RESUMEN
Verifying patient identity before blood product administration Key words: patient identification, patient verification, blood transfusion, blood management, wristband. Surgical site infection risk with allogeneic blood administration Key words: patient blood management, restrictive transfusion triggers, allogeneic blood products, intraoperative blood salvage, surgical site infection. Information on topical thrombin Key words: hemostatic agents, licensed biological product, hemostasis, bovine thrombin, human thrombin. Safe use of topical thrombin Key words: severe adverse events, hemostatic agents, accidental injection, accidental intravascular uptake, product labeling.
RESUMEN
Nursing scope of practice Key words: state nurse practice act (NPA), state board of nursing, decision-making framework, standards, guidance. Practice of unlicensed perioperative personnel Key words: job description, task delegation, unlicensed personnel, allied health care provider, scope of practice. Definition of a cavity for counting procedures Key words: anatomical hollow space, counting, cavity, retained surgical item (RSI), retained foreign object (RFO). Identifying retained suture needles on radiographic images Key words: suture needle size, suture needle length, radiographic imaging, counting procedures, count discrepancy.
RESUMEN
Using antiseptic solutions in surgical wound irrigation Key words: antiseptic solution, povidone-iodine, wound irrigation, toxicity. Use of powered air-purifying respirators in the OR Key words: respiratory protection, powered air-purifying respirator (PAPR), surgical N95 respirator, unfiltered exhaled air, sterile field contamination. Surgical wound classification of cesarean delivery procedures Key words: surgical wound classification, cesarean delivery, devitalized or infected tissue, contamination. Management and documentation of foam dressings used in open wounds Key words: retained surgical items, therapeutic packing, foam dressings, negative-pressure wound-therapy device. Gastric lavage during a malignant hyperthermia crisis Key words: malignant hyperthermia, gastric lavage, patient cooling methods, thermal management, perfusion.
RESUMEN
Containment of unopened sterile supplies during procedures Key words: unopened sterile instruments, unopened sterile supplies, contamination, containment, event-related sterility. Contamination of solutions in sterile basins Key words: sterile basin, splash basin, instrument table, solution contamination, surgical site infection. Preventing contamination of solutions in sterile basins Key words: sterile basin, splash basin, instrument table, solution contamination, airborne particulates. Surgical mask selection Key words: surgical mask, product label, facial fit, barrier level.
RESUMEN
Perioperative personnel with cold sores Key words: herpes labialis, herpes simplex virus type 1 (HSV-1), cold sore, infection transmission, surgical mask. Documenting the use of bone wax Key words: bone wax, documentation, implant, medical device, electronic health record (EHR). Using sterile surgical skin markers on veins Key words: skin marker, isopropyl alcohol, gentian violet, methylene blue, vein. Documenting solutions used to prepare tissue for implantation Key words: documentation, preparing tissue, processing tissue, solutions, implantation. Defining fire Key words: fire, oxidation, chemical reaction, sentinel event.
RESUMEN
BACKGROUND: Pediatric patients undergoing cardiac surgeries are at an increased surgical site infection (SSI) risk, given prolonged cardiopulmonary bypasses and delayed sternal closures. At one institution, the majority of cardiac patients developed SSIs during prolonged recoveries in the cardiovascular intensive care unit (CVICU). Although guidelines have been published to reduce SSIs in the perioperative period, there have been few guidelines to reduce the risk during prolonged hospital recoveries. The aim of this project was to study a postoperative SSI reduction care bundle, with a goal of reducing cardiac SSIs by 50%, from 3.4 to 1.7 per 100 procedures. METHODS: This project was conducted at a quaternary, pediatric academic center with a 20-bed CVICU. Historical control data were recorded from January 2013 through May 2015 and intervention/sustainment data from June 2015 through March 2017. A multidisciplinary SSI reduction team developed five key drivers that led to implementation of 11 postoperative SSI reduction care elements. Statistical process control charts were used to measure process compliance, and Pearson's chi-square test was used to determine differences in SSI rates. RESULTS: Prior to implementation, there were 27 SSIs in 799 pediatric cardiac surgeries (3.4 SSIs per 100 surgeries). After the intervention, SSIs significantly decreased to 5 in 570 procedures (0.9 SSIs per 100 surgeries; pâ¯=â¯0.0045). CONCLUSION: This project describes five key drivers and 11 elements that were dedicated to reducing the risk of SSI during prolonged CVICU recoveries from pediatric cardiac surgery, with demonstrated sustainability.
