Perioperative Personnel Research Articles

Individual and System Level Factors Contributing to Guideline Non-Adherent Surgical Antibiotic Prophylaxis at a Tertiary Health Care System: A Qualitative Analysis.

Antibiotics play a crucial role in preventing surgical site infections, yet adherence to Infectious Disease Society of America (IDSA) guidelines varies widely. This qualitative study aimed to explore factors influencing perioperative antibiotic administration and assess the potential impact of a clinical decision support (CDS) tool on guideline adherence. In this qualitative study, perioperative personnel with diverse roles (surgeons, anesthesiologists, certified nurse anesthetists, trainees, and pharmacists) were interviewed using a semi-structured interview format from September 2023 through April 2024. Interviews were then analyzed for codes which were assigned to concepts using the constant comparison method for assessment of factors that were described as barriers or facilitators of guideline adherence. After piloting with three interviews, we conducted nine sessions with a total of 17 participants: 7 attending anesthesiologists, 3 resident trainees, 2 perioperative pharmacists, 3 Certified Registered Nurse Anesthetists (CRNAs), and 2 attending surgeons. Key themes emerged: (1) Limited familiarity with Infectious Disease Society of America (IDSA) antibiotic guidelines, (2) Lack of standardization and optimization of antibiotic decision-making process, (3) Challenges with managing beta-lactam allergies, (4) Difficulty optimizing vancomycin timing, and (5) Perceived benefit of a Clinical Decision Support (CDS) tool in enhancing workflow and guideline adherence. Non-adherence to antibiotic guidelines in the perioperative setting often results from a lack of structured workflow. Our interviews provide a foundation for developing a clinical decision support tool tailored to provider needs, aiming to improve user satisfaction and promote better adherence to perioperative antibiotic guidelines.

Patient Readiness for Surgery: A Quality Improvement Initiative

ABSTRACTThe use of a surgical safety checklist can help prevent sentinel events; however, a lack of adherence to the checklist can result in inadequate preoperative patient readiness and negative outcomes. The purpose of this quality improvement project was to address preoperative concerns that prevent patient readiness in a military hospital. To change practice, the project involved the use of an evidence‐based practice model and Kurt Lewin's change theory. The primary investigator provided an educational initiative on the required checklist for perioperative personnel and collected data on key elements (ie, consent completion, laboratory test results, antibiotic availability, checklist completion) for 30 days after the initiative. Consent completion rates were 100% both before and after the intervention. Statistical analysis (chi‐square [χ2]) showed significant improvement for the remaining three elements. The results were the most significant for laboratory test results (χ21 = 33.496, P < .00001).

Ten questions concerning particle exposure in open electrosurgery and its control strategies

The increasing use of high-frequency electrosurgical pencils in open surgeries has heightened concerns about the adverse implications of electrosurgical smoke (ES) on perioperative personnel. Since 2015, there has been an increasing amount of research on electrosurgical smoke particles annually. Despite data discrepancies, nanoparticles (core particle size <200 nm) generally dominate in number distributions. Particulate matter (PM) concentration is closely related to the type of target tissue. Most studies show that ultrafine particle (UFP) concentrations near the main surgeon’s breathing zone inversely correlate with operating room air changes and positively correlate with the power of the electrosurgical pencil. Local smoke evacuation devices with negative ions, specialized filters and N95 respirators are more effective in protecting perioperative staff health, particularly against UFPs. The objective is to summarize particle exposure knowledge in open electrosurgery and establish a research agenda to protect medical personnel from ES exposure.

Surgical smoke knowledge and practices before and after onset of COVID-19: A national survey of OR personnel

BackgroundAt the start of the COVID-19 pandemic, new recommendations to evacuate surgical smoke were made due to unknown viral hazards. We evaluated perioperative registered nurses’ and surgical technicians/technologists’ knowledge of surgical smoke and determined smoke evacuation practices before and after the onset of COVID. MethodsAn electronic survey was developed, validated, and distributed nationally. Means and percentages were used for analysis of descriptive data. For comparison analyses, repeated measures were conducted on continuous variables with paired t-tests and mixed factor ANOVAs. ResultsWe found gaps in knowledge regarding surgical smoke hazards, low evacuation device usage, lack of smoke evacuation policies, and little to no air quality or exposure monitoring in ORs. Smoke evacuation practices did not change significantly following the onset of COVID-19. ConclusionsImplications for leadership, education, and research may provide perioperative personnel with improved work environments without surgical smoke hazards.

Guidelines in Practice: A Safe Environment of Care.

Creating a safe environment for performing surgical procedures is essential to achieve successful patient outcomes and protect the perioperative personnel who are providing care. Numerous factors challenge the provision of a safe environment of care and create a complex setting for perioperative nurses to manage. The updated AORN "Guideline for a safe environment of care" provides perioperative nurses with recommendations for establishing a safe environment for both patients and personnel. This article provides an overview of the guideline and discusses recommendations for implementing fire safety protocols, using warming cabinets, and creating a latex-safe environment. It also includes a scenario describing the care of a patient with an unidentified latex allergy who is undergoing a laparoscopic sleeve gastrectomy and hiatal hernia repair. Perioperative nurses should review the guideline in its entirety and implement recommendations as applicable in operative and other procedural settings.

Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal-Approach Hysterectomy at a Midwestern Teaching Hospital.

Accrediting organizations, third-party payers, and patients review the surgical site infection (SSI) rates of health care organizations. Infection preventionists collaborate with perioperative personnel to decrease SSI rates; they also monitor and report SSI information to national organizations. The standard infection ratio is a comparison of the observed number of SSIs to the predicted number of SSIs based on national benchmark data. Leaders of a midwestern teaching hospital convened an interdisciplinary team (eg, surgeons, perioperative leaders, infection preventionists) to address a standard infection ratio after hysterectomies that was greater than 1.0. The team reviewed national guidelines and published articles on decreasing SSIs (including recommendations for vaginal preparation) before developing and implementing a hysterectomy-specific bundle for SSI prevention. The rate of SSIs decreased 68% after the implementation of the bundle. Perioperative personnel at this facility continue to use the bundle and infection preventionists monitor and report compliance with the bundle's elements.

Optimizing the Relationship Between Perioperative Personnel and Infection Preventionists to Reduce Surgical Site Infections.

Prevention of surgical site infections (SSIs) is a critical aspect of ensuring positive patient outcomes. One of the challenges of SSI prevention is the communication barrier between perioperative staff members and infection preventionists (IPs), which may lead to frontline staff members who are primarily responsible for infection prevention being unaware of pertinent hospital SSI data. To overcome this challenge, IPs and perioperative staff members should develop a partnership that facilitates the sharing of feedback on SSI case review data and effective key performance indicators. A partnership also can help engage perioperative staff members in quality improvement efforts and increase collaboration with IPs. Perioperative leaders should identify effective methods to improve data transparency, SSI case reviews, audit and feedback programs, and education for perioperative team members. A strong perioperative-IP partnership and increased sharing of data in accessible formats may improve engagement and interest in SSI prevention.

Guidelines in Practice: Processing Flexible Endoscopes.

Flexible endoscopes allow surgeons and proceduralists to view patients' internal organs through small incisions or natural orifices. These devices may be difficult to clean and dry adequately, and the formation of biofilm can further complicate effective cleaning. The updated AORN "Guideline for processing flexible endoscopes" provides perioperative personnel with evidence-based best practice recommendations on a variety of concepts associated with this topic. This article provides an overview of the guideline and discusses recommendations for point-of-use treatment, transport, cleaning (including verification and drying), and storage of flexible endoscopes. It also includes a scenario that illustrates the importance of adequately drying and storing flexible endoscopes. When processing flexible endoscopes, personnel should adhere to the endoscope and processing equipment manufacturers' instructions for use. Perioperative nurses should review the guideline in its entirety and implement recommendations in practice settings where flexible endoscopes are used.

Guidelines in Practice: Hand Hygiene.

Effective hand hygiene is an important part of infection prevention, especially in perioperative areas. The revised AORN "Guideline for hand hygiene" provides perioperative personnel with evidence-based practice recommendations for hand hygiene. This article presents an overview of the guideline and discusses specific recommendations for maintaining appropriate fingernail and hand condition; wearing or removing hand and wrist jewelry; performing general hand hygiene; performing surgical hand antisepsis with a traditional hand scrub or surgical hand rub; selecting sinks, faucets, and drains to avoid hand contamination; and implementing quality activities to enhance hand hygiene compliance. It also includes a scenario illustrating how nurses can use the guideline to mitigate hand dermatitis associated with surgical hand antisepsis. Perioperative nurses should review the revised guideline in its entirety and apply the recommendations as applicable for their practice.

Emergency Preparedness: Strategies for Maintaining Water Supply Quality and Access for Sterile Processing.

Sterile processing department (SPD) technicians are responsible for providing properly reprocessed surgical instruments for procedures. They use utility (ie, tap) water for precleaning, cleaning, and disinfection; and critical (ie, treated to remove impurities) water for the final rinse and steam sterilization. Water maintenance personnel should work with SPD personnel to ensure that the facility's water supply meets the quality parameters for hardness, pH, conductivity, chlorides, bacteria, and endotoxins. Inadequate water quality and quantity can affect SPD technicians' ability to reprocess instruments correctly and may result in pathogen transmission. When water quality concerns arise, SPD personnel should notify perioperative personnel. Health care facilities should have a water management program to address both normal and abnormal water operations and an emergency water supply plan. Pandemics, geopolitical conflicts, and natural disasters may disrupt water supplies. Proactive planning for water shortages should help facility leaders respond quickly and effectively when shortages occur.

Guidelines in Practice: Positioning the Patient.

Positioning the patient is an important perioperative task; the recently updated AORN "Guideline for positioning the patient" provides perioperative personnel with background information and evidence-based best practices for perioperative patient positioning and focuses on maintaining patient and staff member safety. The revised guideline includes recommendations for placing patients safely in a variety of positions and avoiding positioning injuries, such as postoperative vision loss. This article provides an overview of positioning recommendations for assessing patients' risk for injury, implementing safe positioning practices, placing patients in the Trendelenburg position, and preventing intraocular injuries. It also includes a patient-focused scenario on preventing adverse events associated with the Trendelenburg position that aligns with information discussed in the article. Perioperative nurses should review the guideline in its entirety and implement appropriate recommendations for positioning patients during procedures.

The effectiveness of radiofrequency scanning technology in preventing retained surgical items: An integrative review.

To synthesise evidence on the effectiveness of radiofrequency (RF) scanning technology as an adjunct to manual counting protocols in preventing retained surgical items (RSIs) in the operating room. Despite the implementation of rigorous manual counting protocols, RSIs remain one of the most common reported sentinel events in operating theatres that lead to adverse patient outcomes. An integrative review. This review was guided by the Whittemore and Knafl (2005) framework. A literature search using CINAHL, MEDLINE, ProQuest, PubMed, and Scopus with key search terms related to RSIs and RF was applied to select English articles from January 2011 till August 2021. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was utilised for study quality assessment while reporting of review was guided using the PRISMA checklist. A total of 15 peer-reviewed articles were included, enabling the knowledge on the RF scanning technology to be grouped into four themes, namely: detection accuracy of RF scanning technology, real-time detection of surgical items using RF identification, the impact of the RF scanning technology for detecting RSIs on patient safety, and cost-analysis of integrating the RF scanning technology in operating theatres. Radiofrequency scanning technology is effective in preventing RSIs with significant cost-savings. Perioperative leaders should develop a multidisciplinary process to evaluate and select the most appropriate RF scanning technology as part of their patient safety programs. However, future studies with a larger sample size and robust research design, such as randomised controlled trial, should be considered to enhance the generalisability and rigour of evidence. This review contributes to perioperative personnel's education/training of staff on using RF scanning technology to prevent RSIs. The cost-effectiveness analysis enables the healthcare leaders to decide on the selection of appropriate RF technology.

Active Shooter Preparedness: Is Your OR Ready?

Active shooter events, including those in health care facilities, are expected to increase in incidence. Perioperative personnel may be underprepared for such an event. Understanding how to make the best decision regarding whether to escape, hide, or fight, and being aware of the communication channels during these types of events are crucial to adequate preparation. Health care facilities and critical areas such as the OR should be prepared for an active shooter event. This article briefly describes a firsthand shooting event experience at Johns Hopkins Hospital and includes a review of the literature on active shooter events in health care settings to determine the most practical application of event preparedness for staff members working in the OR. It also discusses the highly relevant concept of patient abandonment.

Perioperative Prewarming: Heat Transfer and Physiology.

To appreciate the strategy of prewarming, perioperative personnel should have a basic understanding of the physics of heat transfer and the thermoregulatory pathophysiology of anesthesia. The dominant cause of postinduction hypothermia is anesthesia-related redistribution of heat within the body; the role of cutaneous heat loss is minimal. Physiologic thermoregulatory system changes that occur in response to anesthesia make it almost impossible to reverse intraoperative hypothermia. However, prewarming is an effective strategy to prevent postinduction hypothermia from redistribution because it creates a temporary excess of heat in the body's peripheral thermal compartment. Perioperative nurses should implement active and passive prewarming strategies in accordance with the warming devices at their facility and available time. This article focuses on two major topics necessary to understand prewarming: the effect of anesthesia on postinduction thermoregulation and thermodynamic conditions that successful treatment strategies must exploit to produce desired outcomes.

Improving Perioperative Communication During the COVID-19 Pandemic.

ABSTRACTPerioperative communication can be ineffective and result in delays or adverse events. Coronavirus disease 2019 (COVID‐19) has placed demands on health care leaders and personnel to integrate information quickly and accurately. When caring for patients diagnosed with COVID‐19 or whose infection status was unknown, perioperative personnel at one facility discovered communication gaps associated with the environmental cleaning process and hand‐over reports. A project team comprising perioperative nurses created five tools to provide critical information to help diverse team members share the same mental model. The project team created one tool in English and Spanish to meet the needs of environmental services personnel whose primary language was Spanish. The team created another tool to support communication with central processing department personnel and facilitate prioritization of case cart cleaning when needed. The development and implementation of the communication tools helped to provide a safe working environment during the COVID‐19 pandemic.

Determining Operating Room Nurses’ Knowledge and Use of Evidence-Based Recommendations on Preventing Surgical Site Infections

PurposeAlthough surgical site infections are a common problem, it is reported that 70% can be prevented by perioperative personnel compliance with evidence-based recommendations. The present study aimed to determine operating room nurses’ knowledge and use of the updated evidence-based guidelines for the prevention of Surgical Site Infection. DesignThis research is a descriptive and cross-sectional study. MethodsThe study was carried out with 228 operating room nurses from 81 different hospitals. Data were collected using a Personal Information Form and Questionnaire for Knowing and Implementing Evidence-Based Guidelines for the Prevention of Surgical Site Infection between April and October 2019. FindingsThe nurses were aware of the guidelines and suggestions for preventing surgical site infection, and the related updates (76.3%-96.6%). However, there were variations in the rate of applying the guidelines’ recommendations in the institutions (40.4%-93.4%). Compliance with the guidelines was generally good in areas under nursing management, such as wearing sterile gloves (93.4%), nail length (91.2%), maintaining normothermia (88.6%), surgical brushing (81.1%) and hair removal with a clip (74.5%). However, it was lower in areas such as a bath with soap or with an antiseptic solution (40.4%), decision to remove hair (46.5%), keeping operating room doors closed (57%), operating room traffic (62.7%), and continuing prophylactic antibiotics after surgery (89.4%). Compliance should be improved in areas such as preoperative washing and minimizing staff numbers in the operating room. ConclusionsIt is important to reflect the guidelines in clinical practice, but the present study shows differences between the proposed application and actual practice. In this case, a possible solution is a range of care bundle, each consisting of a few specific suggestions, that would be selected by the institutions and the perioperative team in accordance with their surgery type and patient group.

Clinical Issues—March 2022

Nursing scope of practice Key words: state nurse practice act (NPA), state board of nursing, decision-making framework, standards, guidance. Practice of unlicensed perioperative personnel Key words: job description, task delegation, unlicensed personnel, allied health care provider, scope of practice. Definition of a cavity for counting procedures Key words: anatomical hollow space, counting, cavity, retained surgical item (RSI), retained foreign object (RFO). Identifying retained suture needles on radiographic images Key words: suture needle size, suture needle length, radiographic imaging, counting procedures, count discrepancy.

Perioperative Interventions to Reduce Surgical Site Infections: A Review.

Surgical site infections (SSIs) contribute to increased health care costs and morbidity after procedures as well as prolonged length of stay. Perioperative personnel can use a variety of interventions to help reduce SSI incidence; however, all strategies are not effective for all patients (eg, antibiotic prophylaxis). Results of randomized controlled trials show that some SSI reduction strategies are generally effective, including preoperative skin antisepsis with an alcohol-based agent, closing surgical wounds with triclosan-coated suture, and applying a negative pressure wound therapy device to open and closed wounds. Study results do not show that irrigating clean wounds with crystalloid solutions containing antibiotics or routinely using plastic drapes with or without impregnated iodophor or silver nylon-impregnated dressings significantly reduces SSI incidence. Perioperative leaders should support the implementation of strategies to prevent SSIs and work with interdisciplinary team members to develop an SSI prevention bundle that will meet the needs of their patients.

Perioperative Infection Prevention Beyond COVID‐19

Perioperative Infection Prevention Beyond COVID‐19

Evaluating the use of narrative pedagogy in person-centred care and human factors in perioperative practice education

Background: There is an international effort to develop understanding from human factors theory and implement this in healthcare to improve person-centred care and patient safety. Aim: This project aimed to evaluate the use of narrative pedagogy to teach human factors to perioperative personnel in the workplace. Methods: Using the action research model, an interactive learning session based on lessons from serious incidents was developed and delivered to perioperative staff in an NHS Trust within a practice development programme. Data were collected in the form of questionnaires and peer reviews to evaluate the learning session, and thematically analysed. Findings: The use of narrative pedagogy to explore human factors theory empowered participants to speak up, and this influenced the workplace safety culture. Conclusion: Narrative pedagogy reconnects healthcare employees with compassionate approaches to person-centred care, and this provides powerful motivation to improve the safety culture. Further studies should focus on different applications of narrative pedagogy in workplace learning, and creative approaches to teaching human factors. Implications for practice: • Narrative pedagogy can be a conduit to develop person-centred practice • Engaging staff through interactive practice development sessions can encourage expansive learning about human factors and their application in practice • Narrative pedagogy motivates healthcare staff to improve the safety culture in practice