Surgical Aseptic Techniques Research Articles

Reduction in Surgical Site Infections Through Obstetrics–Surgical Services Collaboration

St. Jude Medical Center had always enjoyed excellent patient outcomes. However, it was noted that during a 1-year period, there was a rise in the infection rate for cesareans and this was cause for concern. It was discovered that there could be several variables causing the rise in infections, and a plan for education in surgical asepsis was designed to decrease the risk of infection to patients. It was identified that customs and practices that existed in the labor and delivery unit would benefit from a formal review of the structure and processes of surgical aseptic technique. An educational practicum was designed and implemented to provide basic instruction and practice in the perioperative environment. The obstetrics and surgical services departments collaborated to create a program that addressed the knowledge gap caused by lack of consistent perioperative nursing training among the labor and delivery unit nursing staff. Perioperative nurses who had completed preceptorship training were selected and paired with their labor and delivery unit counterparts. Each labor nurse completed a minimum of 16 hours of direct instruction in the main operating room (OR) prior to validation during a cesarean birth. Thirty labor and delivery unit nurses and scrub technologists have completed OR rotations and achieved competency, as documented by the competency validation checklist. This has resulted in a significant decrease in cesarean infections as well as an increased number of personnel available to provide care for women undergoing an emergency cesarean. Since its implementation, the rates of infection and foreign body retention have decreased significantly, and the collaboration between the two departments has resulted in improved patient outcomes. In addition, a complicated, life-threatening cesarean birth was carried out successfully due to the finely honed collaboration between the surgical services and obstetrics departments. By identifying knowledge gaps in perioperative nursing practice, the risk of developing a surgical site infection was significantly decreased.

Application and evaluation of improved surgical aseptic technique curriculum in specialty nurse training in Henan Province

ObjectiveTo develop and apply a novel surgical aseptic technique curriculum in specialty training for operating room (OR) nurses. MethodsAs surgical environments were improved, related specifications were revised. The proposed surgical aseptic procedure was discussed, improved, and recorded as procedure videos. In the new training program, traditional theoretical lecture training was replaced with sequential theoretical lessons and video demonstration, operation presentation, and skill competition. At the end of the training, the trainees were given questionnaires to assess training outcomes. Differences in student satisfaction regarding the proposed training program and conventional training programs were then compared. ResultsA GPA of 3.61 ± 0.58 was recorded after the new training program was implemented. The minimum and maximum average scores of each item were 3.05 ± 0.43 and 4.61 ± 0.33, respectively The satisfaction rate of the trainees in 2013 was significantly higher than that in 2011 (t = 2.14, P = 0.039). ConclusionNovel surgical aseptic technique and application in the curriculum design of training for OR nurses should be developed to enhance their mastery of theoretical and practical skills and to modify their behaviors.

Mejores prácticas para el lavado y manipulación de la bolsa de alimentación enteral Kangaroo

Introducción: La nutrición enteral es una valiosa herramienta en la terapia de los pacientes hospitalizados, especialmente en las unidades de cuidado intensivo y en pacientes que, por sus patologías, pierden su habilidad de ingerir alimentos.Metodología: se aplicó la metodología que señala la práctica clínica basada en evidencia (PCBE) que trata de localizar hallazgos que respondan a la pregunta clínica planteada mediante el estudio y análisis de investigaciones primarias y originales de alta calidad científica.Resultados: Ningún estudio respondió directamente a la pregunta, sin embargo, varias investigaciones aluden que el lavado de manos y el uso de guantes limpios funcionan como estrategia para la manipulación y lavado de este dispositivo. La calidad de los estudios encontrados es baja ya que provienen de investigaciones basadas en la opinión de expertos y revisión de literatura de poca calidad.Conclusiones. No se encuentra evidencia significativa que respalde el uso de técnica aséptica médica y quirúrgica para el manejo y lavado de la bolsa Kangaroo de alimentación enteral.

Scrub Nurse's Performance Concerning Surgical Aseptic Techniques at the Operating Room of Slemani Teaching Hospitals

Background and aim: the study aims is to assess the level of performance among the scrub nurses concerning the surgical aseptic techniques at the operating room, describe the socio- demographic characteristics of the study sample, and to find out the relationship between the scrub performance and variables of some demographic characteristics such as (age, gender, level of education, marital status, and years of experience in operating room). Materials and method: quantitative design, non - probability (purposive) sample of (70) male and female scrub nurses who worked at three teaching hospitals, which represent vital agencies in Slemani city (Iraqi Kurdistan rejoin), during the period of December 2009 up to the end of September 2010. Data were collected through two types of instruments (questionnaire and observational checklist); the researcher modified the study instrument to investigate the scrub nurses practices in the three teaching hospitals: It was based on extensive review of related literature and studies. The study instruments compressed of seven dimensions which include total of (91) items, the content validity of the instrument was established through penal of (20) experts. Reliability of the instrument was determined through the use of equivalence reliability, Inter- rater (Inter observer) approach, (r=0.91). Data were analyzed through the application of descriptive and inferential statistical analysis. Results: the result of the study revealed that the most of the nurses are middle – aged, married female, with a low level of monthly income. The majority of the study sample is institute graduates and they have no long employment in operating room. Most of the study sample has poor skills in scrubbing practices. Furthermore, the study confirms that there is a significant relationship between the economic status and their practices. Recommendations: based on the results of the study, the study recommended that job description have to be legislated to all nursing categories as one of job for better achievement and a periodic in service, educational program for operating room nurses and certified to identify the qualified ones. Further study should be carried out to be recommended to develop operating room work achievements

Wash & go – but with what? Skin antiseptic solutions for central neuraxial block

Wash & go – but with what? Skin antiseptic solutions for central neuraxial block

Aseptic non-touch technique in intravenous therapy

A lack of understanding of aseptic practice can lead to confusion and poor performance of the technique. This article explains the principles of surgical aseptic technique and aseptic non-touch technique in relation to intravenous therapy, and outlines the nurse's role and responsibilities when carrying out the procedure.

Using an aseptic technique to reduce the risk of infection

It is essential that nurses recognise the consequences of patients acquiring a healthcare-associated infection (HCAI). This article outlines how handwashing continues to be the most important factor in reducing HCAI, but that the use of an aseptic technique will further cut the risk of infection. Because most aseptic techniques do not require a surgical aseptic technique, emphasis is placed on the use of an aseptic non-touch technique, which is required for many procedures in hospital and the community.

A Process Change Can Unintentionally Affect Surgical Infections: Tracing the Cesarian-Section Patient from Admission To Identify Underlying Issues

ISSUE: Baptist DeSoto is a 169 bed acute care hospital with an occupancy rate of almost 100%. During the 3rd Quarter of 2004, Infection Control (IC) reviewed recommendations for prevention of Surgical Site Infections (SSI). We revealed that razors were used instead of clippers. In November 2004, both razor kits and razors were removed from unit stock. A log was maintained by Store Room if single-use razors were issued. In March 2005 superficial SSI rate in C-Section procedures had increased. Five (5) C-Section SSI were detected since December 2004. Historically the SSI rate for C-Sections is low (FY03 = 0.51, FY04 = 0.46). This was an unexpected increase. PROJECT: A team of reviewers (IC, Women's Center [WC], and Physicians) began an intensive investigation into the cause for the increasing SSI rate. Assessment included examination of surgical processes related to instrument sterilization, surgical aseptic techniques and analysis of a detailed line listing of infected patient's. A re-education campaign for the preoperative patient occurred in April 2005. Still 4 additional C-Section SSI occurred from May to June. The WC management team began a patient tracer on admission for C-Section patients. Tracer observations identified a missed step during the clipping process. The razor method utilized a “prep kit” which included a tray to hold water with soap and a sponge. The patient's abdomen is scrubbed with the soapy water and then shaved. When the process changed to clipping, prep kits were eliminated and the abdomen was clipped prior to surgery without washing. In August the prep policy was revised to include steps to clean the abdomen with the clipping technique. Educational updates occurred and units are now supplied with a single-use antiseptic sponge to clean the abdomen. RESULTS: The hospital continues to use and recommend clipping for surgical hair removal. Since the refinements to the prepping policy in August 2005 there have been 5 consecutive months without C-Section SSI. LESSONS LEARNED: Effecting even a simple process change to improve outcomes can unintentionally provide inverse results. A few key components proved to be successful. Measuring patient outcomes during change is critical to gauge successful interventions. The patient tracer strategy was useful in identifying the procedural weak link. When investigating adverse outcomes, a format for success is a team based approach. Download full-size image

Skin Disinfection before Epidural Catheterization: Comparative Study of Povidone-Iodine versus Chlorhexidine Ethanol

Background: Chlorhexidine is better than povidone-iodine for skin preparation before intravascular device insertion or blood culture collection, but it is not known whether chlorhexidine is superior in reducing the colonization of continuous epidural catheters. Methods: Patients requiring an epidural catheter for postoperative analgesia were randomly assigned to receive skin preparation with 0.5% chlorhexidine ethanol (CE group) or 10% povidone-iodine (PI group) before catheter insertion. Using surgical aseptic techniques, catheters were inserted into either the lumbar or the thoracic epidural space. Gloves used at catheter insertion, swabs of insertion site skin and the catheter tip at catheter removal were qualitatively cultured. Results: Of 70 randomly assigned patients, 62 were evaluable. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters were kept in place for 49 ± 7 h (mean ± SD). Seven cultures from gloves yielded microorganisms. In 1 case, the leak test of gloves was positive. Fifteen cultures of catheter insertion sites yielded microorganisms: 7/28 (25%) in the PI group and 8/34 (24%) in the CE group. Six cultures of catheter tips yielded microorganisms: 3/28 (11%) in the PI group and 3/34 (9%) in the CE group. As for the incidence of isolation of bacteria, no difference was seen between the two groups. In none of these 62 cases was any inflammatory reaction seen in the skin locally at catheter removal. Conclusions: The effect of 0.5% chlorhexidine ethanol is not different from that of 10% povidone-iodine in reducing catheter colonization associated with short-term epidural catheter placement.

Surgical gowns and drapes as aseptic barriers

The use of surgical gowns and drapes has become the standard of practice in the arena of surgical aseptic technique. Because a myriad of materials, both woven and nonwoven, are currently available, users are faced with the difficult task of choosing a bacteriologic barrier material that is effective, safe, and economical. Although recommendations are available for general selection and use of barrier materials, no specific guidelines exist to assist the user in evaluating the important features of barriers. In addition, standards are lacking for safety characteristics such as flammability and fiber content. The infection control practitioner needs to be aware of the issues surrounding surgical barrier materials to be able to put the infection control merits of these materials in their proper perspective.