Surgical site antisepsis Flashcards
What is an infection that occurs after surgery in the part of the body where the surgery took place?
surgical site infection
What is the goal of preoperative skin antisepsis?
to reduce the patient’s risk of developing an SSI by removing soil and transit microorganisms at the surgical site and surrounding area.
What are 4 reasons skin prep is done?
- to reduce the resident microbial count as much as possible
- in the shortest amount of time
- with the least amount of skin irritation
- to prevent rapid rebound growth of microbes
What are the 3 layers of the skin?
- epidermis
- dermis
- subcutaneous
What are the 3 categories of a surgical site infection?
- superficial incisional
- deep incisional
- organ/space
Where is a superficial incisional SSI located?
epidermis, dermis, and SQ layers
When does a superficial incisional SSI develop?
within 30 days after surgery
Where is deep incisional SSI located?
fascial and muscle layers
When does a deep incisional SSI develop?
between 30 and 90 days after the surgery
Where is organ/space SSI located?
organ/space layer
When does an organ/space SSI develop?
between 30 and 90 days after the surgery
What is the leading cause of hospital readmissions?
surgical site infections
What are the effects of SSI’s on patients?
- lost wages
- loss of employment
- loss of function
- chronic health problems
- loss of limb
- loss of life
What are the effects of SSI’s on facilities?
- loss of revenue due to non-payment for treament
- loss of OR time
- loss of resources
- increased re-admission rates
What are patient related risk factors for SSI’s?
- increased age
- tobacco use
- diabetes
- malnutrition
- lack of knowledge/understanding about condition
What are procedure/envrionment related risk factors for SSI’s?
- emergency versus scheduled surgery
2. degree of bacterial contamination of the surgical site
Are surgical site infections preventable?
YES
What are prevention strategies for SSI?
- patient education
- patient shower the night before
- intraoperative surgical skin prep
- adherence to strict aseptic principles
- careful observation of sterile technique
What are 4 instances to surgery that a nurse will identify in his/her preoperative assessment?
- an allergy to antiseptic solutions
- a skin condition at the surgical site
- jewelry that still needs to be removed
- a surgical site marking that is not visible after the skin prep
Is there a correlation between seafood allergies and iodine allergies?
NO
What are the 6 factors that make a good prep solution?
- applied quickly
- not irritating to the skin
- not inactivated by other chemicals or body fluids
- packaged in single use containers
- colored to enhance visibility of the prepped area
- FDA category 1 compliant
What does the fda category 1 rating for skin antisepsis products include?
- fast acting
- broad spectrum
- persistent
- reduces microbial counts
What does fast acting mean when it comes to FDA category 1 requirements?
acts rapidly
What does broad spectrum mean when it comes to FDA category 1 requirements?
kills a wide range of organisms
What does persistent mean when it comes to FDA category 1 requirements?
has prolonged antimicrobial activity that prevents or inhibits the proliferation of survival of microorganisms after a product’s application
What does “reduces microbial counts” mean when it comes to FDA category 1 requirements?
significantly reduces the number of microbes on intact skin
What are the 2 overarching categories for skin antiseptic products?
- CHG
2. iodine
What 2 category 1 CHG antiseptic products are most commonly used?
- 2% CHG/70% isopropyl alcohol
2. 2%-4% water-based CHG
What 2 category 1 iodine antiseptic products are most commonly used?
- iodine/alcohol
2. iodine scrub/paint
When is a fire risk assessment done?
before incision
What is the dry time for skin antiseptic products when used in the hair?
up to 60 minutes
Why is hair removed outside of the OR?
to prevent dispersal of hair
What should be used to remove hair?
clippers or a depilatory NOT a razor
What are protective measures to avoid prolonged contact with skin antiseptics?
- Protect equipment from skin prep solutions.
o Replace equipment that has come in contact with the prep solution. - Protect the patient’s buttocks with a fluid-resistant pad to prevent a potential chemical burn.
- Remove the skin antiseptic before the application of dressings.
o Refer to the manufacturer’s IFU
What should you not do to skin antiseptic products?
DILUTE THEM
What does dilution create?
- the concentration of the solution becomes unknown
2. contamination of the product may occur during the mixing process
True or false: apply the skin prep to an area smaller than the surgical site
false; it should be larger
What should you always follow with skin antiseptics?
the manufacturer’s IFU
When does prep of the patient begin?
after the patient is positioned and all positioning checks have been completed
What should you know about a skin antiseptic?
- what you are using?
- how long the product must dry before surgical drape application
- if the product is flammable
- how to perform the prep - concentrically, back and forth?
Why should you apply the antiseptic to a larger site?
- shifting of drapes
- extension of the incision
- additional incisions
- and all drain sites
Can you wear non sterile gloves when applying prep?
yes; only if the applicator is long enough to prevent microbe formation
Do you need to wash your hands before prep?
yes
In what way do you prep?
from clean to dirtiest
Do you prep the incision site first?
yes
Who preps the patient?
non-scrubbed personnel
What should you document after the prep?
- Jewelry removal and disposition
- Skin condition at the surgical site - rashes, abrasions, redness, irritation, swelling, burns, eruptions
- Person(s) performing the skin prep
- Skin antiseptic product(s) used
- Area(s) prepped
What should you document after the surgery?
Skin condition –> allergic rxn, hypersensitivity, skin irritation, chemical burn
What product requires a concentric motion?
iodine
What product requires a back and forth motion?
CHG
What must an antiseptic be for eye surgery?
- safe to use around the eye
2. labeled for ophthalmic use
What are other considerations for eye prep?
- 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)
What are other considerations for eye prep?
- 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)
What are the 2 surgical sites included in abdominoperineal prep?
- abdomen
2. vagina
What is the prep area for an abdominoperineal prep?
- abdomen
- pubis
- vagina
- perineum
- anus
- thighs
What is the position for an abdominoperineal prep?
lithotomy with possible trendelenburg
What are general considerations for an abdominoperineal prep?
• Positioning devices/aids o Stirrups/holders
o Patient positioning aids
• Prep kits
• Foley or straight catheter
• The bladder is drained after the vaginal prep.
What are the steps for prepping the vagina first in an abdominoperineal prep?
- prep the pubis, medial thighs to the vagina, and vagina
- treat the abdominal prep as a separate prep area
- if using an applicator, link the abdomen and pubic areas with the skin prep after the abdominal prep has been completed
- 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.
what is the prep for an extremity (leg)?
circumferentially from tourniquet to toes
what is the prep for an extremity (leg)?
circumferentially from tourniquet to toes
What is iodine found in?
amino acids, body substances
