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Quality Improvement of Neurosurgical and Orthopedic Instrument Sterilization Workflows: Closing the Performance Gap to Reduce the Risk of Bioburden and Surgical Site Infections in an Academic Medical Center

Nieminen, Lydia (2024) Quality Improvement of Neurosurgical and Orthopedic Instrument Sterilization Workflows: Closing the Performance Gap to Reduce the Risk of Bioburden and Surgical Site Infections in an Academic Medical Center. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Over 51.4 million in-patient surgical procedures are performed in the US each year with 2-4% of patients experiencing surgical site infections (SSIs) (AHRQ, 2019). SSIs increase the risk of morbidity and mortality and disproportionately affect those with low socioeconomic status, comorbidities, or older age. SSIs are the leading cause of hospital readmissions and cost the US healthcare system $3.5-10 billion annually (Seidelman et al., 2023). Proper medical instrument reprocessing is crucial to prevent the transmission of infectious agents and reduce the risk of SSIs (Jefferson & Young, 2014).
Methods: The primary objective of this study was to examine programmatic management issues that could arise in a clinical setting and explore the connections between the various system components that influence efficient and effective instrument reprocessing. Such information would be valuable in preventing errors that impact patient and staff safety. Behaviors, knowledge, and attitudes regarding instrument reprocessing were measured via researcher observations, staff audits, and anonymous staff interviews.
Results: Twenty neurosurgical and orthopedic surgical case carts were observed within a period of six weeks, in which point-of-use cleaning, precleaning, and disinfection were audited. A surgical tray audit tool was assigned to central sterile processing (CSP) staff who performed a total v
of 183 observations. Both enzymatic spray compliance and bioburden incidence were found to vary by surgical service line and the time of procedure. Three employees from each phase of the reprocessing cycle were interviewed to gauge their knowledge of the workflow, identify potential challenges, and provide suggestions for improvement. Staff interviews expressed a resounding appreciation for instrument reprocessing but indicated lack of education and communication to be potential barriers.
Conclusion: The project identified a correlation between enzymatic spray/pretreatment compliance and bioburden incidence. The study found that higher enzymatic spray/pretreatment compliance rates were associated with lower dried blood and tissue levels. Furthermore, bioburden events were more prevalent during off-shift observations than on-shift observations and less pretreatment was employed during off-shift procedures. These results suggest that maintaining high compliance rates with enzymatic spray/pretreatment may reduce dried bioburden levels and prevent bioburden events, particularly during off-shift procedures.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Nieminen, Lydialjn30@pitt.eduLJN300009-0008-3112-4811
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairFrank, Linda Rosefrankie@pitt.edufrankie
Committee MemberYassin, MohamedMHY8@pitt.eduMHY8
Committee MemberHa, Toantoan.ha@pitt.edutoan.ha
Date: 2 January 2024
Date Type: Publication
Defense Date: 11 December 2023
Approval Date: 2 January 2024
Submission Date: 14 December 2023
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 78
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Reprocessing, Infection Prevention, Surgery, Infectious Disease
Date Deposited: 02 Jan 2024 22:20
Last Modified: 02 Jan 2024 22:23


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