FADavis Quiz Aspesis and Surgical Techniques PDF

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FADavis Quiz Aspesis and Surgical Techniques...

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Surgical Asepsis and the Principles of Sterile Technique Surgical Asepsis

Asepsis refers to the absence of infectious material or infection. Surgical asepsis is the absence of all microorganisms within any type of invasive procedure. Sterile technique is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility (BC Centre for Disease Control, 2010). In the literature, surgical asepsis and sterile technique are commonly used interchangeably, but they mean different things (Kennedy, 2013). Principles of sterile technique help control and prevent infection, prevent the transmission of all microorganisms in a given area, and include all techniques that are practised to maintain sterility. Sterile technique is most commonly practised in operating rooms, labour and delivery rooms, and special procedures or diagnostic areas. It is also used when performing a sterile procedure at the bedside, such as inserting devices into sterile areas of the body or cavities (e.g., insertion of chest tube, central venous line, or indwelling urinary catheter). In health care, sterile technique is always used when the integrity of the skin is accessed, impaired, or broken (e.g., burns or surgical incisions). Sterile technique may include the use of sterile equipment, sterile gowns, and gloves (Perry et al., 2014). Sterile technique is essential to help prevent surgical site infections (SSI), an unintended and oftentimes preventable complication arising from surgery. SSI is defined as an “infection that occurs after surgery in the area of surgery” (CDC, 2010, p. 2). Preventing and reducing SSI are the most important reasons for using sterile technique during invasive procedures and surgeries. Principles of Surgical Asepsis

All personnel involved in an aseptic procedure are required to follow the principles and practice set forth by the Association of periOperative Registered Nurses (AORN). These principles must be strictly applied when performing any aseptic procedures, when assisting with aseptic procedures, and when intervening when the principles of surgical asepsis are breached. It is the responsibility of all health care workers to speak up and protect all patients from infection. See Checklist 9 for the principles of sterile technique.

Checklist 9: Principles of Sterile Technique Disclaimer: Always review and follow your hospital policy regarding this specific skill. Safety considerations:  Hand hygiene is a priority before any aseptic procedure.  When performing a procedure, ensure the patient understands how to prevent contamination of equipment and knows to refrain from sudden movements or touching, laughing, sneezing, or talking over the sterile field.  Choose appropriate PPE to decrease the transmission of microorganisms from patients to health care worker.  Review hospital procedures and requirements for sterile technique prior to initiating any invasive procedure.  Health care providers who are ill should avoid invasive procedures or, if they can’t avoid them, should double mask. Steps 1. All objects used in a sterile field must be sterile.

2. A sterile object becomes non-sterile when touched by a non-sterile object.

3. Sterile items that are below the waist level, or items held below waist level, are considered to be non-sterile. 4. Sterile fields must always be kept in sight to be considered sterile.

Additional Information Commercially packaged sterile supplies are marked as sterile; other packaging will be identified as sterile according to agency policy. Check packages for sterility by assessing intactness, dryness, and expiry date prior to use. Any torn, previously opened, or wet packaging, or packaging that has been dropped on the floor, is considered non-sterile and may not be used in the sterile field. Sterile objects must only be touched by sterile equipment or sterile gloves. Whenever the sterility of an object is questionable, consider it non-sterile. Fluid flows in the direction of gravity. Keep the tips of forceps down during a sterile procedure to prevent fluid travelling over entire forceps and potentially contaminating the sterile field. Keep all sterile equipment and sterile gloves above waist level. Table drapes are only sterile at waist level. Sterile fields must always be kept in sight throughout entire sterile procedure. Never turn your back on the sterile field as

5. When opening sterile equipment and adding supplies to a sterile field, take care to avoid contamination.

6. Any puncture, moisture, or tear that passes through a sterile barrier must be considered contaminated. 7. Once a sterile field is set up, the border of one inch at the edge of the sterile drape is considered non-sterile. 8. If there is any doubt about the sterility of an object, it is considered non-sterile. 9. Sterile persons or sterile objects may only contact sterile areas; non-sterile persons or items contact only non-sterile areas.

10. Movement around and in the sterile field must not compromise or contaminate the sterile field.

Data source: Kennedy, 2013; Infection Control Today, 2000; ORNAC, 2011; Perry et al., 2014; Rothrock, 2014

sterility cannot be guaranteed. Set up sterile trays as close to the time of use as possible. Stay organized and complete procedures as soon as possible. Place large items on the sterile field using sterile gloves or sterile transfer forceps. Sterile objects can become non-sterile by prolonged exposure to airborne microorganisms. Keep sterile surface dry and replace if wet or torn. Place all objects inside the sterile field and away from the one-inch border. Known sterility must be maintained throughout any procedure. The front of the sterile gown is sterile between the shoulders and the waist, and from the sleeves to two inches below the elbow. Non-sterile items should not cross over the sterile field. For example, a non-sterile person should not reach over a sterile field. When opening sterile equipment, follow best practice for adding supplies to a sterile field to avoid contamination. Do not place non-sterile items in the sterile field. Do not sneeze, cough, laugh, or talk over the sterile field. Maintain a safe space or margin of safety between sterile and non-sterile objects and areas. Refrain from reaching over the sterile field. Keep operating room (OR) traffic to a minimum, and keep doors closed. Keep hair tied back. When pouring sterile solutions, only the lip and inner cap of the pouring container is considered sterile. The pouring container must not touch any part of the sterile field. Avoid splashes.

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Skill List > Patient Transfers: To Other Facilities/Units or Hospitals

Patient Transfers: To Other Facilities/Units or Hospitals  Skill Overview Demonstration

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Equipment

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Self-Test Quick Sheet

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Checklist References

  Clinical Alert Determine whether the patient’s condition and safety require life support equipment. Staff assisting with transfer require up-to-date training in life support measures. When the patient is being transported to a new institution, a vehicle equipped with life support equipment is necessary. Priority assessment includes the patient’s ability to maintain their airway, vital signs, level of consciousness and patency of intravenous cannulae, lines, and that the correct fluid is being infused at the prescribed rate.

Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation. Authors: Based on Mosby Nursing Skills Adapted by: Chris Brooker BSc MSc SRN SCM RNT Updated by: Chris Brooker BSc, MSc, SRN, SCM, RNT Last updated: March 2018

Learning Objective

After reading the skill overview, watching the video, following up some of the references/web sites and completing the self-test quiz you should be ready to be assessed in practice in the skill of transferring patients to other facilities/units or hospitals. Introduction Patients transfer to new wards or units and different care settings in order to receive advanced specialist care, appropriate treatment and care, or to be closer to home. During the patient transfer, it is important to ensure continuity of nursing care. The aim is to continue health care and avoid treatment interruptions that might hinder progress towards recovery. Open collaboration with all agencies/health professionals involved and effective communication help ensure quality patient care and safety throughout the transfer. When a patient is being transferred from one unit or ward within the same hospital, it is usually easy to complete the process without interrupting care activities. Policies and procedures are usually similar throughout the hospital; however, this needs to be checked prior to the transfer. The nurse first provides a telephone report to the receiving nurse. This allows the receiving nurse to prepare for the patient (e.g., preparing the bed area or room and securing necessary equipment). As clinically appropriate, the nurse may accompany the patient during transport, providing the receiving nurse with the patient’s medical record, introducing the patient to the receiving nurse, and providing an updated report, including any changes in clinical condition or plan of care. In the emergency department (ED), when a patient is transferred from one hospital to another, the nurse completes the transfer in compliance with local policy. The senior nurse or doctor will liaise with the ambulance service, other types of transport, and the patient’s next of kin. An appropriate transfer includes:   

Explaining to the patient and next of kin the need for the transfer. Obtaining the patient’s or next of kin’s informed consent for transfer. Ascertaining that a bed is available in the appropriate unit, and that the receiving hospital confirms this and is expecting the patient.

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Collecting the patient’s property, and recording all property in the property book according to local policy. Next of kin may wish to take some property home, after checking the property book and signing a receipt. Provide suitable bags. Making copies of all relevant medical records, including a transfer form, sent by the transferring hospital to the hospital receiving the patient. Transporting the patient using qualified personnel and transportation equipment (e.g., ambulance with advanced life support (ALS) and other specialist equipment)

Transfers frequently create anxiety for the patient and next of kin. Carefully repeat instructions regarding transfer at a time when the patient and family are better able to concentrate and understand the explanation. In this situation, always ask the patient (or next of kin) to repeat any critical information and whether they have any questions. Cultural considerations  When transferring patients who are from diverse cultures and religions, it is important to understand their cultural and religious practices.  Assess the use of complementary and alternative medicine to determine the impact the use of these have on a patient’s decisions related to medical care (Giger 2016).  A patient’s cultural practices include family decision making. For example, in some cultures the adult male leader is the decision maker. Develop trust by working with the established family and social hierarchy, recognising those in authority, and with the patient’s permission, involving them in decision making in the patient’s care.  For patients who are Orthodox Jews, plan transfers so the patients can begin observance of the Sabbath (sundown on Friday to sundown on Saturday) undisturbed. Orthodox Jews follow the beliefs of their religion closely (Giger 2016). Be aware of a cultural group’s beliefs in regard to eye contact and touch. For example, eye contact is considered disrespectful and rude by Chinese people. Limit eye contact with members of these groups while you are taking a history or performing an assessment. Some groups, such as Orthodox Jews, find excessive touching offensive. Limit the amount of touching during the transfer process (Giger 2016). Transferring children  Children need their parents’ comfort and security; for this reason, make sure parents are well informed of all arrangements. Involve older children in any discussion regarding transfers. Arrange for a parent to accompany their child in the transfer. Transferring older people

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Relocation of an older adult patient to a new ward or unit, hospital, or other care setting can be stressful. Ensure that significant support persons are still accessible and that the patient is thoroughly oriented to their new surroundings. Also make sure that the patient is able to take important possessions and memorabilia and is fully involved in making decisions about their care.

Preparation and safety  Obtain transfer documentation, including the name of the receiving hospital (when applicable), the receiving doctor’s name, and information regarding the patient’s stability for transfer. ‘The

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main aim in all such transfers is maintaining the continuity of medical care’ (Kulshrestha & Singh 2016). In collaboration with the doctor and relevant health and social care professionals, assess the reason for the patient’s transfer (e.g., change in condition, services available at the new location, patient or family preferences regarding the patient’s location). Explain the purpose of the transfer thoroughly and provide time to discuss the patient’s and family’s feelings about the change in care setting. As necessary, obtain the patient’s informed consent to transfer. If the patient is unable to consent, their family provides informed consent. Assess the patient’s current physical condition and determine the method of transport. When transferring a patient to a new health or care setting, assess the method of transport to the transferring vehicle (e.g., wheelchair, trolley). Assess if the patient requires pain relief or other medicines for symptom management. Routine medicine administration should be up to date. Ensure that staff have notified the patient’s family or significant others of the transfer, as desired by the patient. Arrange for appropriate transport to take the patient to the new hospital or other care setting. When a transfer is being made to another hospital or care setting, contact the relevant person to confirm acceptance of the patient and that a bed is available (the social worker or discharge coordinator may complete this task). The nurse will need to complete discharge documentation and telephone the accepting hospital to provide a verbal report.

Procedure 1. Explain the reason for the transfer with the patient, if appropriate. The next-of-kin must be informed of the transfer. 2. Make sure documentation in the patient’s record is complete. Individualise nursing care measures based on patient need. 3. Complete the nursing care transfer form. The medical notes accompany the patient to a new ward or unit or new hospital. Rationale – The form provides a summary of the patient’s pertinent nursing care needs to ensure continuity of care and prevents unnecessary duplication of services. Medical notes are required for full information so all concerned are aware of the patient’s history, illnesses, treatment, allergies, special dietary requirements, and wishes regarding treatment (e.g. advance decisions, advance statements). 4. Check the patient’s medications. Check the patient’s current medicines against the most recent prescription and the original home medication list. Communicate the current medication list to the new ward or unit, hospital, or care setting. Check whether the patient has their own medicines. Rationale – Ensures that the patient receives the correct medicines at the new care setting and reduces the possibility of drug errors. 5. Collect all patient-specific medications on the unit and transfer with the patient. Rationale – If certain medications are not sent with the patient, there may be a delay in obtaining and administering them in the new ward, unit, or hospital.

6. Collect the patient’s personal care items, clothing, and valuables. Two nurses complete and sign the property book as per local policy. Check the entire bed area or room and all storage areas. Secure items in a suitcase, bags, or container. 7. Anticipate problems the patient may experience before or during transfer. Ask the patient if they need to visit the lavatory or use a commode, bedpan, or urinal. Perform necessary nursing care such as oral care, suctioning, or dressing change. Rationale – Ensures the patient’s comfort and safety during transport. 8. Empty all drains and catheter bags and document the final total intake and output. Rationale – Prevents unnecessary exposure of the transfer personnel and patient to body fluids if drains or collection bags leak during transport. 9. Assist in transferring the patient to a trolley or wheelchair, using safe patient handling techniques. Provide appropriate pressure redistributing (relieving) equipment. Rationale – It is easier to move the patient being transported to an outside institution by trolley into the transport vehicle. Protect pressure areas during transport to the new ward, unit, or hospital. 10. Perform and document a final assessment of the patient’s physical stability. Rationale – Minimises the risk of deterioration or complications during transfer. 11. When the transfer occurs to another hospital or care setting, accompany the patient to the transport vehicle. Rationale – Ensures that qualified personnel are in attendance until the patient leaves the hospital. 12. Contact the new hospital or care setting and notify the staff there of the impending transfer and the patient’s condition. Rationale – Notification of the nurse in charge or nurse assuming care of the patient ensures better continuity of care at the time of the patient’s arrival. 13. Document the transfer in the patient’s record and inform the patient’s family. Ongoing care, monitoring and support  During the final assessment, compare data with the previous findings.  Inspect the patient’s alignment and positioning on the trolley or wheelchair. Rationale – Proper alignment and positioning reduces the risk of an injury during transport.  Confirm that the patient understands the transfer and procedures through discussion and questions.  Determine whether the receiving institution or nurse has questions about the patient’s care.  Notify the family of the patient’s transfer (if requested by the patient or family). Rationale – Transfers may be delayed for numerous reasons. Letting the family know when the transfer is actually occurring can reduce any anxiety of the patient and/or family related to the transfer. Documentation and reporting  All relevant information conveyed to the patient and next of kin and their questions are answered.  Nurse transferring patient: o

patient’s condition, including vital signs and other assessment findings

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o nursing plan of care o date and time of transfer o method of transport. Nurse receiving patient: o date and time of arrival o reason for transfer o method of transport o patient’s condition o care provided at time of arrival.

Module 1.4: Sterile Technique 5.0 1 Review Leave a rating STUDY Flashcards Learn Write Spell Test PLAY Match Gravity

c, Practicing hand hygiene is the most effective way to help prevent the spread of organisms. Nurses need to focus on this simple procedure that can interrupt the cycle of infection. Of all possible nursing interventions to break the chain of infection, which is the most effective?

a. administering medications b. providing good skin care c. practicing hand hygiene d. we...