Evaluating use of flash sterilization in the OR with regard to postoperative infections

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THIS ARTICLE DESCRIBES a quality improvement project that examined postoperative infection rates for 100 surgical procedures in which a total of 121 flash sterilizations were performed and determined the costs of treating the postoperative infections compared to the cost of purchasing additional instruments.

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THE POSTOPERATIVE INFECTION rate on physical examination was 3%, and the overall cost of diagnosing and treating the postoperative infections was found to be lower than the cost of purchasing additional instruments.

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TO MINIMIZE USE of flash sterilization, the hospital has added additional surgical instrument inventory and expanded flash sterilization education requirements for staff members. AORN J 83 (March 2006) 672-680.

     

Loaner instrumentation: processing the unknown

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THE USE OF LOANER INSTRUMENTATION is a growing phenomenon in today's expanding health care environment.

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CENTRAL PROCESSING DEPARTMENT personnel at Walter Reed Medical Center, Washington, DC, undertook a project to determine if loaner instrumentation coming into the facility had been decontaminated.

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SIXTEEN PERCENT of the loaner instruments tested were positive for blood residue.

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THE RESULTS OF THIS PROJECT were used to strengthen internal standard operating procedures and to alert the hospital's infection control committee of a potential safety problem. AORN J 85 (March 2007) 566-573. © AORN, Inc, 2007.

     

Collaborative leadership in product evaluation

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NEW PRODUCT INNOVATIONS can have a siginigicant effect on patient safety and the quality of patient care.

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PERIOPERATIVE NURSES and infection control professionals can collaborate during the selection of new products to ensure the products promote patient safely and improve outcomes.

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INFECTION CONTROLS PROFESSIONALS and perioperative nurse are uniquely positioned to demonstrate leadership in all phases of the product evaluation process. AORN J 85 (February 2007) 334-352. © AORN, Inc, 2007.

     

Using Six Sigma and Lean methodologies to improve OR throughput

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IMPROVING PATIENT FLOW in the perioperative environment is challenging, but it has positive implications for both staff members and for the facility.

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ONE FACILITY IN VERMONT improved patient throughput by incorporating Six Sigma and Lean methodologies for patients undergoing elective procedures.

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THE RESULTS OF THE PROJECT were significantly improved patient flow and increased teamwork and pride among perioperative staff members. AORN J 86 (July 2007) 73-82. © AORN, Inc, 2007.

     

Test-taking strategies for CNOR certification

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A PERIOPERATIVE NURSE who desires to advance his or her career may want to consider becoming CNOR certified.

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TEST QUESTIONS on the CNOR examination are designed to measure a nurse's knowledge of basic facts about perioperative nursing or the application of that knowledge.

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This article provides suggestions for studying and preparing for the CNOR examination with sample test questions and test-taking strategies. AORN J 85 (February 2007) 315-332. © AORN, Inc, 2007.

     

Surgical Care Improvement Project and the perioperative nurse's role

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THE SURGICAL CARE IMPROVEMENT PROJECT (SCIP) was formed by a partnership of national organizations with the goal of reducing surgical complications by 25% by 2010.

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THE FOCUS OF THE SCIP INITIATIVE includes four key components that perioperative health care workers can address in reducing the morbidity and mortality of surgical patients.

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BY IMPLEMENTING SCIP QUALITY measures, hospitals could prevent an estimated 13,000 patient deaths and 271,000 surgical complications each year. AORN J 86 (July 2007)94-101. © AORN, Inc, 2007.

     

Does preoperative anxiety level predict postoperative pain?

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PREOPERATIVE ANXIETY is a common component of the surgical experience, and increased levels of anxiety may alter a patient's surgical course and cause increased postoperative pain.

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A REVIEW OF THE LITERATURE was undertaken to evaluate the presence and significance of any correlation between preoperative anxiety and postoperative pain.

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ALTHOUGH INCONSISTENCY was found in the articles that were reviewed, most of the available evidence revealed a positive correlation between preoperative anxiety and postoperative pain.

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FURTHER STUDIES SHOULD be conducted to establish the correlation between preoperative anxiety and postoperative pain and to determine appropriate nursing interventions. AORN J 85 (March 2007) 589-604. © AORN, Inc, 2007.

     

Safety of personnel working in endoscopy units

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ALL PERSONNEL performing or assisting with endoscopic procedures and those responsible for reprocessing the equipment should be trained in how to handle the infectious and chemical hazards associated with the endoscopic environment.

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ENDOSCOPY PERSONNEL should follow a comprehensive safety program that outlines the steps individuals should take to prevent injuries from the potential hazards they may encounter in endoscopy units.

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SAFETY MEASURES include ensuring that there is adequate lighting and ventilation in the endoscopy unit, cleaning endoscopy instruments thoroughly, and operating equipment safely. AORN J 85 (January 2007) 181-187. © AORN, Inc, 2007.

     

Development of a unit-based practice committee: a form of shared governance

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NURSING LEADERS AT ONE FACILITY challenged staff nurses in the postanesthesia care unit (PACU) to implement a modified process of shared governance, a model that allows staff nurses to influence their practice.

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AS A RESULT OF THIS INITIATIVE, PACU nurses were able to collaborate with other perioperative staff members, ultimately increasing patient safety.

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SUCCESSES INCLUDED increased staff nurse participation in educational projects; increased interdisciplinary collaboration; personal and professional development for the nurses involved; and recognition from a highly esteemed, national organization. AORN J 86 (July 2007) 85-93. © AORN, Inc, 2007.

     

Developing a healthy OR workplace

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INNOVATION IS REQUIRED to develop a positive work environment in the OR.

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COMPONENTS OF A HEALTHY OR workplace identified by staff members of three surgical departments are quality practice standards, excellence in patient care systems, a functional physical environment, effective staff systems, meaningful role definition and clarity, and identified guidelines for teamwork.

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IN ONE OR, STAFF MEMBERS working on a communication team developed and implemented an action plan to enhance respect in the OR setting. AORN J 85 (June 2007) 1213-1223. © AORN, Inc, 2007.

     

A team approach to the prevention of unplanned postoperative hypothermia

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POSTOPERATIVE HYPOTHERMIA (ie, a core temperature lower than 96.8° F [36° C]), is a problem frequently seen in surgical patients, especially those undergoing total joint replacement.

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PATIENTS WHO EXPERIENCE hypothermia may have increased recovery times and postoperative complications.

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A TEAM OF CLINICAL STAFF MEMBERS and personnel from the performance improvement (PI) department of a hospital used a PI model to incorporate use of preoperative forced-air warming blankets that resulted in improved postoperative core temperatures. AORN J 85 (May 2007) 921-929. © AORN, Inc, 2007.

     

2.0 The Role of Surgery in the Management of Septic Shock—Extra-Abdominal Causes of Sepsis

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SEPTIC SHOCK IS A SEVERE inflammatory response to one or more pathogenic micro-organisms. When a person's immune response is excessively intense, a cascade of phenomena may be activated that ultimately is harmful.

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APPROPRIATE MANAGEMENT of septic shock may include surgical intervention to remove or neutralize the septic focus in an effort to treat the inflammatory response cascade.

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THIS IS THE FIRST OF TWO articles presenting current information on the role of surgery in the management of a patient with septic shock. This article describes extra-abdominal sources of sepsis. AORN J 85 (January 2007) 137-146. © AORN, Inc, 2007.

     

Factors influencing perioperative nurses' error reporting preferences

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TO EXPLORE THE INFLUENCE of scope of practice and patient outcomes on error reporting, 13 nurses were interviewed after they reviewed four “error” scenarios ranging in both scope of practice and seriousness of outcome.

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OF 52 THEORETICAL INCIDENTS, only 30 were identified as errors. The nurses indicated they would formally report errors for only eight of the incidents. For another 10 incidents, the nurses would have reported using an informal reporting system only.

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QUALITATIVE ANALYSIS of the interviews revealed that perceived scope of practice influenced reporting preferences, and seriousness of outcome was only a secondary consideration.

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SELECTIVE ERROR REPORTING and the reasons for selective reporting have negative implications for patient safety. AORN J 85 (March 2007) 527-543. © AORN, Inc, 2007.

     

Family-centered care in the perioperative area: an international perspective

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FAMILY-CENTERED CARE developed after research showed that children were emotionally compromised if separated from their parents during traumatic episodes. Few places within the health care system are more foreign and frightening to a child than the surgical department.

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PERIOPERATIVE NURSING evolved as a way to care for patients admitted to the OR for surgery. Family-centered care provides a model for the care of a child within the perioperative environment.

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THIS ARTICLE EXAMINES the development of both family-centered care and perioperative nursing from a historical perspective and explains how family-centered care can be applied to perioperative nursing. AORN J 85 (May 2007) 893-902. ©AORN, Inc, 2007.

     

Perioperative care of the immunocompromised patient

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IMMUNITY REFERS TO THE BODY'S capacity to resist invading organisms and toxins, thereby preventing tissue and organ damage. A patient whose immune system is impaired may be at higher risk for untoward perioperative events.

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SOME POPULATIONS MOST AT RISK for immunocompromise include infants, geriatric patients, people who have undergone organ transplantation, and people with cancer. Patients who are immunocompromised have an increased risk for hypothermia, which can affect postoperative wound healing processes and can increase the risk of wound infection.

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THIS ARTICLE PROVIDES a basic overview of the immune system, a discussion of common disorders and diseases of the immune system, and a guide for perioperative nurses to use when they care for a patient who is immunocompromised. AORN J 85 (March 2007) 544-560. © AORN, Inc, 2007.

     

Improving compliance with prophylactic antibiotic administration guidelines

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TO REDUCE THE INCIDENCE of surgical site infections, preoperative prophylactic antibiotics should be administered within 60 minutes before the initial incision is made. A recent study and anecdotal observations, however, indicate that rates for compliance with these guidelines are low.

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A QUALITY IMPROVEMENT PROJECT was undertaken at a Florida health care facility to determine if implementing changes in preoperative processes would increase compliance with prophylactic antibiotic administration guidelines.

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AFTER THE STRATEGIES were implemented, compliance rates with the national guidelines for administration of antibiotics within 60 minutes of surgical incision increased from 75% at baseline to 95% postimplementation. AORN J 85 (January 2007) 173-180. © AORN, Inc, 2007.

     

Distance learning and perioperative nursing

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DISTANCE LEARNING in nursing education is arriving with unprecedented speed, which has led to much uncertainty among educators. This article provides an overview of distance learning and its application to perioperative nursing.

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LACK OF FACE-TO-FACE INTERACTION is of foremost concern in distance learning, and educators must develop new teaching strategies to address this problem.Models for assessing outcomes and effectiveness are important tools to use when implementing a distance learning program.

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BASIC PERIOPERATIVE NURSING concepts, skills, procedures, and recommended practices can be introduced effectively with online distance learning modalities and then reinforced through a clinical component. AORN J 85 (March 2007) 574-586. © AORN, Inc,2007.

     

3.4 Mitral Valve Repair

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DISEASES THAT AFFECT the mitral valve include mitral regurgitation, mitral stenosis, rheumatic heart disease, and cardiomyopathy.

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THE RESULTS OF DIAGNOSTIC procedures are used to identify and confirm mitral valve disease, evaluate the patient's anatomy, and determine the severity of the disease.

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AFTER THE PATIENT IS PREPARED for surgery, the surgeon performs an intraoperative transesophageal echocardiogram and the patient is placed on cardiopulmonary bypass.

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AREPAIR PROCEDURE (eg, annuloplasty, slidingplasty, chordal repair/transfer/replacement, valve replacement) is performed depending on the patient's specific anatomical abnormalities. AORN J 85 (January 2007) 152-166. © AORN, Inc, 2007.

     

Profile of a Successful AORN Foundation Scholarship Applicant

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EACH YEAR, the AORN Scholarship Committee selects recipients of AORN Foundation scholarships to support educational advancement.

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COMPETITION FOR SCHOLARSHIPS increases as more AORN members return to school.

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SUCCESSFUL APPLICANTS are attentive to detail in following application guidelines, clearly articulate their appeal for a scholarship, include documentation of academic records and the school or program accreditation status, and convey their passion for caring through service to the community and to others. AORN J 79 (March 2004) 637-640.

     

Reduce--recycle--reuse: guidelines for promoting perioperative waste management

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THE PERIOPERATIVE ENVIRONMENT generates large amounts of waste, which negatively affects local and global ecosystems.

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TO MANAGE THIS WASTE, health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes.

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NURSES AND MANAGERS can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting. AORN J 85 (April 2007) 717-728.