Chapter 4

Question 1

What are the three different types of SSI’s

Answer 1

superficial incisional infections
deep incisional
organ/space

Question 2

When are deep incisional and organ/space infections typically diagnosed

Answer 2

before discharge

Question 3

What does aseptic practice included

Answer 3

attire
environmental sanitation, scrubbing
gowning
gloving
setup and maintenance of the sterile field
prepping and draping of the patient
protection of the sterile field until the patient’s procedure is completed.

Question 4

What pathogens are most commonly associated wiht SSI’s

Answer 4

Staphylococcus aureus
Staphylococcus epidermidis
coagulase-negative staphylococci
Enterococcus species.

Question 5

What are some things that increase the risk for SSI’s

Answer 5

(surgical time)
the presence of implants
the amount of ischemic tissue present.
age
poor nutritional status,
obesity
compromised immune system
preexisting disease (especially diabetes)
preexisting infection
burns
nicotine

Question 6

Why does smoking increase the risk for infection

Answer 6

because it reduces the amount of oxygen that reaches the tissues which delays wound healing

Question 7

Why is obesity a risk factor for SSI’s

Answer 7

because fatty tissue isnt very vascular and avascular tissue is suseptible to infections

Question 8

What are some exogenous risk factors for SSI’s

Answer 8

length of surgery 
type of procedure
surgical technique 
extended hospitalization 
number of people in the OR

Question 9

What is a colonized individual

Answer 9

one that carries the organism but isnt infected

Question 10

What is a consideration for fingernails and the OR

Answer 10

no nail polish ever

finger nails longer than a quarter inch have higher bacterial counts

Question 11

What is the first thing a periop nurse needs to do when “opening” a room

Answer 11

wipe down all horizontal surfaces

Question 12

Standard precautions of spreading infection when handling blood and body fluids covers what fluids

Answer 12

blood

all body fluids, secretions and excretions except sweat

Question 13

What are the three types of transmission based precautions

Answer 13

airborne
contact
droplet

Question 14

What is airborne precautions

Answer 14

pathogens 5 microns or smaller

and spread by the air

Question 15

What are some examples of pathogens that require airborrne precaution s

Answer 15

TB
rubeola
varicella

Question 16

What is a consideration with patients that are on airborne precau and they have an elective surgery

Answer 16

postpone the surgery

Question 17

What if someone needs surgery immediately but they are on airborne precau

Answer 17

the surgery should have as few personnel in the room as possible and the room needs to remain vacant and closed after the surgery until the rooms air has been completely exchanged

Question 18

What are droplet precau

Answer 18

5 microns or larger
require a mask for personnel wthin 3 ft of the patient
require that the patient be positioned at least 3 ft from other patients

Question 19

What do droplet and airborne precau pats require during transport

Answer 19

a mask

Question 20

What are pathogen examples that req droplet precau

Answer 20

the flu

mumps

Question 21

What do contact precau req

Answer 21

wearing gloves and gown
wearing mask when their is a risk of aerosolized organisms
cleanign and disinfecting pat equipment

Question 22

When do Masks with face shields or protective eyewear with side shields need to be worn

Answer 22

when splashes, splattering, or aerosolization of blood and body fluids is anticipated.

Question 23

What is the periop nurses primary responsibility

Answer 23

to maintain aseptic practice Surgical attire
•Sterilization of instruments and equipment
• Hand hygiene
• Patient skin preparation
• Creation and maintenance of a sterile field
• Environmental hygiene

Question 24

Does hair removal increase risk of infection

Answer 24

yes

Question 25

When should hair around the site be removeed and where should it be removed

Answer 25

only when it interferes with the procedure and it should be done outside of the OR and as close to the time of surgery as possible

Question 26

What needs to be assessed before removing hair

Answer 26

``` it should be assessed for rashes moles warts any conditions ```

Question 27

What can be used for hair removal

Answer 27

clippers and depilatory cream

Question 28

What should never be used to remove hair

Answer 28

razors

Question 29

Why should the hair be removed outside of the OR

Answer 29

to minimize the risk of contaminating the sterile field with microORGs on the hair

Question 30

What should the pat do for surgical site cleanliness the night before or right before the surg

Answer 30

shower

Question 31

What are the most commonly used skin prep solutions

Answer 31

CHG Alc iodophors all at 60-90 percent

Question 32

What are some considerations for using CHG as a skin prep

Answer 32

dont use on mucous membranes | dont use near eyes or if their is risk of hitting the inner ear cause it can damage to eyes and ears

Question 33

What are some considerations for using alc based skin preps

Answer 33

dont use near eyes or mucous membranes

Question 34

What areas should be cleaned with skin prep

Answer 34

incision site and area around it any anticipated additional incision sites drain insertion sites

Question 35

What is an intervention for rpeventing pooling and thus chemical burns from skin prep

Answer 35

place towels around incision site and remove the towels before draping

Question 36

What are preps that include "dirty" areas that need special cleaning and explain their process

Answer 36

• The umbilicus is cleaned with cotton-tipped applicators before the skin prep begins. • A colostomy or stoma is covered until the surrounding area is prepped, and then it is prepped with a separate sponge. • In a perineal prep, the vagina and/ or anus is prepped last with a separate sponge. In a shoulder prep, the axilla is prepped last.

Question 37

What should you do for unusual wounds or incision sites when it may be difficult to know where to begin

Answer 37

use good judgment to determine the approach that will minimize contamination at the incision site.

Question 38

What should be used to clean patients eyes and where should the cleaning begin

Answer 38

use cotton balls and start from the nose and continue outward

Question 39

What should be used to prep burned or denuded skin

Answer 39

normal saline

Question 40

What temp should you try to make skin prep solutions

Answer 40

warm

Question 41

What should be included in the documentation of a skin prep

Answer 41

``` assessment of the site hair removal (if any) skin allergies/sensitivities the prep agent area prepped name of person performing the prep skin condition post-op ```

Question 42

If hair removal is done, what should be documented

Answer 42

``` the site mehtod time location and person doing it ```

Question 43

What sites are considered unrestricted

Answer 43

break rooms waiting rooms pre-op areas that allow family in street clothes

Question 44

What is considered semi-restricted areas

Answer 44

pre-op admission areas PACU and the peripheral support areas around the surgical room

Question 45

What is considered restricted areas

Answer 45

OR

Question 46

Where should hats or hoods be worn

Answer 46

supply areas | restricted areas

Question 47

Is it okay to take your mask off and let it hang around your neck or put it in your pocket

Answer 47

never

Question 48

How should masks be removed

Answer 48

only by the strings

Question 49

Do you need to wash your hands after removing a mask

Answer 49

yes

Question 50

What is a consideration with single use PPE and the OR

Answer 50

they need to be removed before leavign

Question 51

What type of personnel should not be in a scrub role

Answer 51

resp infection | has cuts or abrasions on arms

Question 52

should sterile gloves have powder

Answer 52

no

Question 53

What is a method of doning sterile gloves by yourself

Answer 53

closed gloving

Question 54

Where is the gown package opened

Answer 54

outside of the sterile field

Question 55

What are the steps for doning a sterile gown

Answer 55

open package and remove towel without spilling water on gown (if traditional surgical hand scrubbing was done) when drying hands, dry with a blotting circular motion from hands to elbow when finished with that hand, use other half of the towel on the other hand insert arms into arm holes, step back from the table and let the gown unfold itself after doning gloves wih closed technique hand cardboard tie to circ nurse and pivot around so the tie wraps around the body then pulls the tie off of the cardboard and tie the ends together