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- Title
Can that be flashed? A process improvement initiative for cranial bone flaps with positive bacterial cultures.
- Authors
Dewar, Brenda; Pelletier, Suzanne; Sandre, Roger
- Abstract
In cranial surgery, when bone flap replacement is delayed, bacterial cultures and cryopreservation are indicated. There are no practice guidelines to manage positive bacterial cultures on autologous bone flaps. In 2013 Health Sciences North (HSN) Infection Prevention and Control department staff (HSN IPAC) learned of two occurrences where Immediate Use Steam Sterilization (IUSS) was used in an attempt to sterilize contaminated autologous bone flaps. The goal of this project was to identify and implement a standard of practice to address the perceived need for sterilization of contaminated bone flaps without IUSS. Project: IPAC HSN studied practices from harvest of the bone flap to re-implantation. This review included discussions with hospital staff in medical device reprocessing, neurosurgeons, and other facilities where human tissue and bone are processed and stored. Scientific publications (4,8,9,10) and practice standards (1,2,3) were reviewed. Collaboration with HSN surgical leads and senior administration clearly emphasized the need for improved harvesting and storage practices and a guided decision tool. Results: Project participants included HSN IPAC, infectious disease physician, Medical Device Reprocessing Department (MDRD) staff, neurosurgeons, hospital administrators and surgical resource staff. The group identified improvement opportunities in the following areas: laboratory specimen collection, storage and documentation practices of the bone flap, appropriate use of IUSS and policy development. An interim guided decision tool was developed and implemented. This collaborative effort empowered staff to apply a consistent practice for cranial bone and managing positive bacterial results that do not include IUSS. Lessons Learned: Practices for management of autologous cranial bone flaps are not clearly defined and vary significantly across Canadian healthcare facilities. A standardized process that is evidence-based is needed to reduce microbial contamination at time of harvesting and to provide disinfection practices that are validated to improve patient outcome without the use for IUSS. Ongoing review is needed with collaboration toward a national practice standard.
- Subjects
SURGICAL flaps; INTERPROFESSIONAL relations; EVALUATION of medical care; MICROBIAL contamination; QUALITY assurance; QUESTIONNAIRES; SKULL; SKULL surgery; STERILIZATION (Disinfection); EVIDENCE-based medicine; PHYSICIAN practice patterns
- Publication
Canadian Journal of Infection Control / Revue Canadienne de Prévention des Infections, 2016, Vol 31, Issue 4, p249
- ISSN
1183-5702
- Publication type
Article