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AORN Periop class > Surgical site antisepsis > Flashcards

Surgical site antisepsis Flashcards

1
Q

What is an infection that occurs after surgery in the part of the body where the surgery took place?

A

surgical site infection

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2
Q

What is the goal of preoperative skin antisepsis?

A

to reduce the patient’s risk of developing an SSI by removing soil and transit microorganisms at the surgical site and surrounding area.

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3
Q

What are 4 reasons skin prep is done?

A
  1. to reduce the resident microbial count as much as possible
  2. in the shortest amount of time
  3. with the least amount of skin irritation
  4. to prevent rapid rebound growth of microbes
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4
Q

What are the 3 layers of the skin?

A
  1. epidermis
  2. dermis
  3. subcutaneous
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5
Q

What are the 3 categories of a surgical site infection?

A
  1. superficial incisional
  2. deep incisional
  3. organ/space
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6
Q

Where is a superficial incisional SSI located?

A

epidermis, dermis, and SQ layers

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7
Q

When does a superficial incisional SSI develop?

A

within 30 days after surgery

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8
Q

Where is deep incisional SSI located?

A

fascial and muscle layers

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9
Q

When does a deep incisional SSI develop?

A

between 30 and 90 days after the surgery

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10
Q

Where is organ/space SSI located?

A

organ/space layer

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11
Q

When does an organ/space SSI develop?

A

between 30 and 90 days after the surgery

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12
Q

What is the leading cause of hospital readmissions?

A

surgical site infections

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13
Q

What are the effects of SSI’s on patients?

A
  1. lost wages
  2. loss of employment
  3. loss of function
  4. chronic health problems
  5. loss of limb
  6. loss of life
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14
Q

What are the effects of SSI’s on facilities?

A
  1. loss of revenue due to non-payment for treament
  2. loss of OR time
  3. loss of resources
  4. increased re-admission rates
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15
Q

What are patient related risk factors for SSI’s?

A
  1. increased age
  2. tobacco use
  3. diabetes
  4. malnutrition
  5. lack of knowledge/understanding about condition
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16
Q

What are procedure/envrionment related risk factors for SSI’s?

A
  1. emergency versus scheduled surgery

2. degree of bacterial contamination of the surgical site

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17
Q

Are surgical site infections preventable?

A

YES

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18
Q

What are prevention strategies for SSI?

A
  1. patient education
  2. patient shower the night before
  3. intraoperative surgical skin prep
  4. adherence to strict aseptic principles
  5. careful observation of sterile technique
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19
Q

What are 4 instances to surgery that a nurse will identify in his/her preoperative assessment?

A
  1. an allergy to antiseptic solutions
  2. a skin condition at the surgical site
  3. jewelry that still needs to be removed
  4. a surgical site marking that is not visible after the skin prep
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20
Q

Is there a correlation between seafood allergies and iodine allergies?

A

NO

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21
Q

What are the 6 factors that make a good prep solution?

A
  1. applied quickly
  2. not irritating to the skin
  3. not inactivated by other chemicals or body fluids
  4. packaged in single use containers
  5. colored to enhance visibility of the prepped area
  6. FDA category 1 compliant
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22
Q

What does the fda category 1 rating for skin antisepsis products include?

A
  • fast acting
  • broad spectrum
  • persistent
  • reduces microbial counts
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23
Q

What does fast acting mean when it comes to FDA category 1 requirements?

A

acts rapidly

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24
Q

What does broad spectrum mean when it comes to FDA category 1 requirements?

A

kills a wide range of organisms

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25
Q

What does persistent mean when it comes to FDA category 1 requirements?

A

has prolonged antimicrobial activity that prevents or inhibits the proliferation of survival of microorganisms after a product’s application

26
Q

What does “reduces microbial counts” mean when it comes to FDA category 1 requirements?

A

significantly reduces the number of microbes on intact skin

27
Q

What are the 2 overarching categories for skin antiseptic products?

A
  1. CHG

2. iodine

28
Q

What 2 category 1 CHG antiseptic products are most commonly used?

A
  1. 2% CHG/70% isopropyl alcohol

2. 2%-4% water-based CHG

29
Q

What 2 category 1 iodine antiseptic products are most commonly used?

A
  1. iodine/alcohol

2. iodine scrub/paint

30
Q

When is a fire risk assessment done?

A

before incision

31
Q

What is the dry time for skin antiseptic products when used in the hair?

A

up to 60 minutes

32
Q

Why is hair removed outside of the OR?

A

to prevent dispersal of hair

33
Q

What should be used to remove hair?

A

clippers or a depilatory NOT a razor

34
Q

What are protective measures to avoid prolonged contact with skin antiseptics?

A
  1. Protect equipment from skin prep solutions.
    o Replace equipment that has come in contact with the prep solution.
  2. Protect the patient’s buttocks with a fluid-resistant pad to prevent a potential chemical burn.
  3. Remove the skin antiseptic before the application of dressings.
    o Refer to the manufacturer’s IFU
35
Q

What should you not do to skin antiseptic products?

A

DILUTE THEM

36
Q

What does dilution create?

A
  1. the concentration of the solution becomes unknown

2. contamination of the product may occur during the mixing process

37
Q

True or false: apply the skin prep to an area smaller than the surgical site

A

false; it should be larger

38
Q

What should you always follow with skin antiseptics?

A

the manufacturer’s IFU

39
Q

When does prep of the patient begin?

A

after the patient is positioned and all positioning checks have been completed

40
Q

What should you know about a skin antiseptic?

A
  1. what you are using?
  2. how long the product must dry before surgical drape application
  3. if the product is flammable
  4. how to perform the prep - concentrically, back and forth?
41
Q

Why should you apply the antiseptic to a larger site?

A
  1. shifting of drapes
  2. extension of the incision
  3. additional incisions
  4. and all drain sites
42
Q

Can you wear non sterile gloves when applying prep?

A

yes; only if the applicator is long enough to prevent microbe formation

43
Q

Do you need to wash your hands before prep?

A

yes

44
Q

In what way do you prep?

A

from clean to dirtiest

45
Q

Do you prep the incision site first?

A

yes

46
Q

Who preps the patient?

A

non-scrubbed personnel

47
Q

What should you document after the prep?

A
  1. Jewelry removal and disposition
  2. Skin condition at the surgical site - rashes, abrasions, redness, irritation, swelling, burns, eruptions
  3. Person(s) performing the skin prep
  4. Skin antiseptic product(s) used
  5. Area(s) prepped
48
Q

What should you document after the surgery?

A

Skin condition –> allergic rxn, hypersensitivity, skin irritation, chemical burn

49
Q

What product requires a concentric motion?

A

iodine

50
Q

What product requires a back and forth motion?

A

CHG

51
Q

What must an antiseptic be for eye surgery?

A
  1. safe to use around the eye

2. labeled for ophthalmic use

52
Q

What are other considerations for eye prep?

A
  1. do not use an alcohol-based solution

2. for patients with an allergy to iodine solutions, use a combo fo baby shampoo and balanced slat solution (BSS)

53
Q

What are other considerations for eye prep?

A
  1. do not use an alcohol-based solution

2. for patients with an allergy to iodine solutions, use a combo fo baby shampoo and balanced slat solution (BSS)

54
Q

What are the 2 surgical sites included in abdominoperineal prep?

A
  1. abdomen

2. vagina

55
Q

What is the prep area for an abdominoperineal prep?

A
  1. abdomen
  2. pubis
  3. vagina
  4. perineum
  5. anus
  6. thighs
56
Q

What is the position for an abdominoperineal prep?

A

lithotomy with possible trendelenburg

57
Q

What are general considerations for an abdominoperineal prep?

A

• Positioning devices/aids o Stirrups/holders
o Patient positioning aids
• Prep kits
• Foley or straight catheter
• The bladder is drained after the vaginal prep.

58
Q

What are the steps for prepping the vagina first in an abdominoperineal prep?

A
  1. prep the pubis, medial thighs to the vagina, and vagina
  2. treat the abdominal prep as a separate prep area
  3. if using an applicator, link the abdomen and pubic areas with the skin prep after the abdominal prep has been completed
  4. If using a sponge prep, clean the abdominal/pubic border with both soap and paint applications, disposing of the sponges once the border area is cleaned and not returning the abdomen.
59
Q

what is the prep for an extremity (leg)?

A

circumferentially from tourniquet to toes

60
Q

what is the prep for an extremity (leg)?

A

circumferentially from tourniquet to toes

61
Q

What is iodine found in?

A

amino acids, body substances

AORN Periop class (23 decks)

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