Week 2: Patient Safety 1 Flashcards
What is DVT?
A blood clot that forms in the veins of the legs; attached to the vessel wall
What is an embolism?
A blood clot which breaks off the vessel wall and travels freely throughout circulation; likely to become lodged in pulmonary (PE) or cerebral vessels causing obstruction of blood flow
What are the signs of a PE?
Shortness of breath Cyanosis Chest pain Low sats High RR Diagnosed with CT scan
How many VTE cases are the in Australia?
15000 annually 9250 female: oral contraceptives risk factor 5466 male 3 331 677 between 2002-2009 1 in 10 die
Why does surgery place patients at risk of VTE?
Dehydration –> reduced circulating blood volume –> changed blood viscosity
Extended immobility
Ceasing anticoagulants
What are the risk factors for VTE?
Hospitalisation Female Surgery Smoking, diet Older Comorbidities: malignancies, medical or surgical treatments Caucasian or African American Winter: less active, less fluid intake
What are strong risk factors for VTE?
Orthopaedic surgery Tourniquet Spinal cord injury Major general surgery Major trauma
What are moderate risk factors for VTE?
Central venous access Chemo HRT CHF/resp failure Malignancy Oral contraceptives Pregnancy/post-partum Previous VTE
What are weak risk factors for VTE?
Bed rest > 3 days Seated immobility Age Lap surgery Obesity Varicose veins
What is the rate SSIs in Australia?
2.7% of surgical cases
Which surgical specialties have a higher risk of SSI?
Orthopaedics
Cardiac (coronary artery bypass)
Obstetrics (lower segment cesarean section)
Colorectal
How can SSIs be reduced?
Reduce traffic around sterile field Prophylactic antibiotics ANTT package opening Negative pressure air ventilation Skin prep Instrumentation sterilisation Scrub technique Curved floor corner for easier cleaning WHO surgical safety checklist
What is a pressure injury?
Wound caused by lock of blood flow due to pressure between external surface and bone
What are intraop risk factors for pressure injury?
Surgery duration
Bony prominences/padding
Friction and shear when transferring patient
What are the instrinsic risk factors for pressure injury?
60 + years Low albumin ASA 3 + Diabetes BMI < 19 or > 40 CVA Hypotension: reduced circulation to peripheries Pulmonary disease Renal insuffiency Warming mattress
What are the extrinsic risk factors for pressure injury?
Preop immobilisation time Operation time Postop immobilisation time Prone Trauma Hypotension Extended use of vasopressors Specialty: cardiac, ortho, vascular, transplant, bariatric
What is the most common nerve injury in the OR?
Ulna nerve
What are the risks of arms up in prone?
Brachial plexus injury
Dislocation
What is the first stage of pressure injury?
Erythemia, no skin break down
What is the second stage of pressure injury?
Adipose tissue exposed
What is the third stage of pressure injury?
Muscle exposed
What is the fourth stage of pressure injury?
Bone/cartilage exposed
How do you assess for pressure injury?
Pressure injury risk assessment tool
Skin assessment/visual inspection
What are the preventative strategies for VTE?
Reduced fasting time IV fluids: increase circulating volume Positioning Thrombo-embolic device: TEDs Sequential Compression Device: calf compressors Prophylactic anticoagulants
What are the four classifications of a surgical wound?
Clean
Clean/contaminated
Contaminated
Dirty
What is the definition of a clean wound?
Non-traumatic, elective surgery; GI, resp & GU tracts not entered
What are examples of clean surgical wounds?
Mastectomy
Vascular
Hernia repair
What is the definition of a clean/contaminated surgical wound?
Resp, GI or GU tract entered with minimal contamination
What are examples of clean/contaminated surgical wounds?
Gastrectomy
Hysterectomy
What is the definition of a contaminated surgical wound?
Open, fresh, traumatic wounds; uncontrolled spillage; minor break in sterile technique
What are examples of contaminated surgical wounds?
Ruptured appendix
Emergency bowel resection
What is the definition of a dirty surgical wound?
Open, traumatic, dirty wounds; perforation of hollow viscus; frank pus in wound
What are examples of dirty surgical wounds?
Intestinal fistula resection
MVAs
What are the different types of sterilisation process?
Steam autoclave Plasma hydrogen peroxide Peracetic acid Ethylene oxide Cidex OPA Gamma irradiation
What is peracetic acid?
Sterris
Acetic acid, hydrogen peroxide, water
Reacts with proteins and enzymes to cause cell destruction
Sterilant concentrate mixes with water
30 min cycle
Full PPE: carcinogenic, toxic, chemical burns
What is ethylene oxide?
Gas
Alkynation agent disrupts DNA in micro-organisms to prevent multiplication
Low temp
Replaced by plasma hydrogen peroxide
What is Cidex OPA?
Hazardous chemical: good ventilation, designated area, PPE
Used in places that don’t have Sterris
What is gamma irradiation?
Short wavelength with high penetrative intensity to destroy micro-organisms
Lucas Centre
Mass sterilisation
All implants
How is SSI reduced by the OR environment?
Safe handling and storage of sterile items
Air ventilation
OR design: traffic patterns, flooring materials
How can you prevent SSI in your own clinical practice?
Opening sterile items Preparing and maintaining sterile field Movement around sterile field Scrub, gown and glove Prep and drape Surgical conscience: doing what is right even though no one is watching, speak up about contamination
What pharmacotherapy is used to prevent SSI?
Antimicrobial patient wash preop
Prophylactic A/Bs
Antimicrobial impregnated drapes and dressings
Antibiotic irrigation solutions
What are the different tools for risk assessing pressure injury?
Braden
Munro
Scott Triggers
Waterlow
What are strategies for preventing pressure injury?
Positioning
Pre and postop inspection
Open team communication: safe position, worst case scenario
