Chapter 4 Flashcards
What are the three different types of SSI’s
superficial incisional infections
deep incisional
organ/space
When are deep incisional and organ/space infections typically diagnosed
before discharge
What does aseptic practice included
attire
environmental sanitation, scrubbing
gowning
gloving
setup and maintenance of the sterile field
prepping and draping of the patient
protection of the sterile field until the patient’s procedure is completed.
What pathogens are most commonly associated wiht SSI’s
Staphylococcus aureus
Staphylococcus epidermidis
coagulase-negative staphylococci
Enterococcus species.
What are some things that increase the risk for SSI’s
(surgical time) the presence of implants the amount of ischemic tissue present. age poor nutritional status, obesity compromised immune system preexisting disease (especially diabetes) preexisting infection burns nicotine
Why does smoking increase the risk for infection
because it reduces the amount of oxygen that reaches the tissues which delays wound healing
Why is obesity a risk factor for SSI’s
because fatty tissue isnt very vascular and avascular tissue is suseptible to infections
What are some exogenous risk factors for SSI’s
length of surgery type of procedure surgical technique extended hospitalization number of people in the OR
What is a colonized individual
one that carries the organism but isnt infected
What is a consideration for fingernails and the OR
no nail polish ever
finger nails longer than a quarter inch have higher bacterial counts
What is the first thing a periop nurse needs to do when “opening” a room
wipe down all horizontal surfaces
Standard precautions of spreading infection when handling blood and body fluids covers what fluids
blood
all body fluids, secretions and excretions except sweat
What are the three types of transmission based precautions
airborne
contact
droplet
What is airborne precautions
pathogens 5 microns or smaller
and spread by the air
What are some examples of pathogens that require airborrne precaution s
TB
rubeola
varicella
What is a consideration with patients that are on airborne precau and they have an elective surgery
postpone the surgery
What if someone needs surgery immediately but they are on airborne precau
the surgery should have as few personnel in the room as possible and the room needs to remain vacant and closed after the surgery until the rooms air has been completely exchanged
What are droplet precau
5 microns or larger
require a mask for personnel wthin 3 ft of the patient
require that the patient be positioned at least 3 ft from other patients
What do droplet and airborne precau pats require during transport
a mask
What are pathogen examples that req droplet precau
the flu
mumps
What do contact precau req
wearing gloves and gown
wearing mask when their is a risk of aerosolized organisms
cleanign and disinfecting pat equipment
When do Masks with face shields or protective eyewear with side shields need to be worn
when splashes, splattering, or aerosolization of blood and body fluids is anticipated.
What is the periop nurses primary responsibility
to maintain aseptic practice Surgical attire
•Sterilization of instruments and equipment
• Hand hygiene
• Patient skin preparation
• Creation and maintenance of a sterile field
• Environmental hygiene
Does hair removal increase risk of infection
yes
When should hair around the site be removeed and where should it be removed
only when it interferes with the procedure and it should be done outside of the OR and as close to the time of surgery as possible
What needs to be assessed before removing hair
it should be assessed for rashes moles warts any conditions
What can be used for hair removal
clippers and depilatory cream
What should never be used to remove hair
razors
Why should the hair be removed outside of the OR
to minimize the risk of contaminating the sterile field with microORGs on the hair
What should the pat do for surgical site cleanliness the night before or right before the surg
shower
What are the most commonly used skin prep solutions
CHG
Alc
iodophors
all at 60-90 percent
What are some considerations for using CHG as a skin prep
dont use on mucous membranes
dont use near eyes or if their is risk of hitting the inner ear cause it can damage to eyes and ears
What are some considerations for using alc based skin preps
dont use near eyes or mucous membranes
What areas should be cleaned with skin prep
incision site and area around it
any anticipated additional incision sites
drain insertion sites
What is an intervention for rpeventing pooling and thus chemical burns from skin prep
place towels around incision site and remove the towels before draping
What are preps that include “dirty” areas that need special cleaning and explain their process
• The umbilicus is cleaned with cotton-tipped applicators before the skin prep begins.
• A colostomy or stoma is covered until the surrounding area is prepped, and then it is prepped with a separate sponge.
• In a perineal prep, the vagina and/ or anus is prepped last with a separate sponge.
In a shoulder prep, the axilla is prepped last.
What should you do for unusual wounds or incision sites when it may be difficult to know where to begin
use good judgment to determine the approach that will minimize contamination at the incision site.
What should be used to clean patients eyes and where should the cleaning begin
use cotton balls and start from the nose and continue outward
What should be used to prep burned or denuded skin
normal saline
What temp should you try to make skin prep solutions
warm
What should be included in the documentation of a skin prep
assessment of the site hair removal (if any) skin allergies/sensitivities the prep agent area prepped name of person performing the prep skin condition post-op
If hair removal is done, what should be documented
the site mehtod time location and person doing it
What sites are considered unrestricted
break rooms
waiting rooms
pre-op areas that allow family in street clothes
What is considered semi-restricted areas
pre-op admission areas
PACU
and the peripheral support areas around the surgical room
What is considered restricted areas
OR
Where should hats or hoods be worn
supply areas
restricted areas
Is it okay to take your mask off and let it hang around your neck or put it in your pocket
never
How should masks be removed
only by the strings
Do you need to wash your hands after removing a mask
yes
What is a consideration with single use PPE and the OR
they need to be removed before leavign
What type of personnel should not be in a scrub role
resp infection
has cuts or abrasions on arms
should sterile gloves have powder
no
What is a method of doning sterile gloves by yourself
closed gloving
Where is the gown package opened
outside of the sterile field
What are the steps for doning a sterile gown
open package and remove towel without spilling water on gown (if traditional surgical hand scrubbing was done)
when drying hands, dry with a blotting circular motion from hands to elbow
when finished with that hand, use other half of the towel on the other hand
insert arms into arm holes, step back from the table and let the gown unfold itself
after doning gloves wih closed technique hand cardboard tie to circ nurse and pivot around so the tie wraps around the body then pulls the tie off of the cardboard and tie the ends together
