ANSWERS


1. C: Shaving causes microscopic skin cuts that allow sur- face bacteria to penetrate, causing infections.


$ 7KH LQưDPPDWRU\ H[XGDWHV WKDW IRUP ZKHQ WLVVXH LQWHJULW\ LV GLVUXSWHG E\ D VXUJLFDO LQFLVLRQ HPEHG WKH FRQWDPLQDWLQJ EDFWHULD LQ D ƮEULQ FORW PDWUL[ PDNLQJ LW GLƱFXOW IRU DQWLELRWLFV WR UHDFK WKH EDFWHULD


' 6&,3 ZDV GHVLJQHG E\ D SDUWQHUVKLS RI QDWLRQDO RUJD- QL]DWLRQV IRFXVHG RQ UHGXFLQJ SDWLHQW VXUJLFDO FRPSOLFD- WLRQV E\


E\


dissemination of particulates in the air. Surfaces such as push plates, cabinet handles and knobs/buttons/keyboards can harbor harmful bacteria and endospores, such as clostridia (e.g., Clos- tridium difficile). ORs have specialized air-handling systems that exert positive pressure when the door is opened and negative pressure in the corridors. Tis prevents additional particulate matter from being pulled into the room from the hallway if the door is opened.5


Some specialty rooms have a system of laminar


airflow that directs the cleanest air possible toward the sterile field. Some entryways have ultraviolet light for additional bacte- riostatic protection. Te air quality is maintained at the cleanest levels possible, but air itself is never sterile.5 Human factors in bacterial spread include the attire of the


OR staff: sterile gowns and gloves, hair covers that completely cover the hair and ears, and masks. Skull caps should be avoided because the hair at the nape of the neck protrudes and can shed bacteria and particulate into the surgical site.5 Te amount of bacteria in the incision at the end of surgery


is the major determinant of SSIs. More than 40 years ago, the CDC used a clinical estimate of the amount of bacteria likely to be encountered in the surgical site during surgery to develop a surgical wound classification system. (See chart on previous page.) Surgical risk is further defined by three additional risk factors


that play a significant role in wound infections: an operation lasting more than two hours, one involving the abdomen or one performed on a patient having three or more underlying diagnoses (indicative of the patient’s clinical comorbidity). Te addition of these three factors to the CDC wound classification system makes predicting the risk of a wound infection twice as helpful as the traditional wound classification alone.3,5


Note that


wound class is documented at the end of the surgical procedure and not before. Te perioperative nurse has no way to predict what conditions may be encountered during the procedure or if a major break in technique might occur before closure. For example: A Class 2 cholecystectomy can become a Class 3 if bile spills into the abdomen.5


Knowledge vs. practice Te introduction of antibiotics in the 1940s led to the belief that treating wound infections with antibiotics after surgery might be the answer to SSI. However, bacteria developed drug resistance that continues into modern times. It has taken hundreds of clinical trials to understand the most effective and appropriate methods of using antibiotics to prevent SSIs. Te efficacy of antibiotics against SSIs was established in the


1960s, when studies determined they were most effective in prevent- ing wound infections when given before the inoculation of bacteria into the wound and ineffective if given three hours after inocula- tion.3


Studies also confirmed that giving antibiotics for more than


24 hours after wound closure offered no additional benefits unless the patient was obese with poor tissue perfusion.3


Although this


important information resulted in good evidence-based guidelines, surgeons continue to use and time antibiotics inappropriately in many surgical procedures in U.S. hospitals. Surgeons, nurses, surgical technologists, anesthesiologists, infec-


tion control practitioners, pharmacists and hospital administrators can work together to improve patient safety by providing care


2016 • Visit us at NURSE.com 31


At her hospital’s quarterly infection control committee meeting, Sharon, an infection control nurse, presented the hospital-acquired infections surveillance results for the quar- WHU 66,V ZHUH VLJQLƮFDQWO\ KLJKHU WKDQ LQ SUHYLRXV TXDUWHUV $ VXEFRPPLWWHH ZDV IRUPHG WR ƮQG RXW ZK\


1. Which practice could be increasing SSIs?


a. Prophylactic antibiotics were given to each patient within 30 to 60 minutes of incision.


b. Cefazolin (Ancef) was the drug of choice for most surgeries.


c. The surgical sites of all patients were shaved the night before surgery


d. All patients bathed with an antimicrobial soap the night before surgery.


2. Although most surgeons gave prophylactic anti- biotics within 30 to 60 minutes of incision time, a few ordered antibiotics to be given in the recovery room after surgery. What reasons support giving antibiotics before incision time?


a. Antibiotics are not able to penetrate into the sur- URXQGLQJ VXUJLFDO DUHD WKURXJK WKH ƮEULQ FORW PDWUL[ that begins forming immediately when tissue integri- ty is disrupted by a surgical incision.


b. The high blood sugar levels that occur in many pa- WLHQWV VKRUWO\ DIWHU VXUJHU\ UHGXFH WKH HƬHFWLYHQHVV of antibiotics.


c. Antibiotics should not be given after surgery because they increase the time the patient has to re- main in the recovery room so that nurses can watch for allergic reactions.


d. Nearly all patients become hypothermic in the recov- ery room. The resulting vasoconstriction prevents antibiotics from reaching the bacteria.


3. Sharon told the committee that healthcare quality would improve by following SCIP performance mea- sures. When asked about SCIP, she said:


a. SCIP (Start Comparing Insurance Premiums) was designed to help patients compare what costs their health insurance would cover for surgeries.


b. SCIP stands for the Secure Communication Imple- mentation Protocol, a HIPAA measure to secure SDWLHQW FRQƮGHQWLDOLW\


c. SCIP (Senior Care Information Program) is a new Joint Commission standard created to provide elder- O\ SDWLHQWV ZLWK LQIRUPDWLRQ RQ ZKDW WR H[SHFW ZKHQ entering a hospital for surgery.


d. SCIP (Surgical Care Improvement Project) was designed to reduce the morbidity and mortality asso- ciated with postoperative SSIs.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46