Perioperative Strategies for Surgical Site Infection Prevention.

Surgical site infections (SSIs) are some of the most common and costly health care-associated infections. Although the rate of SSIs has declined significantly in the past decade, patient safety remains at risk. Perioperative nurses employ a variety of evidence-based best practices to prevent SSIs and facilitate a safe surgical experience for their patients, including hand hygiene, preoperative patient skin antisepsis, and antimicrobial irrigation. This article explores the causes of SSIs, such as modifiable and nonmodifiable patient factors and preoperative, intraoperative, and postoperative procedural factors, and discusses some of the specific recommended strategies related to the prevention of SSIs that perioperative nurses can initiate in their workplace.

A systematic review of clinical supervision evaluation studies in nursing.

According to the international, extant literature published during the last 20 years or so, clinical supervision (CS) in nursing is now a reasonably common phenomenon. Nevertheless, what appears to be noticeably 'thin on the ground' in this body of literature are empirical evaluations of CS, especially those pertaining to client outcomes. Accordingly, the authors undertook a systematic review of empirical evaluations of CS in nursing to determine the state of the science. Adopting the approach documented by Stroup et al. (JAMA, 283, 2000, 2008), the authors searched for reports of evaluation studies of CS in nursing - published during the years 1995 to 2015. Keywords for the search were 'clinical supervision', 'evaluation', 'efficacy', 'nursing', and combinations of these keywords. Electronic databases used were CINAHL, MEDLINE, PsychLIT, and the British Nursing Index. The research evidence from twenty-eight (28) studies reviewed is presented, outlining the main findings with an overview of each study presented. The following broad themes were identified and are each discussed in the study: narrative/anecdotal accounts of positive outcomes for clinical supervision, narrative/anecdotal accounts of negative outcomes for clinical supervision, empirical positive outcomes reported by supervisee, and empirical findings showing no effect by supervisee.

Coagulopathy In and Outside the Intensive Care Unit.

Coagulopathy is life threatening. Through technologic advances of today, early recognition of the signs and symptoms of coagulopathy and the complicating factors is possible in most settings. By implementing appropriate treatment modalities early, the progression of coagulopathy can be halted, reducing morbidity and mortality.

Guideline Implementation: Processing Flexible Endoscopes.

The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Learning Outcome Measurement in Nurse Participants After Disaster Training.

OBJECTIVE: The National Disaster Health Consortium is an interprofessional disaster training program. Using the Hierarchical Learning Framework of Competency Sets in Disaster Medicine and Public Health, this program educates nurses and other professionals to provide competent care and leadership within the interprofessional team. This study examined outcomes of this training. METHODS: Training consisted of a combination of online and on-site training. Learning outcomes were measured by using the Emergency Preparedness Information Questionnaire (EPIQ) pre/post training and participant performance during live functional exercises with the use of rubrics based on Homeland Security Exercise and Evaluation principles. RESULTS: A total of 64 participants completed the EPIQ before and after training. The mean EPIQ pre-training score of 154 and mean post-training score of 81 (reverse-scored) was found to be statistically significant by paired t-test (P<0.001). Performance was evaluated in the areas of triage, re-triage, surge response, and sheltering. Greater than 90% of the exercise criteria were either met or partially met. Participants successfully achieved overall objectives in all scenarios. CONCLUSIONS: Disaster response requires nurses and other providers to function in interprofessional teams. Educational projects, like the National Disaster Health Consortium program, offer the potential to address the need for a standardized, interprofessional disaster training curriculum to promote positive outcomes. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

Guideline Implementation: Preventing Hypothermia.

The updated AORN "Guideline for prevention of unplanned patient hypothermia" provides guidance for identifying factors associated with intraoperative hypothermia, preventing hypothermia, educating perioperative personnel on this topic, and developing relevant policies and procedures. This article focuses on key points of the guideline, which addresses performing a preoperative assessment for factors that may contribute to hypothermia, measuring and monitoring the patient's temperature in all phases of perioperative care, and implementing interventions to prevent hypothermia. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Integrating Simulations Into Perioperative Education for Undergraduate Nursing Students.

Incorporating high-fidelity simulations into an undergraduate nursing program's perioperative elective course capitalizes on students' active learning. Simulations allow students the opportunity to assess and participate in clinical scenarios, apply standards, and demonstrate correct nursing actions without compromising patient safety. Incorporating a high-risk, low-volume malignant hyperthermia simulation experience into the undergraduate nursing curriculum emphasizes active learning and provides an opportunity for students to experience an uncommon emergency perioperative event. A high-fidelity malignant hyperthermia simulation links a scenario with course content, incorporates didactic information from previous courses, and emphasizes the importance of debriefing.

Guideline Implementation: Autologous Tissue Management.

Managing autologous tissue correctly may help prevent patients who are undergoing replantation or autotransplantation of tissue from developing a surgical site infection. The updated AORN "Guideline for autologous tissue management" provides guidance on transferring tissue from the sterile field, packaging and labeling, transporting and storing, and handling autologous tissue for delayed replantation or autotransplantation within the same facility. This article focuses on key points of the guideline to help perioperative personnel develop protocols for autologous tissue management. The key points address some of the major tissue types-avulsed teeth, cranial bone flaps, autologous skin-that may be preserved and replanted or autotransplanted. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

New graduate nurse residency: a network approach.

Newly graduated RNs are the workforce of the future. The complex healthcare environment makes the transition from new graduate to competent RN challenging. A structured support system is essential to smooth the transition process. Nursing residency programs are well established in the literature as a mechanism of support. This article describes the implementation of a system-level new-graduate nurse residency across multiple facilities.

Surgical risk factors in geriatric perioperative patients.

The geriatric population is growing in number, and risk factors commonly seen in this population of patients can seriously affect the outcomes of surgical interventions. Identification of surgical risk factors (eg, hearing and vision loss, inadequate nutrition, preexisting conditions) and early intervention by the perioperative nurse to plan for, correct, or accommodate physical limitations often can minimize or eliminate problems and potential complications.