fold,
respectively.155 Other studies corroborate these findings.
156,157 Chlorhexidine gluconate-containing products
require several applications to attain maximum antimicrobial
benefit, so repeated antiseptic showers are usually indicated.
158 Even though preoperative showers reduce the
skin’s microbial colony counts, they have not definitively
been shown to reduce SSI rates.159-165
b. Preoperative hair removal
Preoperative shaving of the surgical site the night
before an operation is associated with a significantly higher
SSI risk than either the use of depilatory agents or no
hair removal.16,100,166-169 In one study, SSI rates were 5.6% in
patients who had hair removed by razor shave compared to
a 0.6% rate among those who had hair removed by depilatory
or who had no hair removed.166 The increased SSI risk
associated with shaving has been attributed to microscopic
cuts in the skin that later serve as foci for bacterial multiplication.
Shaving immediately before the operation compared
to shaving within 24 hours preoperatively was associated
with decreased SSI rates (3.1% vs 7.1%); if shaving
was performed >24 hours prior to operation, the SSI rate
exceeded 20%.166 Clipping hair immediately before an operation
also has been associated with a lower risk of SSI than
shaving or clipping the night before an operation (SSI rates
immediately before = 1.8% vs night before = 4.0%).170-173
Although the use of depilatories has been associated with a
lower SSI risk than shaving or clipping,166,167 depilatories
sometimes produce hypersensitivity reactions.166 Other
studies showed that preoperative hair removal by any
means was associated with increased SSI rates and suggested
that no hair be removed.100,174,175

I know that you are not encouraging patients to shave pre-op, but perhaps some patients think that they are ‘helping’ or perhaps they are modest and think that they can avoid having the doctor shave them in sensitive areas. At any rate, I will add a statement in out new PAC Booklet to emphasize that patients are NOT to shave themselves at their surgical site. Please emphasize this to the patients when you are doing your teaching.

Workshops

New Workshops Announced in Ontario!

Please check out the following from NursingLinks.ca to check out new dates for workshops.

Question & Answers Re: Droperidol

Thanks to Delia for requesting information regarding the correct route of Droperidol administration. As per the following emails, the end result is that Anesthesiologists should not be ordering Droperidol for PONV until it has been passed through the P&T committee.

Question:
Hi Helen (Zhong) and John (Iazzetta)
Recently there have been anesthesiologists ordering Droperidol for post-op nausea and vomiting in the PACU. I can’t seem to find it in the Sunnybrook formulary, nor under the IV authorization for Nurses. Is this a new medication being used at SB? If it is, the trend seems to be that we will be using it more frequently in PACU as drug of choice for PONV and it should be added to the above pharmacy sections.
Can you find out how it is meant to be given ie: can the RN’s push it (like gravol) or does it need to be hung in a minibag?
Thanks for clarifying, I look forward to your response!
Ramona


(email from John Iazzetta, Pharm.D.Drug Information Service)
As you may be aware, Jason is proposing revising the PONV algorithm, especially the rescue antiemetics. One change is the routine use of IV droperidol in the PACU. A major for this change are that it is considered by many to be the most effective antiemetic in the PONV setting.

The reason for it’s lack of use over the years is that case reports published years ago had associated it’s use with prolonged QT-interval and rarely, Torsade de Pointe. As a result of these reports the FDA required a black box to be included in the product monograph, warning of the potential for this arrhythmia. Because of the black box most anesthesiologists stopped using it because medical-legal concerns.

However, over the past few years the initial reports implicating droperidol have been critically reviewed by many experts in this area and concluded that the warning was unfounded because in the majority of cases there were other contributing factors and the doses used greatly exceeded the usual antiemetic doses used in PONV.

Many experts and consensus guidelines have concluded that droperidol is an effective and relatively safe antiemetic when used in low doses (eg 1mg) and for one or two doses. As safeguards, the anesthesiologists/APS should still screen patients who might be at risk for QT-prolongation and patients should undergo ECG monitoring during and for a brief period following the dose. In recalling my discussion with Jason, we agreed to administer the dose via a minibag, at least initially.

The plan is to take the revised PONV algorithm to P&T for approval, at which time we would request that the PACU nurses be authorized to administer droperidol IV. My suggestion is that the anesthesiologists be requested to not prescribe the drug with the expectation that the PACU nurses will administer until it is officially approved by P&T (pharmacy cannot add droperidol to the authorized IV list without P&T approval). In the interim, although it may not be practical, the physicians are free to administer droperidol IV at their discretion.

(From John)
Dr. Morningstar has responded to the email and has offered to review the literature on the efficacy and safety of IV droperidol for PONV and propose a protocol for its administration in the PACU. Unfortunately, because of scheduling conflicts the earliest we can present this issue at the P&T Committee is in April.

Until there is an approved protocol we would ask that that you please refrain from prescribing the drug.

Thank you for your cooperation.

John