Reducing Infection Rates: The Impact of an ASC’s Safety Culture
By Amanda Sosnosky, Administrator of Orthopedic Surgery Center of Green Bay and Orthopedic Surgery Center of the Fox Valley
As the demand for elective orthopedic surgery continues to rise, patient safety remains a top priority for healthcare providers. Ambulatory surgery centers (ASCs) are proven to offer several benefits for elective orthopedic surgery, including
- Cost savings 1
- Shorter recovery times 2
- Higher success rates 3
- Reduced risks of infection due to their controlled environment 4
In particular, at Orthopedic and Sports Medicine Specialists (OSMS), our Orthopedic Surgery Centers have an impressively low postoperative infection rate of 0.15%, significantly lower than the ASC average of 0.85% and the hospital average of 2.5%.4 Our own data, coupled with third-party research, highlights a shift toward increased use of ASCs for orthopedic procedures that can not only benefit individual patients but also employers looking to reduce healthcare costs while ensuring superior outcomes.
This article will delve further into why postoperative infection rates matter, the benefits of choosing ASCs for elective orthopedic surgery, and how OSMS’s three-pronged approach achieves lower infection rates by:
- Fostering a culture of safety, from practice owners and leadership to the front desk clerks and cleaning staff.
- Following evidence-based best practice standards for cleaning, decontamination, and more to maintain sterile environments.
- Educating and empowering patients to take control of their health and safety before and after their operation to reduce their risk of infection.
Why infection rates matter
Postoperative infections present significant issues for patients who have undergone surgery. Infections not only lead to prolonged hospital stays but can also cause serious health complications and even death in some cases. The Agency for Healthcare Research and Quality estimates that 3% of patients who contract a surgical site infection (SSI) will die from the resulting complications.4 This is a devastating statistic, making it essential to take preventive measures to reduce SSI rates as much as possible.
In addition to the obvious health risks to patients, SSIs create financial burdens for healthcare systems and increase healthcare utilization dollars for patient employers. According to research by the Association of Perioperative Registered Nurses, patients with SSIs can double the cost of care to the hospital and the length of their stay in the hospital.5 Extended hospital stays and the additional diagnostic tests and treatments required for recovery translate to higher insurance costs and uncertainty for employees returning to work. Ultimately, healthcare practices must do everything possible to prevent SSIs and thus reduce the economic and clinical burdens that impact all parties.
High postoperative infection rates can also negatively impact patients’ satisfaction and trust in care providers. Collaboration between healthcare providers, patients, and other stakeholders is critical to upholding effective preventive strategies and reducing postoperative infection rates.6
Innovation in medical research is critical for healthier and safer communities. This requires orthopedic care providers to deliver comprehensive care addressing patients’ physical and emotional needs. At OSMS, we believe successful orthopedic care entails equipping patients and their employers with the necessary support and information about treatment, recovery, and risks to help patients and their employers make informed decisions. Through such progressive measures, medical providers can drive the frontiers of research and care.
Why choose an ASC?
When deciding between traditional hospital care and ASCs for elective surgery, patients should not take the decision lightly, as it has significant implications for postoperative outcomes. Hospital settings often have long wait times, increasing patients’ stress.
The high cost of hospital care can also take a toll on their pocketbooks while increasing the financial burden on employers who must assume the cost of their employees’ healthcare. Postoperative recovery times are often longer in a hospital setting, meaning patients can expect more time away from work or other activities. Conversely, ASCs offer shorter waiting times, lower costs, and quicker recoveries without sacrificing quality of care.
The value of physician ownership is at the core of many ASCs’ cultures. According to the Ambulatory Surgery Center Association, physician ownership has several benefits, including physicians having maximum professional control over the clinical environment and the care delivered to patients. This translates to intensified quality control processes and personally guided, innovative strategies for governance, leadership, and quality initiatives.7
Considering the heavy burden caused by postoperative infections, healthcare providers must make every effort to reduce their occurrence as much as possible through preventive measures and early detection methods. Acting now can help save lives and reduce financial costs associated with SSIs in the future.
Safety starts with organizational culture
Ensuring safety and minimal infection rates in healthcare requires a system-wide commitment to best practices. All members of the healthcare system should be engaged, informed, and committed to implementing best practices to maintain a low infection rate and keep patients safe. To achieve this objective, administrators and doctors should receive appropriate training and educate and empower patients on mitigating the risk of infection.
At OSMS, we believe that when we care for a patient like they are a loved family member, we know they are getting the best care possible. The best care possible also means the safest care possible, and we achieve this through a thorough list of safety measures:
- We believe that having established doctors leads to lower operating times and lower infection rates due to their extensive knowledge and experience. Not only are our doctors highly trained and have longstanding tenure within our organization, but because OSMS is doctor-owned, they also drive our culture of patient safety and satisfaction. All of these aspects result in a safer, faster, and more successful patient outcome.
- Our Infection Control Nurse is a part of the Association for Professionals in Infection Control and Epidemiology and is responsible for monitoring infection rates and potential risks. This position provides ongoing training and information to keep our staff informed of the latest infection control practices and procedures.
- At OSMS, we don’t punish staff for stopping the chain of a procedure when they feel it’s necessary or safety is being compromised. Everyone is encouraged to speak up at any time during the process to put safety first.
- OSMS fosters a positive team environment that starts with trust and respect. We believe that when everyone is happy and content in their environment, it creates a low-stress atmosphere that ultimately leads to better outcomes for our patients.
By putting patient care first, providing ongoing staff training, and creating a low-stress environment, we are doing everything in our power to build a culture of safety in our organization that will lead to reduced infection rates and improved overall patient safety.
Clean facilities
The foundational principle of patient safety and infection control is cleanliness and hygiene. According to the Centers for Disease Control and Prevention, adherence to infection prevention and control practices is essential to providing safe, high-quality patient care across all healthcare settings.8 Proper cleaning reduces the risk of acquiring potentially serious infections from pathogens that may be present in the environment. This is why healthcare providers must take exceptional care to sterilize instruments, dispose of medical waste correctly, and adhere to rigorous handwashing protocols along with taking measures to make sure the employees and patients within the facility remain healthy.
At OSMS, we go to great lengths to ensure that our working environments meet the highest standards of safety and hygiene:
- OSMS partners with a health cleaning service to ensure the utmost cleanliness for our facilities. We receive periodic inspections from this trusted provider and take their reports seriously to keep everyone safe and healthy.
- Our dedicated team conducts meticulous secret shopper and white-glove evaluations to ensure our spaces are always pristine and spotless.
- We take hand hygiene seriously—from the front desk administrators registering patient arrivals to staff members in the clinic to surgery teams performing operations. Rigorous audits ensure everyone is washing their hands between each patient contact and wiping down any shared surfaces to maintain a clean and safe environment for all!
From protocol in the operating room to interactions between surgeons and patients, we’re committed to ensuring every individual follows proper cleanliness standards. By maintaining a structured approach to cleanliness, we prioritize the health and safety of all those who enter our doors.
This is also where culture plays a key role in patient safety. At OSMS, we believe all employees have the right to report any patient safety concerns or protocol violations without fear of punishment, regardless of their job title or seniority. Unlike some larger healthcare systems that may have strict hierarchies, we prioritize a culture of transparency and accountability.
Another reason ASCs have become increasingly popular in recent years is their ability to provide a more controlled and personalized environment for patients undergoing surgical procedures. Many ASCs have strict selection criteria for their patients, a common one being that they will not accept individuals with active infections. This precautionary measure ensures that the risk of infection is minimized, making the space a safer place for all patients. Overall, ASCs offer patients a positive and efficient alternative to hospitals, where they can receive high-quality care in a more intimate setting.
Operation-day safety
Following protocols during operations is an essential part of reducing infection rates. Studies have found that healthcare facilities with stricter adherence to established protocols had significantly lower postoperative infection rates than those with less oversight.9 Preventive measures include proper preoperative skin preparation, use of antiseptic solutions during surgery, appropriate handling of surgical instruments, and proper gloving and garbing.
OSMS understands the importance of adhering to quality assurance standards to provide our patients with the best possible care. That’s why we take sterilizing and decontaminating our equipment and instruments very seriously. We follow the latest Association for the Advancement of Medical Instrumentation and American National Standards Institute standards to ensure our tools are fully sanitized and ready for use. One area where many facilities have opportunities to improve their process is throughout the decontamination procedure. In the decontamination suite, where instruments for procedures are cleaned and prepared for use, it’s critical to maintain a sterile environment to prevent any cross-contamination. To achieve this, we ensure that all personnel entering the room are fully garbed, including eye protection, gowns, and bonnets. We understand that even the tiniest lapse in protocol can have serious consequences.
One shortcut prevalent in the medical field is immediate-use steam sterilization (IUSS). According to the Joint Commission International (JCI), IUSS refers to the steam sterilization of instruments immediately aseptically transferred to the sterile field.10 Some practices may take this shortcut because it uses a shorter cycle to sterilize equipment and allows for a quicker turnaround time to use equipment and instrumentation in the next case.
However, this type of sterilization is not a best practice and should not be used for convenience or to avoid the cost of additional instruments.10 Safety standards and best practices are most often compromised when employees in the reprocessing department are asked to deviate from their standard procedure due to tight schedules or the demands of a physician.10
The JCI also emphasizes that when practices prioritize optimal facilities and equipment, and when they make supplies available, safety related to reprocessing equipment can be achieved:
- Standard workflows and procedures can be established and enforced.
- Best practices are implemented and followed by all.
- Staff members receive sufficient training and are competent.
At OSMS, we believe that IUSS is not the benchmark standard, and we refuse to cut this corner in our practice. Our commitment to patient safety means that our physician owners have invested in enough equipment and instrumentation for us to forego this method entirely. OSMS meticulously manages its workflows, surgery schedule, and patient loads to provide realistic turnaround times and ensure staff can adhere to its decontamination and sterilization standards.
Preoperative patient education and planning
One of the most important aspects of safety is patient education. Because ASCs handle elective surgeries, they can take extra care to help patients understand their role in preventing infections and improving their recovery time.11
Patient education is crucial because it directly correlates to better patient outcomes. In a study performed by Gallup, it was found that when patients knew what to expect after surgery, were prepared for their postoperative experience, and followed post-surgery instructions, such as rehabilitation or medication, they reported significantly higher satisfaction and significantly lower problem incidence compared to those who did not feel completely prepared.12
OSMS takes time to make sure patients are adequately informed and prepared for their surgery. This includes addressing any health concerns such as smoking cessation, weight loss, and other issues that could affect the outcome of the surgery. OSMS also spends considerable time on discharge planning with each patient to avoid postoperative infections or complications. To achieve this, OSMS doctors:
- Outline clear lifting, weight, and movement restrictions to prevent tearing open wounds.
- Discuss meal planning to ensure that patients don’t have to strain themselves to reach pantry shelves, pull anything heavy out of the fridge or bend over to reach into an oven.
- Assess the patient’s environment for potential risks, such as rugs or stairs, that could be hazardous during recovery.
- Address any pets in the home and how they interact with wound bandages, equipment, and the patient. This is also the time to discuss a pet’s temperament, which can impact if the patient can care for their pet postoperatively.
By carefully assessing all possible risks ahead of time, patients can rest assured that they are fully prepared for successful surgery and recovery.
In conclusion, ASCs provide numerous advantages for patients and employers alike. Patients can benefit from cost savings, shorter recovery time, higher success rates, and fewer complications due to reduced risk of infections. Employers also have much to gain because they can reduce workers’ compensation claims, control healthcare costs, and get employees back to work faster.
ASCs layer in additional benefits to patients and employers by being doctor-owned, including having greater control over their clinical environments to ensure patients receive the highest quality care possible. OSMS prioritizes safety from the top down, creating a team culture that works together to provide the best possible care for patients, leading to lower infection rates and higher patient satisfaction. Our physician owners have invested in the necessary equipment to guarantee that our patients receive only the highest quality service throughout their surgical journey. From preoperative education to sterilization protocols, every detail is considered so that each individual receives a safe and successful experience with us. With our commitment to providing superior care, you can be sure that your health is always in good hands at OSMS.
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