Prevention of infection for both surgical patients and healthcare workers is a primary objective for perioperative personnel; improvements in infection control practices can reduce the incidence of healthcare-associated infections and exposure to communicable disease. The appropriate selection and use of gloves in the perioperative practice environment is a key infection control practice. Therefore, nurses and other perioperative personnel should be knowledgeable about the key considerations in selecting gloves that are appropriate for the various tasks they perform in their patient care activities on a daily basis. This continuing education activity will provide a brief historical review of the evolution of the use of gloves as a protective barrier and several important issues related to gloving. The various types of materials used to manufacture gloves will be presented. The protective qualities of examination and surgical gloves currently used in the clinical practice settings will be explored, including a review of glove barrier properties, strength, durability, and other very important characteristics. The current recommendations by regulatory agencies and professional associations for glove manufacturing and glove usage also will be outlined. Specific criteria for the selection and use of examination and surgical gloves will be presented. Finally, selected case studies will provide the participant with the opportunity to synthesize the information and evaluate workplace scenarios with regard to appropriate glove selection and use.
As the requisite use of protective barriers has evolved over the years, the use of gloves also has become more prevalent as a key strategy for reducing the risk of an exposure incident. Perioperative personnel use gloves on a daily basis to protect themselves from exposure to blood and other potentially infectious materials in the surgical practice setting. But in today’s healthcare environment, new pathogens, in addition to well-known pathogens that have developed resistance to therapeutic modalities, have given greater awareness to the use of gloves as a primary protective barrier for perioperative staff members. Paralleling these developments is the practice of double-gloving. Therefore, it is imperative that members of the surgical team understand the role of protective barriers, as well as the practice of double-gloving as an exposure risk reduction strategy. This continuing education activity will provide an historical review of the evolution of the use of gloves as a protective barrier. The current impact of occupational exposure on healthcare workers will be presented. The contemporary literature citing the practice of double-gloving as an effective risk reduction strategy also will be reviewed. Recommendations promulgated by professional associations will be outlined. The implications of double-gloving in the surgical practice setting, including approaches to implement a change in practice and the identification of perceived barriers, will be discussed. Finally, selected case studies will provide the participant with the opportunity to synthesize the information and evaluate workplace scenarios with regard to double-gloving practices and policies.
Surgical site infections (SSIs) are a significant source of patient morbidity and mortality, extended hospital stays, and increased heath care costs. For these reasons, preventing the development of SSIs for all surgical patients is a goal of every member of the perioperative team. The incidence of SSIs is influenced by several risk factors, one of which is preoperative hair removal. Traditionally, preparing patients for surgery included the routine shaving of the proposed operative site; however, research has shown the practice of routine hair removal should be reevaluated, based on the available research. Therefore, perioperative personnel should be aware of the current evidence and evidence-based practices related to preoperative hair removal to reduce the risk for an SSI. This continuing education activity will present an overview of the clinical and economic impact of SSIs in today’s health care environment. The evolution of the practice of preoperative hair removal will be outlined. Clinical issues related to hair removal, including the timing and various methods will be discussed. Relevant research data that support evidence-based practices for preoperative hair removal will be reviewed. Finally, recommended practices and guidelines used to develop policies and procedures for hair removal in the surgical practice setting will be outlined.
Incontinence-associated dermatitis (IAD) is an inflammatory skin condition that occurs when the skin is exposed to urine or stool and can lead to secondary infection, pain, and pressure ulcers. Incontinence-associated dermatitis (IAD) is physically painful and emotionally upsetting and often confused with pressure ulcers. Reported prevalence rates (ie, the percentage of a population that has a condition; in IAD studies, the figure often is calculated from admission data) vary from 5.6% to 50%. Incidence rates (ie, the number of new cases that develop during a specific time period, usually four weeks for IAD) vary from 3.4% to 25%. Incontinence usually has many causes, is incompletely understood, and includes psychological and physiological factors. Recent evidence indicates that approximately 20% of acute care patients are incontinent and that 42.5% of incontinent patients have some type of skin injury. Although the pathophysiology of IAD is not completely understood, disturbance of the skin's acid mantle as a protective barrier is thought to play a key role. It is a daily challenge for health professionals in hospitals, nursing homes, and community care to maintain a healthy skin in patients with incontinence. Strategies include prevention of incontinence, use of containment products, regular skin assessment, proper differential diagnosis, development of effective treatment protocols, and staff education.
This online course provides an overview of the impact of surgical attire (scrub apparel and head covers) on patient safety in the operating room.
- Historical development of attire
- Major types of materials used in fabrication of attire
- Guidelines related to surgical attire
- Rationale for surgical attire
- Clinical scenarios
The educational activity focuses on local temperature therapy which is the application of heat and cold for therapeutic intervention of pain and discomfort. It is important to use the appropriate therapy to relief pain, improve blood flow and reduce swelling. A brief review of the process of thermoregulation will be presented along with the use of heat and cold packs will be described. Regulations and guidelines for use will be discussed. Healthcare professionals in various practice settings will benefit from the knowledge regarding the use of localized temperature therapy.
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Urinary Incontinence (UI) is a stigmatized, underreported, under-diagnosed, under-treated condition that is erroneously thought to be a normal part of aging. It is much more common in women than men. It is so common among hospitalized older adults and those in long-term care that it's often seen as inevitable. People older than 65 constitute a growing hospital population and studies have found that 20% to 42% of adult patients in acute care settings are affected by UI. In addition, 20% to 35% of previously continent older adults admitted to the hospital will go on to develop UI. Among its many complications, UI can lead to skin irritation leading to pressure ulcers. Recent evidence indicates that 42.5% of incontinent patients have some type of skin injury. Patients with incontinence are more likely to be immobile and elderly, both of which have been demonstrated to be strongly associated with pressure ulcer development. The financial costs of incontinence care in acute settings include staff time for assessment and toileting assistance, clothing and linen changes, incontinence products, catheter care, and laundry services. Nurses play a key role in the assessment and management of UI and it is a daily challenge to maintain a healthy skin in patients with incontinence.
Upon completion of this continuing nursing education activity, the participant should be able to:
- Describe the causes and risk factors for urinary incontinence.
- Explain the relationship of urinary incontinence to pressure ulcers.
- Describe nursing interventions for managing incontinence in acute care settings.
- Describe nursing interventions for preventing pressure ulcers in incontinent patients.
- Discuss the role of skin-care protocols and absorbent products in managing patients with urinary incontinence.
Of all patients in the acute care setting, nearly 50% are at high risk for developing pressure ulcers. 1% to 38% will develop an ulcer. Pressure ulcers are a significant and costly healthcare concern. They cause significant pain, they cost between $10,000 and $40,000 per ulcer to treat, they are viewed as an indicator of poor care by CMS and The Joint Commission. CMS will no longer reimburse hospitals for pressure ulcers developed during hospitalization, and they can be a basis for legal action against facilities, physicians, and nurses. Most pressure ulcers can be prevented. Most early-stage pressure ulcers can be healed. In this course, participants will learn the basic facts about pressure ulcers, how to prevent pressure ulcers as well as how to document pressure ulcer prevention and treatment. This information will help improve patient health, comply with regulatory standards, and protect healthcare workers from legal liability.
A pressure ulcer, previously called a bed sore or decubitus ulcer, is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear and/or friction. Pressure ulcers are painful, costly, and often preventable complications that threaten many individuals in hospitals, nursing homes, and home care. Pressure ulcers can increase nursing time up to 50% and are very costly in time and resources. Every year, pressure ulcers affect more than one million acute care and nursing home patients. Most pressure ulcers are preventable. Preventing pressure ulcers entails to two major steps: first, identifying patients at risk; and second, reliably implementing prevention strategies for all patients who are identified as being at risk. This continuing education activity will provide health care workers with an overview of the etiology of pressure ulcers, including an examination of patient risk factors and pressure ulcer staging classifications. Preventive strategies will be presented, including a review of the various types of support surfaces that help prevent the occurrences of pressure ulcers and help to ensure positive patient outcomes. Guidelines for treatments of pressure ulcers also will be described.
A challenge that hospitals are facing is how to successfully integrate recycling practices into a patient care setting, and understanding the economic, regulatory, resourcing and infrastructure nuances that come with it. This continuing education module will address the process of activating a plastics recycling program in a patient care setting from initial planning and business decisions through program implementation and improvement considerations.
For the past 50 years, polymethylmethacrylate (PMMA) bone cements have been widely used as the anchoring/grouting agent in total joint replacements of the hip, knee, ankle, elbow, and shoulder. Good quality cement is essential for long-term implant survival and the role of the perioperative nurse in preparing that cement is vitally important. Strict adherence to good cement mixing and application techniques is a key factor in reducing the rate of loosening and also in increasing the long-term survival of the prosthesis. The purpose of this continuing education activity is to provide a review of key concepts regarding composition, properties, and types of bone cements and factors that affect bone cement polymerization. The evolution of mixing and application techniques also will be described. The activity concludes with a discussion of potential hazards posed by bone cement and safety considerations for patients and members of the surgical team.
An expected outcome for all surgical patients is that they are free from the signs and symptoms of infection. Today, surgical site infections (SSIs) represent an important health care concern, because they are a source of patient morbidity and mortality and a contributing factor to increased health care costs. A key strategy for reducing the risk of SSIs is the provision of surgical instruments and other devices that are free from contamination at the time of use; an important aspect in implementing this strategy is appropriate packaging of the items for sterilization. As a barrier material used in the perioperative practice setting, sterilization wrap must provide an effective barrier to microbial penetration, protect the packaged items from contamination during handling, and allow aseptic delivery of the contents to the sterile field. Because the materials used for sterilization wraps continue to evolve, all members of the perioperative team should be aware of the various products available today in order to select and use them properly. Personnel should also understand proper handling techniques for sterilization wrap and wrapped operating room (OR) trays to protect patients from developing SSIs. This continuing education activity will provide a brief overview of the clinical impact and economic burden of SSIs today. The key characteristics of sterilization wrap materials that help reduce the risk for SSIs, with a focus on nonwoven double layer sterilization wrap, including test data that should be obtained from the manufacturer, will be reviewed. Clinical considerations related to proper care and handling techniques for sterilization wrap and wrapped OR trays, based on professional standards and recommended practices, will be discussed.
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Preventing infections in patients undergoing surgical procedures is a primary goal for all members of the healthcare team. This is especially important in today’s dynamic healthcare environment, in the face of newly recognized pathogens, well-known microorganisms that have become resistant to treatment modalities, and the economic pressures to reduce healthcare-associated infections. A key infection control practice for reducing the likelihood of a surgical site infection is proper reprocessing of surgical instruments. However, effective reprocessing of instrumentation can only take place after thorough cleaning, as any disinfection or sterilization process is adversely affected by the presence of bioburden.
The detergent or disinfectant agent used to clean surgical instruments is a key factor in instrument reprocessing, as well as safe patient care. Because there are various types of detergents available today, all personnel involved in the care and cleaning of surgical instruments must be knowledgeable about these agents and the proper instrument cleaning process. This continuing education activity will provide a review of the key considerations related to the selection and use of detergents and disinfectants for instrument cleaning. It will outline the steps of the instrument cleaning process. The characteristics of the various types of detergents and high-level disinfectants will be described. Troubleshooting steps for the cleaning process and mechanical equipment will be presented. Finally, the applicable regulations and standards related to instrument care and cleaning will be reviewed.
A key measure in reducing the risk of infection during an operative or invasive procedure is to provide surgical instruments and devices that are sterile at the time of use. In order to assure their sterility, surgical instruments and other medical devices must be packaged appropriately prior to sterilization. Sterilization wrap or packaging material must provide an effective barrier to microbial penetration and also protect the packaged items from contact contamination during handling. Therefore, perioperative personnel involved in the use, care, and handling of sterile surgical items must remain aware of the relationship between proper packaging and sterility assurance of the packaged items. This continuing education activity will provide a review of sterility assurance with a focus on packaging. A brief overview of the impact of surgical site infections will be presented. Sterility assurance as it relates to the various sterilization processes and sterile packaging will be discussed. Key criteria for the appropriate selection and use of packaging materials will be reviewed, followed by various professional guidelines for best practices related to packaging. The types of sterilization wraps will be described, highlighting the advantages of double-layer wraps for simultaneous wrapping. Finally, troubleshooting techniques to avoid and resolve wet packs will be outlined.
This online course provides information about surgical fires, including how they occur and practices to prevent them.
- Components of the fire triangle
- Measures for prevention of surgical fires
- Tools to assess risk of fire
- Patient care scenarios for appropriate intervention
The operating room (OR) is a unique practice environment that by its nature, places staff members at higher risk for certain exposure incidents and injuries. An understanding of the numerous risk factors for these incidents and injuries, as well as the applicable regulations and safety guidelines, is imperative for maintaining compliance with the standards, thereby promoting employee safety. This continuing education activity will provide a review of various workplace safety standards and regulations as well their implications for perioperative nurse managers and educators who are responsible for maintaining compliance. The Occupational Safety and Health Administration’s (OSHA) role in the development of workplace safety standards, followed by the OSHA standards applicable in the OR setting, will be reviewed. Other employee safety issues and professional practice guidelines, including those related to fire safety, ergonomics, laser safety, latex and powder allergies, exposure to surgical smoke plume and chemicals, and radiological exposure will also be discussed. Finally, selected case studies will provide the participant the opportunity to synthesize the information and evaluate workplace scenarios in regard to compliance with employee safety standards.
The "Taking Safety Into Your Own Hands" continuing education program includes two activities: (1) DVD video and (2) study guide. It will be presented in an in-service format only.
Wound closure and healing are essential for achieving optimal outcomes for all surgical patients. The healing process is facilitated by proper closure of the surgical wound. Today, ongoing advancements in topical skin adhesives supplement the armamentarium of wound closure techniques. Therefore, the perioperative nurse should remain knowledgeable about the use of topical skin adhesives as a strong, secure and effective skin closure technique. This continuing education activity provides valuable information regarding the use of topical skin adhesives in surgery, specifically the family of butyl- and octyl-cyanoacrylate skin adhesives. The key clinical considerations in wound closure and the wound healing process are briefly described. The history behind the development of skin adhesives is provided, including a discussion of regulatory classification. The current indications and contraindications for use, as well as the advantages and disadvantages of topical skin adhesives are presented. The steps involved in the application of topical skin adhesives, including patient preparation and instructions are outlined. Finally, the clinical benefits associated with the use of topical skin adhesives as reported in the literature are discussed.
This online course explains the provisions of the ANSI/AAMI PB70 in detail, as well as the standardized tests and other factors that must be taken into account when choosing barrier products. After completing this continuing education activity, the participant should be able to:
- Summarize the clinical rationale for the use of surgical gowns and drapes
- Identify standardized tests used in the industry to evaluate the effectiveness of barrier materials, with emphasis on tests specified ANSI/AAMI PB70 and other pertinent testing methods
- List factors that must be taken into account when choosing barrier products, including barrier performance, strength, comfort, safety, cost effectiveness, and environmental concerns
- Identify the clinical importance of high-performing drapes and gowns
This online course provides a review of the clinical considerations regarding the appropriate selection and use of facial protection devices in various surgical practice settings.
- Types of facial protection devices available today and their components
- Regulations governing the manufacture and performance standards of facial protection devices
- Key criteria in the selection and use of facial protection devices for specific clinical applications
Vascular access is just what it sounds like—a procedure that allows a clinician access to a patient’s vascular system. Specifically, vascular access procedures are used in patients who need intravenous (IV) access for a short time, or for a considerable length of time—such as those receiving a course of chemotherapy, several weeks of IV antibiotic treatment or long-term IV feeding.
There are various types of vascular access devices. Clinicians choose the appropriate type of device based on various factors—including duration of use, reason for use, and other patient-specific variables. In this unit, you will learn about the different types of devices available, the circumstances under which they are used, and how they are placed. Before examining specific devices, however, the unit begins with a quick refresher on vascular anatomy and a brief overview of the history of vascular access and how the procedure was changed by the advent of the Seldinger technique.
The module contains the following six units:
- Unit 1.1 Anatomy/Terminology
- Unit 1.2 Vascular Access History, Procedures & Products
- Unit 1.3 Central Venous Catheters
- Unit 1.4 Silicone Lines
- Unit 1.5 Arterial Lines
- Unit 1.6 Intraosseous Infusion Needles
Wound healing is the complex and dynamic process of restoring disrupted cellular structures and tissues. Wound closure and healing are essential for achieving optimal outcomes for all surgical patients. The primary goal of nursing care for the surgical patient is prevention of postoperative surgical site infections, because they are a major source of clinical complications and economic consequences today. Wound drains inserted at the time of surgery provide a route through which air and body fluids can be evacuated from the operative site to prevent their accumulation and risk for infection, thereby facilitating the process of wound healing. Perioperative personnel should be aware of the different types of wound drains and drainage systems available today in order to use them properly and promote positive patient outcomes. This continuing education activity will provide a review of the basic principles of wound healing. Key wound assessment factors will be outlined. The various types of wound drains and drainage systems, including their use and applications, will be described. Standards of care and recommended practices for wound care, infection prevention, and wound drainage system maintenance will be discussed.