Onsite
Reducing Surgical Site Infections in Operating Rooms by Connecting Clinical and Environmental Microbiology though Environmental Quality Indicators

In today’s healthcare facilities, there is an increased drive to reduce surgical site infections (SSI). Among healthcare-associated infections (HAIs), SSIs are one of the more pronounced complications of care, affecting a substantial portion of the patient population admitted to acute-care hospitals and ambulatory surgery centers worldwide. An effective way to mitigate SSI is by optimizing environmental quality conditions to reduce airborne and surface contamination. Careful analysis and evidence-backed data are the key pillars for augmenting aseptic environments.

This is where OnSite LLC brings value to care facilities.

Having worked closely with many healthcare providers, OnSite understands that their clients often only conduct environmental samples when outbreaks or clusters—groups of harm-related incidents—occur. This is partially due to the lack of guidelines and regulations surrounding when and how to conduct environmental sampling as well as how to interpret the data. Furthermore, the collection of microbiological samples is expensive, time consuming, and with a five-day or longer incubation time, corrective actions are reactive instead of proactive. OnSite helps their clients be proactive in infection prevention by improving the cleanliness of the environment, minimizing the risk for microbial contamination, and maintaining that clean space before contamination can occur and lead to SSI.

OnSite LLC is a multidisciplinary research, consulting, and engineering company focused on testing indoor environmental qualities against specific methodologies, clinical processes or procedures, medical equipment, and engineering systems performance. The company helps care facilities "hardwire" improvement modifications into their day to-day clinical and infection prevention operations. OnSite is led by an expert team of physicians, clinicians, microbiologists, industrial hygienists, scientists, engineers, and technology medical professionals with extensive, collective experience in testing, planning, commissioning, and surveillance of healthcare environments, infection prevention and the role of the microbiome in the care environment.

“We are uniquely qualified to conduct and use research-based evidence from studying how spaces are contaminated during normal use times (dynamic conditions) to help facilities optimize their patient spaces by using fewer resources to improve aseptic environments and clinical outcomes,” says Damon Greeley, PE, a-IPC, Managing Partner at OnSite.

Similar to the pharmacy and manufacturing cleanrooms, operating rooms should have policies to ensure they maintain the most aseptic environment possible when it is the most important – when the room is occupied and patients are exposed.

OnSite, to this end, is proficient in scrutinizing a wide variety of environmental quality indicators to continuously assess and predict the risk for an increase in microbial contamination. They effectively eliminate the tedious and time-consuming process of collecting microbiological samples for laboratory assessments by helping clients acquire immediate actionable insights to minimize microbial contamination risks.

Onsite employs a method of studying in-room contamination levels during active use of the room and has developed an algorithm to predict the risk for increased microbial contamination by sector within the room. This serves two purposes: one, to understand where the risks are the greatest, and two, to effectively optimize and maintain the asepsis of the space. Through this process, OnSite’s clients learn to better understand the environment in which they are working and how to improve infection prevention and maintain that improved condition.

“By understanding the environment as a whole, and the environmental qualities that affect the risk for microbiological contamination, infection prevention teams, facilities, and clinical microbiology can strategize to maintain cleaner environments and prevent HAIs and SSIs and, in turn, augment antimicrobial stewardship,” adds Jennifer Wagner, Ph.D., Managing Partner at OnSite.

With their specialization in identifying hidden causes of contamination and predicting risk, OnSite has developed the BEACONTM Program. The carefully vetted approach is standardized yet customizable to the specific needs of the individual hospital or ambulatory facilities. For example, to improve the airborne environments in operating rooms, BEACONTM measures environmental quality indicators (EQI), including relative humidity, temperature, particle counts, supply air velocity at the diffuser face and surgical table, among others, and then develops a visual room map of existing risk. This approach, supported by augmented intelligence and machine learning, helps uncover better ways to improve the aseptic environment, often without modification to existing infrastructure.

Currently, OnSite is digitizing OR spaces and embedding environmental quality testing and predictive algorithms into hardware and software devices for continuous in-room monitoring through BEACONTM. It is aimed at helping clients understand how to continuously monitor, control, measure, and improve critical care environments.

The efficacy of their strategies has been validated in multiple case studies published in peer-reviewed journals across different critical spaces, including ORs, in which the SSI rates were significantly reduced after implementing the company's risk-based recommendations. OnSite is the only U.S. company continually measuring and mapping dynamic, simulated, and live cases and processes, allowing them to create a visual model of in-room microbial and particulate contamination. They benchmark all the data obtained with healthcare networks across the country and worldwide to give clients an in-depth understanding of their areas for improvement.

With a multidisciplinary team and advanced research backed strategies, OnSite continues to help their clients take long strides to maintain aseptic environments and improve positive clinical outcomes.