Association Of periOperative Registered Nurses Research Articles

Not Just Non-Consensual Pelvic Exams

Not Just Non-Consensual Pelvic Exams

Analysis of alternate material Onyx™ for total knee arthroplasty instrumentation sets.

A 25-pound weight limit is currently set on containerized instrumentation sets by the Association of periOperative Registered Nurses (AORN) and the Association for the Advancement of Medical Instrumentation (AAMI), in order to reduce strain on the staff and ensure that the sets are not too crowded in order to preserve sterilization and drying of the instruments. This is pushing companies to reduce the weight and number of instrumentation sets for the operating room. One solution has been to explore the viability of new, lighter materials such as Onyx. The goal of this study is to evaluate the novel material Onyx as a viable material utilized in reusable total knee arthroplasty (TKA) instrumentation sets utilizing traditional steam sterilization as the sterilization method. Mechanical and biocompatibility tests according to the American Society for Testing Materials (ASTM) and International Organization for Standardization (ISO) 10,993 were run to evaluate the Onyx Material to see if it would be a viable alternative to the stainless and martensitic steel that is currently being utilized. Gross warping and cracking after 10 rounds of sterilization was observed. This was qualitatively worse in the Onyx without a carbon fiber component. The Onyx material did not meet biocompatibility standards for its application. Onyx was determined to not be a viable material for TKA instruments regarding multiple high-pressure and -temperature sterilizations and cytotoxic cell testing.

Analysis of publications on surgical gloves

Aims: This bibliometric analysis aimed to examine the trends and characteristics of publications related to surgical gloves. The study analyzed articles retrieved from the Elsevier Scopus database, focusing on topics such as the history of glove usage, the importance of sterility, glove punctures, and advancements in glove designs. Methods: The data in this study were obtained by searching the Elsevier Scopus database. The search was selected from records containing the keywords in the title “surgical gloves” and a single day was chosen for the sake of being unbiased. In this study, only the articles were analyzed and the online library and digital resources of Çanakkale Onsekiz Mart University were used. Scopus' visuals were used for visualization after data analysis. Results: A total of 568 publications were included in the analysis, consisting of articles, letters, reviews, and other study documents. The majority of articles were written in English, and the top three countries in terms of publication output were the United States, United Kingdom, and Germany. Medical journals accounted for the largest share of publications, followed by nursing journals. Notably, there was a rising trend in the number of studies on glove punctures and advancements in glove designs. Richard F. Edlich from the University of Virginia School of Medicine emerged as the most productive author, and the Association of periOperative Registered Nurses (AORN) Journal was the most prolific journal in this field. Conclusion: Today, studies on surgical gloves; focuses on latex glove allergy and surgical site infections. These studies; It is important for the prevention of infection during surgery in the future and the prevention of infectious diseases in healthcare workers.

Intraoperative airborne bacterial contamination and covered sterile instrument tables: Is the standard two-drape method better than the single-drape method? Experimental study

BackgroundWe purposed to assess and compare the effectiveness and safety of covering with the single-drape method versus the standard two-drape method recommended by the Association of Perioperative Registered Nurses (AORN) in reducing contamination of the prepared sterile instrument tables (PSITs) with airborne bacteria-carrying particles (ABCPs). MethodsSix agar plates (n = 810) were used to measure the load of ABCPs on each PSIT both at rest (static period) and during a simulated surgical operation (dynamic period). At every time point, this arrangement was repeated two times during data collecting (81 PSITs were established in total). Experimental groups contained PSITs covered with the single-drape and the standard two-drape methods or no cover. We collected the plates after 60, 120, 180, 240 min, and 24 h. ResultsAt all-time points, covering the PSITs during static and dynamic operating theater (OT) conditions led to a meaningfully reduced load of ABCPs on the PSITs (P < 0.05). Moreover, no differences were found between the recommended two-drape method by the AORN and the single-drape method (P > 0.05). ConclusionCovering the PSITs during nonuse and active surgeries helps prevent the PSITs from becoming contaminated and thus can help decrease the incidence of surgical wound infection (SWI). Covering the PSITs with a sterile drape helps protect them from ABCPs that may be shed from the hair and skin of OT nurses (OTNs). Our study showed no priority for using the standard two-drape method compared with the single-drape method.

The impact of quality improvement interventions on compliance with standardised surgical count protocol and count discrepancies: A quality improvement study

Background: Unintentionally retained surgical items (RSI) are a global problem contributing to adverse events for surgical patients. The Association of periOperative Registered Nurses (AORN) has developed a standardised protocol for the surgical count; however, many hospitals do not follow the protocol for the surgical count. This study was conducted to investigate the effect of implementing quality improvement interventions, for counting surgical sponges, on compliance with the AORN surgical count protocol and occurrence of count discrepancies.

Perioperative pressure injury prevention: National Pressure Injury Advisory Panel root cause analysis toolkit 3.0

Operating room-related pressure injuries (ORPI) are particularly challenging to examine for several reasons. Time in the OR is often a distinct event within the hospitalisation, and discovery of an ORPI may occur between several hours and up to 5 days postoperatively. The National Pressure Injury Advisory Panel (NPIAP) first developed a root cause analysis (RCA) toolkit in 2017 as a systematic strategy for investigating the root causes of facility-acquired pressure injury (PI). The purpose of this 2021 RCA toolkit update was to address an expanded investigation of medical device-related PIs (MDRPIs), both inside and outside the OR, as well as the specific PI prevention issues of the perioperative area. Clinicians have been using the 2017 toolkit as a basis for ongoing quality improvement tracking, since it provides more accurate information than data extractions from patient health records. A small working group consisting of NPIAP board and panel members developed investigative questions to identify the ORPI root causes and compliance with best practices for the entire perioperative experience. Action items are linked to evidence-based recommendations from the NPIAP/European Pressure Ulcer Advisory Panel/Pan Pacific Pressure Injury Alliance 2019 International Guideline and the Association of PeriOperative Registered Nurses (AORN) Guidelines for Perioperative Practice. A multidisciplinary clinician guide was also developed to identify practice gaps and to compile the information into an action plan for staff education and/or process improvement. The updated NPIAP RCA toolkit provides mechanisms for investigating, compiling and trending data as a basis for data-driven quality improvement. Using the enhanced investigative tools, the root causes of both MDRPIs and ORPIs can be better understood to target efforts to reduce their occurrence.

The safety of a novel single-drape cover for sterile back tables in the operating room compared to the standard two-drape method: an experimental study

BackgroundCovering the prepared sterile back tables (PSBTs) during periods of nonuse and during active surgeries may decrease contamination of sterile surgical instruments that have direct contact to surgical wound. The Association of periOperative Registered Nurses (AORN) declared that an easy method for covering and removing the drape will ultimately be most effective (e.g. standard two-drape method). Hence, this study was designed to test the hypothesis that using a novel single-drape cover had more efficiency and safety in decreasing airborne bacteria-carrying particles (ABCPs) settling on the PSBTs during static and dynamic periods than the standard two-drape method.MethodsThis experimental study was conducted with using 918 agar plates to detect contamination of the PSBTs with ABCPs on two conditions (static and dynamic) at an academic medical center in Kashan, Iran, from September 25, 2021, to January 20, 2022. The contamination of PSBTs was evaluated by 6 agar settle plates (n = 918 in total) on each PSBT in static and dynamic operating room (OR) conditions. At each time-point, this set-up was repeated on two occasions else during data collection, establishing 81 PSBTs in total. Tested groups included the PSBTs covered with the standard two-drape method, the novel single-drape cover, or no cover. The plates were collected after 15, 30, 45, 60, 120, 180, 240 min and 24 h. The primary outcome measured was comparison of mean bioburden of ABCPs settling on covered PSBTs on two conditions by using agar settle plates. The secondary outcomes measured were to determine the role of covering in decreasing contamination of PSBTs and the estimation of time-dependent surgical instrument contamination in the uncovered PSBTs on two conditions by using agar settle plates.ResultsCovering the PSBTs during static and dynamic OR conditions lead to a significantly decreased bioburden of ABCPs on them (P < 0.05). No differences were seen between the standard two-drape method and the novel single-drape cover (P > 0.05).ConclusionsWe found that there is no preference for using the novel single-drape cover than the standard two-drape method. Our results showed a significant decrease in bioburden of ABCPs on the PSBTs when those were covered during static and dynamic OR conditions, indicating the efficiency for covering the PSBTs during periods of nonuse and during active surgery.

The effects of educational intervention on operating room nurses' use of electrosurgical units

BackgroundElectrosurgical units are used in over 80% of operations worldwide. The consequences of incorrect use of electrosurgical units for patients and the surgical team include skin burns, inhalation of electrosurgical smoke, fire, and disruption to the functioning of cardiac pacemakers. Training operating room personnel in the correct use of electrosurgical units and evaluating their performance plays a crucial role in making optimal use of the units and extending their lifetime, reducing occupational hazards for surgical teams, and enhancing the safety of patients. Therefore, the present study was done to investigate the effects of an educational intervention on electrosurgical units by operating room nurses. MethodsIn this quasi-experimental research, the performance of 100 operating room nurses concerning their application of electrosurgical units in 200 operations (100 before and 100 one month after the educational intervention) was observed and evaluated. The data collection instruments consisted of a Demographic Information Questionnaire, a surgery checklist, and the checklist for the use of electrosurgical units by operating room nurses. The content of the poster was based upon the standard principles of using electrosurgical units based on the guidelines by the Association of periOperative Registered Nurses (AORN), Association of Surgical Technologists (AST), and the Association for PeriOperative Practice (AFFP). ResultsThe average age of the participating nurses were 31.540 ± 6.772 years. Before (18.330 ± 2.666) and after (20.820 ± 3.400) the educational intervention, the results showed a statistically significant difference between the means and standard deviations of the scores of electrosurgical units by operating room nurses. ConclusionIntroducing operating room nurses to the standard guidelines for applying electrosurgical units can improve the quality of services provided by the nurses, increase the safety of patients, and reduce occupational hazards. Thus, medical managers and policymakers should pay more attention to on-the-job training programs to improve the professional performance of operating room nurses in the use of electrosurgical units.

Incorrect Surgical Counts: A Potential for Retained Surgical Items.

In the main operating rooms of a large academic hospital there was a report of 408 count discrepancies in 2015-2016 and 13 incidences of retained surgical items (RSIs). There was a lack of a consistent and standardized surgical count process among nurses. To reduce count discrepancies by 25%, prevent RSIs, and improve the compliance of the perioperative nursing team regarding the surgical count process. An evidence-based quality improvement project with a sample of 455 surgical procedures and 118 nurses. Data collection occurred over an eight-week period in 2018 using a Plan-Do-Study-Act (PDSA) methodology to study the effectiveness of the utilization of the Association of periOperative Registered Nurses (AORN) practice guidelines for the prevention of RSIs. The inclusion of risk reduction strategies such as the utilization of an AORN guideline whiteboard to record surgical items and the identification of high-risk items for retained device fragments or high-risk surgical items for RSIs resulted in the reduction of incorrect surgical counts by 71.43%, with no incidence of RSIs. Further, nurse compliance on surgical count practices improved significantly, F (5, 46) = 2.47, p = .046, PES = .21. The implementation of the AORN guidelines for perioperative surgical count practices by the perioperative nursing team provided an improved surgical count process. A system approach to performance improvement is needed to prevent RSIs.

The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective.

No patient arrives at the hospital to undergo general anesthesia for its own sake. Anesthesiology is a symbiont specialty, with the primary mission of preventing physical and psychological pain, easing anxiety, and shepherding physiologic homeostasis so that other care may safely progress. For most elective surgeries, the patient-anesthesiologist relationship begins shortly before and ends after the immediate perioperative period. While this may tempt anesthesiologists to defer goals of care discussions to our surgical or primary care colleagues, we have both an ethical and a practical imperative to share this responsibility. Since the early 1990s, the American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), and the Association of Perioperative Registered Nurses (AORN) have mandated a "required reconsideration" of do-not-resuscitate (DNR) orders. Key ethical considerations and guiding principles informing this "required reconsideration" have been extensively discussed in the literature and include respect for patient autonomy, beneficence, and nonmaleficence. In this article, we address how well these principles and guidelines are translated into daily clinical practice and how often anesthesiologists actually discuss goals of care or potential limitations to life-sustaining medical treatments (LSMTs) before administering anesthesia or sedation. Having done so, we review how often providers implement goal-concordant care, that is, care that reflects and adheres to the stated patient wishes. We conclude with describing several key gaps in the literature on goal-concordance of perioperative care for patients with limitations on LSMT and summarize novel strategies and promising efforts described in recent literature to improve goal-concordance of perioperative care.

Analysis: Overcoming Human Factors Challenges of Endoscope Culturing with Turbulent Fluid Flow.

Analysis: Overcoming Human Factors Challenges of Endoscope Culturing with Turbulent Fluid Flow.

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Abstract The COVID-19 pandemic has magnified the importance of delivering high-quality healthcare while preserving limited or depleted resources. This is particularly true in cardiac surgery, which depends on the same equipment, hospital capacity, and personnel that have been re-directed to COVID-19 care. Enhanced recovery programs promote standardized, consistent perioperative care, with an emphasis on incorporating evidence-based measures to optimize the patient experience, improve outcomes and utilize resources efficiently. Developing and implementing a program in the current COVID-19 environment is a daunting task. The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac), representing an international, multi-disciplinary group of experts, provides the rationale, supportive evidence, and a proposed outline for a sustainable modified program within the constraints of the COVID-19 pandemic. It is feasible to launch in the current healthcare climate and is designed to preserve resources, reduce case backlog, and protect patient and provider safety while improving patient care and preserving institutional quality metrics. The program can also create the foundation for future growth.

Thinking Outside the Box: Development of an Audit Tool to Track Reusable Instruments Outside of SPD

<h3>Background</h3> Infection Control (IC) standard IC.02.02.01 is the most common finding by The Joint Commission (TJC). The primary focus for proper implementation of this standard has historically been the Sterile Processing Department (SPD) and endoscopy lab. This study, however, focuses on bedside staff's implementation of IC.02.02.01 by deploying an internally developed audit tool to quantify knowledge and compliance with safe instrument transport. <h3>Methods</h3> Meetings with SPD were held to ascertain the list of departments utilizing instrumentation undergoing HLD or sterilization. Infection Prevention (IP) developed a nine-question audit tool to measure elements of guidelines from the Association for the Advancement of Medical Instrumentation (AAMI), the Association of periOperative Registered Nurses (AORN), and the Occupational Safety and Health Administration (OSHA). A rating for each question of ‘Yes,' ‘No,' or ‘Not Applicable' and one open-ended question of ‘Other findings' was included. An IP and a member of SPD leadership visited each department. The standardized monitoring tool was completed, and recommendations on practice changes were communicated. <h3>Results</h3> Twenty-three patient care areas were identified as receiving reusable instrumentation from SPD. Each area was evaluated using the audit tool, and no area was found to be 100% compliant. The most often cited non-compliant measures were: (1) staff not wearing appropriate personal protective equipment and (2) compliance with moistening and removing gross soil at the point of use. <h3>Conclusions</h3> Decentralized hospital departments working with reusable instrumentation are sometimes forgotten when educating on the importance of standard IC.02.02.01. After auditing the end user in this study, IP determined that more education on bloodborne pathogen exposure and the importance of precleaning at point of use are needed. Routine compliance monitoring with a standardized tool is helpful to quickly find staff knowledge gaps and address issues.

Preventing Hypothermia during Cesarean Birth: An Integrative Review.

The purpose of this integrative review was to assess common warming measures used for prevention of hypothermia during the perioperative period for women having cesarean birth and to determine their efficacy. A literature search was conducted via electronic databases EBSCO, PUBMED, Academic Search Premier, Google Scholar, and CINAHL using keyword search terms hypothermia, cesarean, and warming. Inclusion criteria were articles written in English and published between 2006 and 2018. Seventeen articles were included in the review, covering three common warming measures; intravenous (IV) fluid warming, forced-air warming, and combined IV fluid and forced-air warming. Several other warming modalities were noted including warming mattresses and various combinations of interventions. Maternal hypothermia risk is increased during the perioperative period for women having cesarean birth without use of warming measures. Warming modalities that are beneficial in preventing maternal hypothermia in women having cesarean birth are IV fluid warming, upper body force-air warming, ambient OR temperature, and warming mattresses. National standards and guidelines from the American Society of PeriAnesthesia Nurses, the Association of Perioperative Registered Nurses, and the Association of Women's Health, Obstetric, and Neonatal Nurses are consistent with current evidence and should be in place and followed in every maternity unit caring for women having cesarean birth.

Pneumatic tourniquets in maxillofacial surgery: do we need to change practice? A national study

The use of pneumatic tourniquets during the harvest of free flaps is an established practice in oral and maxillofacial surgery. Their use can be associated with severe but preventable complications, for which operating surgeons are ultimately responsible. The aim of this study was to find any pitfalls concerning the safe use of tourniquets by maxillofacial surgeons. An electronic questionnaire based on the Association of Perioperative Registered Nurses (AORN) guidelines was distributed to maxillofacial surgeons nationally. A total of 37 questionnaires were completed and analysed. The mean (range) score for the knowledge-based questions for all respondents was 72.8% (47.3%–94.7%). The number of clinicians who answered correctly on topics relating to cuff position, reperfusion time and contraindications for the use of tourniquets were 15, 10 and 6, respectively. A total of 35 clinicians had had no formal training on the application of a tourniquet. Our study shows that knowledge about their use by maxillofacial surgeons is poor, and it highlights the importance of formal education during basic and higher surgical training.

Educational games developed for students in perioperative nursing: A systematic review and appraisal of the evidence.

A systematic review was conducted on electronic databases of MEDLINE/PubMed, Scopus, ISI Web of Science, CINAHL, and Embase until December 2017, using relevant keywords for educational games developed for nursing students in perioperative field. To evaluate the level of strength and quality of the evidence, the Association of periOperative Registered Nurses (AORN) revised model for evidence appraisal was used. Of the 852 evidence, only 10 met the criteria and were reviewed and appraised. Educational games had focused on different learning domains, including skills, feelings, emotion, knowledge, performance, attitude, motivation, and interest. With respect to the evidence level, most evidence was categorized as V (expert opinion = 2, case report = 2, literature review = 1, and organizational experiences = 1), and only one was in level I (randomized controlled trial). The quality level of most evidence was high (n = 4) and low (n = 4), and the rating of most of them was moderate (n = 4) and limited (n = 4). Based on the findings, most evidence had inappropriate quality and was found to be weak. It seems that the investigated games are insufficient to promote the nursing students' learning outcomes in different domains. Accordingly, more high-quality studies are required to design and develop innovative and practical games for students in perioperative nursing by considering validity and reliability process.

Take the initiative to reduce surgical site infections

Take the initiative to reduce surgical site infections

Operating Room Attire Policy and Healthcare Cost: Favoring Evidence over Action for Prevention of Surgical Site Infections

The Association of Perioperative Registered Nurses (AORN) released new guidelines for operating room attire in 2015 in an attempt to reduce surgical site infections (SSIs). These guidelines have been adopted by the Centers for Medicare and Medicaid Services. We aimed to assess the relationships among operating room attire, SSIs, and healthcare costs. In March 2016, our center introduced the AORN attire policy. National Health Safety Network data from our hospital were collected on general surgery, cardiac, neurosurgery, orthopaedic, and gynecology procedures from January 2014 to November 2017. The SSI rates and microbiological culture data for 30,493 procedures before and after policy implementation were compared using propensity score matching. The associated costs of the AORN policy were analyzed. After 1:1 propensity score matching, 12,585 matched pairs spanning the policy change were included (25,170 patients total); before policy change (BC group) and after policy change (AC group). The rate of SSIs did not differ between groups (1.0% AC group vs 1.1% BC group; p= 0.7). There was no difference in the incidence of Staphylococcal species cultured from wounds (19.3% AC group vs 16.8% BC group; p= 0.6). Multivariable analyses demonstrated that wound classification and emergent procedures were the strongest independent predictors of SSIs. The cost of attire for 1 person entering the operating room increased from $0.07 to $0.12 before policy change to $1.11 to $1.38 after policy change. Use of the mandated operating room long-sleeved jackets alone in our institution was associated with an added cost of $1,128,078 annually, which translates to an estimated $540 million per year for all US hospitals combined. Implementation of the AORN guidelines has not decreased SSIs and has increased healthcare costs.

Are knowledge and attitudes of perioperative registered nurses associated with the practices of covering and monitoring sterile tables?

BackgroundThe researchers assessed whether the knowledge and attitudes of perioperative registered nurses involved in operative procedures were associated with the practices of covering and observing sterile tables during periods of delay or non-use. MethodsThe researchers designed a survey to measure knowledge, attitudes, and practices related to covering and observing sterile tables. The Association of Perioperative Registered Nurses sent the 59-question survey to a random sample of 18,196 members. A statistician analyzed the survey responses using descriptive and inferential statistics. ResultsThe researchers included responses from 857 members who completed the survey in the data analysis. The results showed that both knowledge and attitudes of perioperative registered nurses involved in operative procedures were associated with practice. ConclusionFurther research is warranted to investigate best methods for covering sterile tables as well as the need for direct observation of prepared covered tables and the effect of these practices on sterility, facility productivity, efficiency, and cost.

A Pilot Study to Evaluate Compliance with Guidelines for Preprocedural Reconsideration of Code Status Limitations.

Periprocedural providers are encountering more patients with code status limitations (CSLs) regarding their preferences for resuscitation and life-sustaining treatment who choose to undergo palliative procedures. Surgical and anesthesia guidelines for preprocedural reconsideration of CSLs have been available for several years, but it is not known whether they are being followed in practice. We assessed compliance with existing guidelines for patients undergoing venting gastrostomy tube (VGT) for malignant bowel obstruction (MBO), serving as an example of a palliative procedure received by patients near the end of life. Code status was determined at admission and throughout the hospitalization by chart review. Documentation of code status discussions (CSDs) was identified from provider notes and compared with existing guidelines. An institutional database retrospectively identified patients who underwent VGT placement for MBO at two academic hospitals (2014-2015). We identified 53 patients who underwent VGT placement for MBO. Interventional radiologists performed 88% of these procedures. Other periprocedural providers involved in these cases included surgeons, gastroenterologists, anesthesiologists, and sedation nurses. CSLs were documented before the procedure in only 43% of cases, and a documented CSD with a periprocedural provider was identified in only 22% of CSL cases. Of all VGT placements performed in patients with CSLs before the procedure, only 13% were compliant with the guidelines of preprocedural reconsideration of CSLs. Increased compliance with guidelines published by the American Society of Anesthesiologists, the American College of Surgeons, and the Association of Perioperative Registered Nurses is necessary to ensure goal-concordant care of patients with CSLs who undergo a procedure. Efforts should be made to incorporate these guidelines into the training of all periprocedural providers.