Week 2: Patient Safety 1

Question 1

What is DVT?

Answer 1

A blood clot that forms in the veins of the legs; attached to the vessel wall

Question 2

What is an embolism?

Answer 2

A blood clot which breaks off the vessel wall and travels freely throughout circulation; likely to become lodged in pulmonary (PE) or cerebral vessels causing obstruction of blood flow

Question 3

What are the signs of a PE?

Answer 3

Shortness of breath
Cyanosis
Chest pain
Low sats
High RR
Diagnosed with CT scan

Question 4

How many VTE cases are the in Australia?

Answer 4

15000 annually
9250 female: oral contraceptives risk factor
5466 male
3 331 677 between 2002-2009
1 in 10 die

Question 5

Why does surgery place patients at risk of VTE?

Answer 5

Dehydration –> reduced circulating blood volume –> changed blood viscosity
Extended immobility
Ceasing anticoagulants

Question 6

What are the risk factors for VTE?

Answer 6

Hospitalisation
Female
Surgery
Smoking, diet
Older
Comorbidities: malignancies, medical or surgical treatments
Caucasian or African American
Winter: less active, less fluid intake

Question 7

What are strong risk factors for VTE?

Answer 7

Orthopaedic surgery
Tourniquet
Spinal cord injury
Major general surgery
Major trauma

Question 8

What are moderate risk factors for VTE?

Answer 8

Central venous access
Chemo
HRT
CHF/resp failure
Malignancy
Oral contraceptives
Pregnancy/post-partum
Previous VTE

Question 9

What are weak risk factors for VTE?

Answer 9

Bed rest > 3 days
Seated immobility 
Age
Lap surgery
Obesity
Varicose veins

Question 10

What is the rate SSIs in Australia?

Answer 10

2.7% of surgical cases

Question 11

Which surgical specialties have a higher risk of SSI?

Answer 11

Orthopaedics
Cardiac (coronary artery bypass)
Obstetrics (lower segment cesarean section)
Colorectal

Question 12

How can SSIs be reduced?

Answer 12

Reduce traffic around sterile field
Prophylactic antibiotics
ANTT package opening
Negative pressure air ventilation
Skin prep
Instrumentation sterilisation
Scrub technique
Curved floor corner for easier cleaning
WHO surgical safety checklist

Question 13

What is a pressure injury?

Answer 13

Wound caused by lock of blood flow due to pressure between external surface and bone

Question 14

What are intraop risk factors for pressure injury?

Answer 14

Surgery duration
Bony prominences/padding
Friction and shear when transferring patient

Question 15

What are the instrinsic risk factors for pressure injury?

Answer 15

60 + years
Low albumin
ASA 3 +
Diabetes
BMI < 19 or > 40
CVA
Hypotension: reduced circulation to peripheries
Pulmonary disease
Renal insuffiency
Warming mattress

Question 16

What are the extrinsic risk factors for pressure injury?

Answer 16

Preop immobilisation time
Operation time
Postop immobilisation time
Prone
Trauma
Hypotension
Extended use of vasopressors
Specialty: cardiac, ortho, vascular, transplant, bariatric

Question 17

What is the most common nerve injury in the OR?

Answer 17

Ulna nerve

Question 18

What are the risks of arms up in prone?

Answer 18

Brachial plexus injury

Dislocation

Question 19

What is the first stage of pressure injury?

Answer 19

Erythemia, no skin break down

Question 20

What is the second stage of pressure injury?

Answer 20

Adipose tissue exposed

Question 21

What is the third stage of pressure injury?

Answer 21

Muscle exposed

Question 22

What is the fourth stage of pressure injury?

Answer 22

Bone/cartilage exposed

Question 23

How do you assess for pressure injury?

Answer 23

Pressure injury risk assessment tool

Skin assessment/visual inspection

Question 24

What are the preventative strategies for VTE?

Answer 24

Reduced fasting time
IV fluids: increase circulating volume
Positioning
Thrombo-embolic device: TEDs
Sequential Compression Device: calf compressors
Prophylactic anticoagulants

Question 25

What are the four classifications of a surgical wound?

Answer 25

Clean Clean/contaminated Contaminated Dirty

Question 26

What is the definition of a clean wound?

Answer 26

Non-traumatic, elective surgery; GI, resp & GU tracts not entered

Question 27

What are examples of clean surgical wounds?

Answer 27

Mastectomy Vascular Hernia repair

Question 28

What is the definition of a clean/contaminated surgical wound?

Answer 28

Resp, GI or GU tract entered with minimal contamination

Question 29

What are examples of clean/contaminated surgical wounds?

Answer 29

Gastrectomy | Hysterectomy

Question 30

What is the definition of a contaminated surgical wound?

Answer 30

Open, fresh, traumatic wounds; uncontrolled spillage; minor break in sterile technique

Question 31

What are examples of contaminated surgical wounds?

Answer 31

Ruptured appendix | Emergency bowel resection

Question 32

What is the definition of a dirty surgical wound?

Answer 32

Open, traumatic, dirty wounds; perforation of hollow viscus; frank pus in wound

Question 33

What are examples of dirty surgical wounds?

Answer 33

Intestinal fistula resection | MVAs

Question 34

What are the different types of sterilisation process?

Answer 34

``` Steam autoclave Plasma hydrogen peroxide Peracetic acid Ethylene oxide Cidex OPA Gamma irradiation ```

Question 35

What is peracetic acid?

Answer 35

Sterris Acetic acid, hydrogen peroxide, water Reacts with proteins and enzymes to cause cell destruction Sterilant concentrate mixes with water 30 min cycle Full PPE: carcinogenic, toxic, chemical burns

Question 36

What is ethylene oxide?

Answer 36

Gas Alkynation agent disrupts DNA in micro-organisms to prevent multiplication Low temp Replaced by plasma hydrogen peroxide

Question 37

What is Cidex OPA?

Answer 37

Hazardous chemical: good ventilation, designated area, PPE | Used in places that don't have Sterris

Question 38

What is gamma irradiation?

Answer 38

Short wavelength with high penetrative intensity to destroy micro-organisms Lucas Centre Mass sterilisation All implants

Question 39

How is SSI reduced by the OR environment?

Answer 39

Safe handling and storage of sterile items Air ventilation OR design: traffic patterns, flooring materials

Question 40

How can you prevent SSI in your own clinical practice?

Answer 40

``` Opening sterile items Preparing and maintaining sterile field Movement around sterile field Scrub, gown and glove Prep and drape Surgical conscience: doing what is right even though no one is watching, speak up about contamination ```

Question 41

What pharmacotherapy is used to prevent SSI?

Answer 41

Antimicrobial patient wash preop Prophylactic A/Bs Antimicrobial impregnated drapes and dressings Antibiotic irrigation solutions

Question 42

What are the different tools for risk assessing pressure injury?

Answer 42

Braden Munro Scott Triggers Waterlow

Question 43

What are strategies for preventing pressure injury?

Answer 43

Positioning Pre and postop inspection Open team communication: safe position, worst case scenario