Best Practices: Clip, Prep, Drape

Transcription

1 Best Practices: Clip, Prep, Drape 1 Welcome! Topic: Facilitators: Speaker: Best Practices: Clip, Prep, Drape DeAnn Hammer Maret Millard Jodi Lippert Housekeeping Questions Mute feature (*7 = unmute; *6 = mute) Chat feature Technical difficulties Post session follow-up 2 Disclosure Statement Maret Millard and Jodi Lippert 3M Technical Service Specialists 3M Infection Prevention Division 3 1

2 How do I get a CE Certificate? Next week, all of today s meeting participants will be sent an containing instructions for obtaining a CE Certificate for today s meeting. The will be sent to the address you provided when you logged-in to today s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate to them. 4 Objectives Participants will be able to: Discuss the clinical benefits of hair removal by means of clipping versus shaving Identify the properties of effective surgical skin preparation agents Describe the principles of draping as they relate to prevention of infection 5 6 2

3 Brief History Early 19 th Century surgeon operated in a Prince Albert coat and used the same sponges for every patient treated. Mid 19 th century protection of surgical wound 7 Surgical Conscience No Compromise Mental discipline Inspection and regulation 8 Developing the Surgical Conscience Is this the best practice? Do I have everything necessary for the procedure? Have I done all I can do to provide a safe,therapeutic environment for the patient? 9 3

4 Precision Counts! Aseptic Technique Prevention of microbial contamination in the environment Sterile Technique: Creation of and working in a sterile field 10 Hair Removal What is the first line of defense against infection? According to the CDC Guidelines for Prevention of Surgical Site Infections (SSI), for most SSIs, the source of pathogens is the endogenous ous flora of the patient s skin, mucous membranes or hollow viscera When mucous membranes or skin is incised,the exposed tissues are at risk for contamination with endogenous flora 12 4

5 Hair Removal Methods Shaving (Razor) Clipping Chemical Depilatory Alexander, Wesley et al, The Influence of Hair Removal Methods on Wound Infections, Archives of Surgery, 1983; 118: AORN Recommendation #III The patient s skin condition should be assessed for the presence of lesions or other tissue conditions at the surgical site before skin preparation begins. Unintentional removal of lesions (eg, nevi) traumatizes the skin on the surgical site and provides and opportunity for wound colonization by microorganisms. The presence of excessive hair that may interfere with the surgical procedure should be identified. 15 5

6 PreOp Hair Removal Hair removal should be performed the day of surgery. Hair should be removed in a location outside of the operating or procedure room AORN Recommendation #IV Hair at the surgical site should be left in place (i.e., not removed) whenever possible Patients should be instructed not to shave at home Hair should not be removed by a razor Head and Neck surgery alternatives include braiding or the use of nonflammable gels to keep hair away from incision If the presence of hair will interfere with the surgical procedure Remove the day of surgery, outside the OR Only remove hair that interferes with the procedure should be clipped Only the use of a single-use electric or battery operated clipper, or one with reusable head that can be disinfected between patients, is recommended Depilatories can be used if skin testing has been done 17 AORN and Clipping 1-2mm of stubble remaining recommended 18 6

7 Stubble Length Razors cause microscopic cuts and nicks, some of which are not visible to the naked eye. In fact the stubble should be reassuring, commented William C. Beck,MD,FACS, 1986 Surgery, Gynecology & Obstetrics. it gives assurance that the superficial skin squames have not been disturbed. 19 Supporting Organizations American College of Surgeons (ACS) follows the CDC Guidelines The Association of Practitioners in Infection Control (APIC) also recommends clipping National Quality Forum (NQF) The Surgical Care Improvement Project (SCIP) 20 Recommended Practices and Guidelines CDC: if hair is removed, remove immediately before the operation,,preferably with electric clippers. 21 7

8 Surgical Skin Antisepsis i 2012 AORN Recommended Practices for Skin Preparation of Patients The goal of pre-op skin prep is to reduce the risk of postoperative surgical site infection by: Remove soil and transient organisms Reduce resident microbial count to sub pathogenic levels with the least amount of tissue irritation Inhibit rapid rebound growth of microorganisms

9 25 Preop Showers/Wipes Recommended Practices and Guidelines The 1999 CDC Guideline for Prevention of Surgical Site Infection Require patients to shower or bathe with an antiseptic agent on at least the night before the operation Remove gross contamination before performing antiseptic skin prep 27 9

10 2012 AORN Recommended Practice # I Patients undergoing open Class 1 surgical procedures below the chin should have two preoperative showers with CHG before surgery when appropriate Sufficient evidence reduction of microbial counts Insufficient research link reduction in SSI AORN Recommended Practice # I Patients undergoing head and neck procedures Two shampoos with 4% CHG prior to surgery Avoid CHG contact Eye could cause corneal damage Inner ears could result in permanent deafness 29 Surgical lpatient t Prep 10

11 CDC SSI Guideline Use an appropriate antiseptic agent for skin preparation. No one antiseptic is preferred over other antiseptics. Skin prep should be applied in concentric circles moving toward the periphery, prep area should be large enough to extend the incision or create new incisions or drain sites 31 National Quality Forum Preoperatively use solutions that contain isopropyl alcohol as skin antiseptic preparation until other alternatives have been proven as safe and effective, and allow appropriate drying time per product guidelines AORN Recommended Practice# II Preoperative skin antiseptic agents that have been FDA-approved or cleared and approved by the health care organization s infection control personnel should be used for all preoperative skin preparation. Agents Should: Significantly reduce microorganisms Non irritating Broad spectrum Fast acting and persistent 33 11

12 2012 AORN Recommended Practice# III The antiseptic agent should be selected based on the patient assessment Allergies Contraindications ti Surgical site manufacture s written information Surgeon preference Skin condition ID surgical site before prep AORN Recommended Practice # V The skin around the surgical site should be free of soil, debris, exudates, and transient microorganisms to minimize contamination of the surgical wound before e application of the antiseptic skin preparation. Efficacy dependent on clean skin umbilicus cleaned before prep Specific information on several areas AORN Recommended Practice # VI Protective measures should be implemented to prevent skin and tissue injury due to prolonged contact with skin prep agents. Detailed protective measures Soaked linen / tape Lithotomy / vaginal procedures ESU, tourniquets 36 12

13 2012 AORN Recommended Practice # VII The antiseptic agent should be applied to the skin over the surgical site and surrounding area in a manner to minimize contamination, preserve skin integrity, and prevent tissue damage AORN Recommended Practice # VIII If a flammable prep agent is used, additional precautions should be taken to minimize the risk of a surgical fire and patient burn injury. Storage, use & disposal Single use Contact with fabrics remove solution soaked materials Pooling wicked away Allowed to dry & vapors to dissipated Disposal- Alcohol product use discussed during time out CMS Guidance on Alcohol-based Skin Preparations in Anesthetizing Locations Risk Reduction Measures Use unit dose applicators manufacture directions Prevent soaking into patient s hair or linens Completely dry before draping Verification and documentation Establish & document use of policies & procedures When risk reduction measures not taken could be cited as non-compliance with CMS

14 2012 AORN Recommended Practice # IX Manufactures written recommendations and MSDSs for handling, storing, and heating of all skin preparation agents should be readily available, reviewed, and followed AORN Recommended Practice # X At the end of the surgical procedure, the skin preparation agent should be thoroughly removed from the skin unless otherwise indicated by the manufacturer s written instructions AORN Recommended Practice # XI Competency Education Training Competency validation 42 14

15 2012 AORN Recommended Practice # XII Documentation Patient skin preparation should be documented in the medical record. Pre-op instruction, compliance with shower Hair removal method Area prepped, Jewelry removal Precautions with flammable agents Removal of prepping agent Postoperative skin condition AORN Recommended Practice # XIII Policies and Procedures Policies and procedures on the skin preparation of patients should be written, reviewed annually, and readily available within the practice setting AORN Recommended Practice # XIV Quality A quality management program should be in place to evaluate skin preparation procedures and identify and respond to opportunities for improvement 45 15

16 Factors to Consider When Choosing a Patient Skin Prep Immediate and persistent activity Drape adhesion Affect of blood and/or saline Application instructions for both clean dry skin and moist areas (groin) Product warnings 46 Choosing the Right Antimicrobial Challenges that face surgical preps very different from those for surgical hand antisepsis and even intravascular catheter site preps. Choosing the right antimicrobial for the right indication is critical in helping reduce the risk of surgical site infection for your patients 47 Surgical ldrapes 16

17 49 CDC SSI Guidelines Use surgical gowns and drapes that are effective barriers when wet (i.e., materials that resist liquid penetration). Category IB 50 Drape Materials Reusable or multiple use products Disposable or single use products Regardless of material - must meet drape characteristics 51 17

18 AORN Recommended Practices for Selection and Use of Gowns/Drapes Surgical Drapes should: Provide appropriate barriers Be appropriate to methods of sterilization Maintain adequate integrity and durability Withstand physical conditions Resist tears, punctures, fiber strains, and abrasions 52 AORN Recommended Practices for Selection and Use of Gowns/Drapes Surgical Drapes should: Be free of toxic ingredients Be low linting Have positive cost;benefit ratios Have an acceptable quality level Be used and processed according to manufacturers written instructions 53 Surgical Drapes AAMI TIR11:2005 AAMI protective barriers classification and minimum requirements for protective apparel and drapes used Resistant Barrier Low Level Splash and Spray Protocol using water High Level Pressure Protocol using bloodbourne pathogen stimulants 54 18

19 55 56 Principles of Draping Isolate Barrier Sterile Field

20 Equipment Covers Fluid Control Sterile Surface 58 Sterile Surface Incise drapes provide a sterile surface to the wound edge Lock bacteria under the drape Antimicrobial incise drapes kill bacteria 59 Skin flora is the leading cause of surgical site infection 60 20

21 Bacteria can be a resourceful traveler. Organisms that remain on the skin can potentially migrate into the surgical wound. Bacteria can be transferred to the wound through contact with instruments, gloves or sponges. 61 Drape Adhesion The adhesion of the incise drape is critical in maintain the adhesion of the drape to the would edge. One study showed that drape lift at the wound edge was associated with a 6-fold increase in SSI The choice of prep can play a significant role in drape adhesion. Water insoluble preps will provide better drape adhesion than water soluble preps. 62 Summary SSIs - second most common healthcare associated infection (HAI) among hospitalized patients These infections number approximately 500,000 per year, among an estimated 27 million surgical procedures, and account for approximately one quarter of the HAIs in the United States each year Infections result in longer hospitalization and higher costs Bacteria from the patient s own skin are often the cause of surgical site infections 63 21

22 Summary Best practices for clipping, prepping and draping can help reduce skin bacteria and help reduce the risk of SSI Following manufacturers directions for use help ensure that products are applied and removed is a safe and effective manner Patient safety should always be at the forefront of all we do in caring for the surgical patient