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HNB3219 Perioperative Nursing

Strategies to prevent surgical site infections in acute care hospitals Infection Control and Hospital Epidemiology.

Surgical wound irrigation a call for evidence-based standardization of practice.

Big data in health care: using analytics to identify and manage high-risk and high-cost patients.

Making the invisible visible–operating theatre nurses’ perceptions of caring in perioperative practice. 

Partnerships and new learning models to create the future perioperative nursing workforce.

Validation of the core elements of perioperative nursing. Journal of clinical nursing,

World Allergy Organization Guidelines for the assessment and management of anaphylaxis. 

Perioperative Nursing Leaders Implement Clinical Practice Guidelines Using the Iowa Model of Evidence?Based Practice

A compendium of strategies to prevent healthcare-associated infections in acute care hospitals:

Answer:

Introduction

Perioperative nursing involves provision of care to the patients before, during and after surgical procedures or interventions. It is categorised into pre-operative, intraoperative and postoperative nursing. It is a multidisciplinary approach which is composed of the nurse at the receiving and holding bay, anesthetic team, circulating nurse, scrub or instrument nurse, surgeon, and the nurse at the post-anesthetic recovery room. This essay will discuss the infection control in relation to risk management and patient safety. The essay will also outline the role of the nurse in ensuring adherence to effective and safe practices in perioperative care.

Infection control is one of the fundamental aspects of the role of the nurse and also the responsibility of all other healthcare professionals in the perioperative clinical setting. Infection control remains a key goal in all settings of healthcare and effective collaboration and responsibility of all professionals ensures achievement of this fundamental goal. Infection control is totally a collaborative approach (Steelman, Graling, & Perkhounkova, 2013).

In perioperative nursing, professional accountability is a very broad descriptor that encompass a wide range of things starting from the dressing and grooming, values, moral beliefs and ethics. Professional accountability is the cornerstone of perioperative nursing clinical practice to ensure infection control and patient’s safety. Measures of infection prevention can be applied preoperatively, intraoperatively, and postoperatively (Steelman et al., 2013).

Pre-operatively, infections are frequently attributed to bacteria which are found on the patient’s skin surface. Therefore, reduction of the number of the bacteria on the skin is one of the commonly applied practice to ensure patient safety by staying infection-free through the entire surgical process for effective recovery and improved quality of life. Preoperative skin preparation should include removal of hair through shaving t


he surgical site, proper cleaning of the surgical sites and application of an antiseptic agent before making surgical intervention to prevent infections (White, & Spruce, 2015).

Removal of hair using a clipper or razor may cause skin abrasion or nicks which can result to the development of infections like pseudofolliculities which can subsequently result in surgical site infection. For the positive patient outcome, the perioperative nurses should take part to ensure effective preoperative preparation hence infection control.  Preoperative showers should be applied to reduce the likelihood of skin colonization by the staphylococci bacteria. Various agents such as chlorohexidine, alcohol disinfectants and iodine can be used in prevention of infection (Steelman et al., 2013).  

Use of antibiotics before and during the surgical procedure is one of the key measures of infection control. Antiobiotics are important in the prevention and treatment of bacterial infections. Antibiotic resistance occurs following the bacterial change in response to the administered medications. Failure to use medications in perioperative care may lead to increased risk of development of infections which consequently results in increased duration of hospitalization, high costs of medicine and healthcare, and increased rates of morbidity and mortality (Spruce, 2014).

Appropriate handling of used and infection items is essential in minimizing the risk of cross contamination and risk of infection development in the clinical setting. The healthcare professionals should regularly change or remove used aprons and gloves and dispose them in the appropriate linen bags or waste bins. In the perioperative settings, there should be strict adherence to the waste segregation guidelines to ensure effective control of infections (Berrios-Torres et al., 2017).

Risk assessment and management in infection control to ensure patient safety

In perioperative clinical setting, infection control risk assessment provides the foundation for infection surveillance, control, and prevention activities. It helps in identification of the at-risk procedures and population in the setting. Additionally, risk assessment and management help the management to focus their efforts of surveillance towards the set goals of perioperative nursing and to meet the regulatory requirements for patient safety (Simons et al., 2012).

Risk assessment in infection control puts more consideration of the potential hazards and prioritizes them for establishment of goals and strategy development. Risks of infection control stems from a wide range of areas and sections of the perioperative clinical setting and most of them can cause significant harm to the patients. Some of these risks include lack of or poor hand hygiene, unsafe practices of injections, inadequate cleaning of the environment and unsafe waste segregation practices (Bates, Saria, Ohno-Machado, Shah, & Escobar, 2014).  

Poor cleaning, sterilization, and disinfection scopes and instruments also pose a great risk of infection in the perioperative settings of clinical care. Therefore, risk assessment is very essential in order to identify the risks which have the greatest risk of infection in the setting. On assessment, the management team involved should document the findings and prioritize processes in for improved outcomes to ensure patient safety (Simons et al., 2012).

In the risk assessment and management, one should focus of key elements such as weather, topography, population, patterns of communication, population of healthcare employees or professionals, environment, competency and education evaluation. Other important factors that should be considered in perioperative clinical setting to ensure patient safety include cleaning, sterilization, disinfection, procedures, risk for infection, and emergency management (Bates et al., 2014).  

There is wide range of major risks for infection in healthcare clinical settings which should be mitigated to ensure patient safety. Some of these risks include diarrheal diseases like clostridium difficile, significant microorganisms such as MRSA, post-surgical pneumonia or sepsis, and surgical device-related infections. In the risk assessment, patient demographics such as gender, age, socioeconomic status and other factors that may impact on their health should be considered (Gregory, Bolling, & Langston, 2014).

Communication patterns and strategies in the perioperative setting should also be considered since poor communication between the healthcare personnel contributes to risk of infection hence corrupting the patient’s safety needs.  In the clinical setting, thee should be comprehensive plans on one to coordinate, communicate and work with third parties such as emergency medical services, emergency management team, professional groups, departments, and medical societies (Gillespie, Gwinner, Chaboyer, & Fairweather, 2013).

The perioperative department should gauge how the healthcare professionals manage and provide healthcare services to the patients. There should be strict requirements and guidelines on hand hygiene and close monitoring for compliance should be put in place for effective and safe practices of infection control to ensure patient safety. The management should also assess on whether the healthcare team complies to the sharps injuries protocols to prevent unnecessary risks (Gregory et al., 2014).

There should be adequate space of disinfection, cleaning, and sterilization in the clinical setting. The management should put in place procedures for monitoring the use of all sterilizers, disposables, high-level disinfectants, and the steps that are taken following a failure of the sterilizer or disinfectant. Additionally, there should be a log and a schedule for preventive maintenance on the surgical and other related equipment to maximize on the efficiency (Barnes, Spencer, Graham, & Johnson, 2014).

Regarding environment, there should be adequate space, proper lighting and ventilation, sufficient sterilization, cleaning, and disinfection resources, furnishings, and scopes. A healthy and clean environment calls for better protocols of biohazard waste management and upgraded systems of ventilation (Yokoe et al., 2014).  Infections in the perioperative setting can be associated with little knowledge or lack of competency by the healthcare workers. Therefore, in risk assessment this should not be left out. To ensure patient safety and ensure effective infection control, there should be regular training programs and competency testing for all healthcare professionals and workers to enlighten them on the effective measures of infection prevention and control to ensure patient safety (Barnes et al., 2014).

Role of the nurse in ensuring adherence to effective and safe practices in perioperative care.

The nurses can be categorised into a holding nurse, anesthetic nurse, scrub nurse, circulating nurse, instrument nurse, and post-surgical recovery nurse. Preoperatively, the nurse has two major roles that are important in enhancing patient safety. These roles include education and patient evaluation (Lamberg, Salantera, & Junttila, 2013). The nurse is responsible for the assessment of the patient while providing critical medical history to the surgical team. This ensures effective familiarity of the patient by the surgical team. The nurse also provides preoperative patient and family education to ensure that they are well informed and demonstrates adequate preparedness for the surgical intervention (Gillespie et al., 2013).

The holding bay or receiving nurse plays an essential role in infection prevention. He or she is responsible for the care and admission of the patients who have been brought into the pre-operative area. When attending to the patient, he or she should have protective garments and other equipment such as gloves and face masks to prevent the spread of infection. The nurse at this area is responsible for getting vital medical information that is relevant in the preparation of the patients for the surgical procedure (Rauta, Salantera, Nivalainen, & Junttila, 2013).

The holding bay nurse also controls the traffic by enlightening the family members of the patient on the importance of traffic control in perioperative settings. This is because, crowding may lead to spread of microorganisms from one individual to another especially from the patient to the staff or the members. Therefore, to ensure effective infection control, the nurse should be very strict to avoid crowding in the perioperative settings (Rauta et al., 2013).

Upon obtaining the information, the receiving nurse should document and communicate to the surgical team. Such information may include any known sensitivities or allergies to food or medications, fasting and hydration status, pathology reports, administration of medication, and radiological investigations that had been done for the patient based on his or her diagnosis. This information helps the nurse and the entire team to apply effective and appropriate techniques and practices in the perioperative settings to ensure prevention and control of infections (Blomberg, Bisholt, Nilsson, & Lindwall, 2015).

The anesthetic nurse has a key role in the control of infections in the perioperative clinical setting.  He or she is well trained and has adequate expertise in the provision of support to the anesthetist and the patient before and during the entire surgical procedure. He or she assists the anesthetists in administering anesthetic during the surgical intervention. He or she is fully involved in the equipment preparation, monitoring the condition of the patient, and reacting the instructions given by the anesthetic team (Blomberg et al., 2015).

He or she works under the instructions given by the anesthetist. The anesthetic nurse may also assume some of the roles and responsibilities of the circulating nurse. To ensure adherence to safe and effective practices for control of infection, the nurse should always employ the aseptic technique in and every step taken in perioperative care. The nurse should also ensure that the other members of the surgical team strictly adhere to the infection control guidelines (Rauta et al., 2013).

Another important member of the surgical team in the perioperative settings is the circulating nurse. He or she is responsible for provision of all the required surgical supplies to the surgical team. He or she should ensure that the supplies are promptly and correctly supplied to the operating theatres. To ensure effective infection control, the circulating nurse should check all the surgical equipment and supplies for cleanliness, sterility and expiry. This is because, use of dirty, non-sterile and expired supplies is a key contributor the development of infections to the patient (Magill et al., 2014).

Other duties of the nurse in the perioperative settings include documentation and management of surgical supplies, collecting patient specimens, verification of patient’s consent forms, ensuring accuracy in the count of instrumentation, and predation of the surgical equipment.  He or she should ensure sterility in all these steps to ensure patient safety (Olans, & DeMaria, 2015).

The instrument nurse is mainly responsible for all supplies used in the surgical theatres and he or she is always in anticipation of the needs of the surgical team. For effective infection control and prevention, the instrument nurse always ensure that the surgical instruments, equipment, and supplies are sterile and well-functioning. He or she remains vigilant throughout the entire surgical procedure for early recognition of the changing condition of the patient and the potential intra-surgical complications for initiation of immediate and appropriate response to prevent the development of infections (Olans, & DeMaria, 2015).

Not to forget, the scrub nurse is the core of infection control and prevention in the perioperative clinical setting. He or she ensures readiness, cleanliness, sterility and adequate supply of surgical instruments. When handling the surgical instruments, he or she ensures strict adherence to the guidelines of aseptic techniques to control infections. He or she monitors the other surgical team for sterility in the clinical setting.  The scrub nurse responds to the hand motions of the surgeon and assesses the condition and safety of the patient (Anderson et al., 2014).

Conclusion

Infection control is a very essential aspect of ensuring patient safety in perioperative clinical setting. Infection control is a collaborative and multi-disciplinary approach in clinical setting. In risk assessment, elements such as disinfection, cleaning, risk for infections, education and competency of personnel, environment, procedures, communication, population, and weather should be considered. Nurses play a role in infection control through adherence to aseptic techniques in all their activities. Use of antibiotics, hygiene, aseptic techniques and proper communication are one of the key measures of infection control.

References

Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., ... & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S66-S88.

Barnes, S., Spencer, M., Graham, D., & Johnson, H. B. (2014). Surgical wound irrigation: a call for evidence-based standardization of practice. American journal of infection control, 42(5), 525-529.

Bates, D. W., Saria, S., Ohno-Machado, L., Shah, A., & Escobar, G. (2014). Big data in health care: using analytics to identify and manage high-risk and high-cost patients. Health Affairs, 33(7), 1123-1131.

Berrios-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., ... & Dellinger, E. P. (2017). Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery, 152(8), 784-791.

Blomberg, A. C., Bisholt, B., Nilsson, J., & Lindwall, L. (2015). Making the invisible visible–operating theatre nurses’ perceptions of caring in perioperative practice. Scandinavian journal of caring sciences, 29(2), 361-368.

Gillespie, B. M., Gwinner, K., Chaboyer, W., & Fairweather, N. (2013). Team communications in surgery–creating a culture of safety. Journal of interprofessional care, 27(5), 387-393.

Gregory, S., Bolling, D. R., & Langston, N. F. (2014). Partnerships and new learning models to create the future perioperative nursing workforce. AORN journal, 99(1), 96-105.

Lamberg, E., Salantera, S., & Junttila, K. (2013). Evaluating perioperative nursing in Finland: an initial validation of perioperative nursing data set outcomes. AORN journal, 98(2), 172-185.

Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., ... & Ray, S. M. (2014). Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine, 370(13), 1198-1208.

Olans, R. N., & DeMaria, A. (2015). The critical role of the staff nurse in antimicrobial stewardship—unrecognized, but already there. Clinical Infectious Diseases, 62(1), 84-89.

Rauta, S., Salantera, S., Nivalainen, J., & Junttila, K. (2013). Validation of the core elements of perioperative nursing. Journal of clinical nursing, 22(9-10), 1391-1399.

Simons, F. E. R., Ardusso, L. R., Bilo, M. B., Dimov, V., Ebisawa, M., El-Gamal, Y. M., ... & Senna, G. E. (2012). 2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis. Current opinion in allergy and clinical immunology, 12(4), 389-399.

Spruce, L. (2014). Back to basics: preventing surgical site infections. AORN journal, 99(5), 600-611.

Steelman, V. M., Graling, P. R., & Perkhounkova, Y. (2013). Priority patient safety issues identified by perioperative nurses. AORN journal, 97(4), 402-418.

White, S., & Spruce, L. (2015). Perioperative Nursing Leaders Implement Clinical Practice Guidelines Using the Iowa Model of Evidence?Based Practice. AORN journal, 102(1), 50-59.

Yokoe, D. S., Anderson, D. J., Berenholtz, S. M., Calfee, D. P., Dubberke, E. R., Eilingson, K. D., ... & Lo, E. (2014). A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infection Control & Hospital Epidemiology, 35(S2), S21-S31.

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