consistent with medical evidence and clinical practice guidelines. Te following evidence-based SCIP performance measures can serve as a framework to monitor progress in improving


This course is 1 Contact Hour 1. Read the continuing education article.


2. This continuing education course is FREE ONLINE until Febrary 25, 2017, courtesy of Wound Care Education Institute. To take the test for FREE, go to CE.Nurse.com/ course/CE734.


surgical patient safety:3,5 SCIP — Infection 1: Prophylactic antibiotic received no


earlier than one hour before surgical incision or within two hours before incision if vancomycin (Vancocin) or a fluoro- quinolone (ciprofloxacin) is required for prophylaxis. Timing is also important if a tourniquet will be used. Te drug should be permitted to have adequate penetration time before the tourniquet is inflated.3,5 Improving the timing of antibiotic administration is a crucial


first step in preventing SSIs. Antibiotics should be given as close to the time of incision as clinically practical and no more than 60 minutes before surgery or tourniquet inflation unless the use of a fluoroquinolone or vancomycin is indicated.3 When a surgical incision disrupts tissue integrity, an inflamma-


After that date, you can take the course for $12 at Nurse.com/CE.


If you have a CE Direct login and password


(generally provided by your employer), please login as you normally would at CEDirect.ContinuingEducation. com and complete the course on that system.


DEADLINE


Courses must be completed by April 15, 2017


3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.


4. Once you successfully complete the short test associ- ated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.


5. All users must complete the evaluation process to com- SOHWH WKH FRXUVH <RX ZLOO EH DEOH WR YLHZ D FHUWLƮFDWH RQ screen and print or save it for your records.


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OnCourse Learning is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.


OnCourse Learning is also accredited by the Florida Board of Nursing, District of Columbia Board of Nursing, and Georgia Board of Nursing (provider # 50-1489). OnCourse Learning is approved by the California Board of Registered Nursing, provider # CEP16588.


ONLINE Nurse.com/CE


You can take this test online or select from the list of courses available.


Prices subject to change. QUESTIONS Or for a complete listing of our courses Phone 800-866-0919 32 Visit us at NURSE.com • 2016 Email ce@nurse.com


tory exudate (neutrophils, macrophages, blood cells, coagulation cascade proteins and fibrin strands) begins filling the space around the wound, embedding the contaminating bacteria in a fibrin clot matrix. To penetrate the fibrin clot matrix, the antibiotic must be present at the time of fibrin formation. To ensure a therapeutic level of antibiotic at the time of incision and during the surgical procedure, the patient should receive the antibiotic just before the incision is made.3 After an incision is closed, antibiotics have no appreciable


effect on preventing infections. In addition, after the wound is closed, the increased hydrostatic pressure secondary to edema formation makes it difficult for antibiotics to gain access to the area around the wound space.3 Hospitals need standard protocols to ensure that prophylactic


antibiotics are delivered no more than one hour before the surgical incision is made. Patients should receive antibiotics when they reach the preop area or the OR rather than “on call.” With on-call dosing, case delays can result in patients’ not receiving preoper- ative doses within the recommended time frame. If an “on call” dose is given followed by delay, the patient should be redosed.3 Redosing may be necessary if the patient has experienced a large


volume of blood loss.3 SCIP — Infection 2: Prophylactic antibiotic selection for


surgical patients Surgical patients should receive prophylactic antibiotics in


accord with current published guidelines for each type of proce- dure.3


Colon procedures on patients requiring For most surgeries, cephalosporins are the drugs of choice,


and first- or second-generation cephalosporins, such as cefazolin (Ancef, Kefzol) or cefoxitin (Mefoxin) for colon surgeries, are ideally suited for prophylaxis.2,3


a mechanical bowel prep can also benefit from simultaneous oral antibiotics. Cephalosporins have a broad spectrum of activity against gram-positive and gram-negative bacteria and a wide ratio of therapeutic to toxic dosages. Cephalosporins are also in- expensive and easy to administer, and allergic reactions are rare.3 Te average adult dose of cephalosporin is usually 2 g for a 70


kg to 80 kg patient. Obese patients’ doses range around 3 g for a 120-kg patient. Pediatric doses are usually 30 mg/kg.3 To ensure that appropriate antibiotics are used for prophylaxis, hospitals should follow recommendations from the American


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