Continuous Quality Improvement

Concurrent Education Session - 60 minutes

2301 - Preoperative Wellness: An Ounce of Prevention

Thursday, June 15
2:15 PM - 3:15 PM
Location: Oregon Convention Center, B 113 - 114

Traditional surgical quality improvement efforts have focused on intraoperative management and postoperative interventions. Preoperative evaluation has largely been relegated to the concept of “clearance,” assuring that the patient’s heart, lungs, and other vital systems will survive the procedure. Unfortunately, the traditional concept of clearance results in many patients arriving in surgery frail, malnourished, relatively immunocompromised, fully colonized with bacteria, and with some continuing to smoke. These patients are at an increased risk of complications such as surgical site infections (SSIs), wound dehiscence, pneumonia, and death. In an effort to improve the outcomes for elective surgical patients, a collaborative team from Indiana University (IU) Health have committed to changing the paradigm for preoperative assessment: to move away from simple clearance to optimization of patients before surgery by improving the wellness of patients preoperatively in order to minimize the risk of postoperative complications. The IU Health preoperative wellness program focuses on the creation of a comprehensive bundle of the best-known evidence-based practices that are comprehensive enough to be effective while still being simple enough for consistent patient compliance. This presentation will review evidence-based elements of preoperative wellness (ERAS) that have shown reduction in the risk of surgical complications, describe the IU Health preoperative wellness program (respiratory wellness: tobacco cessation and preoperative incentive spirometry; cardiovascular and musculoskeletal wellness: preoperative exercise; immunonutrition: usage of a specialized nutritional product to stimulate the immune system and improve nutrition and healing; decolonization: routine application of antibacterials to decrease the skin and nasal flora), describe how to organize and implement a preoperative wellness program, and analyze the appropriate patient outcome measures impacted by patient compliance with the best practice bundle.

Learning Objectives:


Heather A. Hohenberger

Administrative Director Perioperative Services
Indiana University Health Arnett Hospital
Lafayette, Indiana

Heather Hohenberger, MSN, RN, CIC, CNOR, CPHQ, FAPIC has almost 20 years of experience in nursing. She has worked at the bedside in pre-op, post-op, PACU, and the OR. She transitioned to surgical education and infection prevention in 2009, earning her certification in infection control (CIC) in 2011. Her previous work experience has been vital in her role as administrative director for perioperative services at Indiana University Health Arnett Hospital. Heather served as the APIC liaison to the AORN Guidelines Advisory Board from 2014-2016 and has authored several articles on infection prevention, perioperative quality, and patient safety in the perioperative setting.

Presentation(s):

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Kristen Kelley

Director, Infection Prevention
Indiana University Health
Carmel, Indiana

Kristen Kelley is the director of infection prevention and epidemiology for the Indiana University Health Academic Health Center. An infection preventionist since 2004, Kristen has experience with both adult and pediatric populations. As the director of infection prevention, she has led multihospital projects focused on collaboration between disciplines for reduction of CLABSI, CAUTI, and surgical site infections.

Presentation(s):

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Darlene Carey

System Director Infection Prevention and Control
Gwinnett Medical Center
Lawrenceville, Georgia

Darlene Carey is currently a doctoral candidate and serves as the system director of infection prevention and control at Gwinnett Medical Center in Lawrenceville, Georgia. She also serves as the vice chair for APIC’s Practice Guidance Committee. Ms. Carey has developed numerous risk assessment tools and has presented these tools at national workshops on optimal utilization of risk assessments and identifying and mitigating infection risks for the GI lab. In keeping with her affectionate title of “Scope Czar” and her focus on endoscope reprocessing, she recently authored an article entitled “Two Teams, One Shared Goal”, collaborating with gastroenterology and infection prevention colleagues to become infection prevention champions! Ms. Carey continues to focus on patient safety and reducing risk by providing operational proficiency.

Presentation(s):

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