A Randomized Controlled Trial of Povidone-Iodine Versus Chlorhexidine Gluconate With Isopropyl Alcohol for Preoperative Vaginal Antisepsis.

Many surgeons request use of 10% povidone-iodine (PI) for vaginal antisepsis; however, when PI is contraindicated, some surgeons request use of chlorhexidine gluconate (CHG) instead. The purpose of this randomized controlled trial was to determine any significant differences in self-reported symptoms associated with vaginal antisepsis with either 10% PI scrub or 4% CHG with 4% isopropyl alcohol. The control group comprised 62 participants who underwent vaginal antisepsis with the PI product, and the intervention group comprised 58 participants who underwent vaginal antisepsis with the CHG product. Participants completed surveys immediately before surgery, immediately after surgery, and 48 to 72 hours after surgery. No significant differences were found in the reported vaginal symptoms between the two groups for any survey. One participant in the intervention group reported symptoms consistent with an allergic reaction. Additional studies are needed on the use of CHG for vaginal antisepsis.

Using Innovation in Credentialing to Foster Meaningful Transitions to Practice and Support Continuing Professional Development.

Certification within specialized areas in nursing has long been an avenue by which nurses demonstrate competence and dedication toward professional development. Because of innovation within the credentialing arena, certification also can serve as an avenue that supports nursing professional development practitioners who are assisting nurses transitioning into new roles or new practices. [J Contin Educ Nurs. 2023;54(9):413-420.].

Intraoperative Code Blue: Improving Teamwork and Code Response Through Interprofessional, In Situ Simulation.

INTRODUCTION: An intraoperative cardiac arrest requires perioperative teams to be equipped with the technical skills, nontechnical skills, and confidence to provide the best resuscitative measures for the patient. In situ simulation (simulation conducted in health professionals' work environment, such as a patient care unit, and not in an off-site location) has the potential to improve team performance. The research team assessed the effects of in situ simulation on code response, teamwork, communication, and comfort in intraoperative resuscitations. METHODS: This study included seven interprofessional teams consisting of RNs, anesthesiologists, surgical technologists, and patient care technicians working in the operating room of a community hospital in New Jersey. The hour-long interdisciplinary simulation training sessions consisted of a code blue scenario run twice; both times video recorded, retrospectively reviewed, and compared to each other. Technical skills were measured by "time-to-tasks"; nontechnical skills were assessed using the Team Emergency Assessment Measure (TEAM) instrument. Self-reported comfort in skills was collected before the simulation program and after completion of the training. RESULTS: A total of 21 perioperative nurses, 7 anesthesiologists, 7 surgical technologists, and 4 patient care technicians participated from January to April 2021. There was a significant (p < 0.05) decrease in time to compressions (by 14 seconds, 53.5% improvement) and in time to defibrillation (by 49 seconds) between the two simulations. Significant improvements were noted in confidence levels of certain CPR-related technical skills. There were statistically significant improvements in TEAM scores in the two teams that performed lowest in the pre-debrief simulation (p < 0.05). CONCLUSION: In the operative setting, where time and space for training are limited, in situ simulation training was associated with improvement in technical skills of individuals and teams, with significantly improved teamwork in teams that required the most training. The long-term effects of such training and its effects on patient outcomes require additional research.

Cricoid Pressure: Contradictory Evidence Regarding a Standard Practice.

The purpose of applying cricoid pressure is to prevent pulmonary aspiration of regurgitated gastric contents during airway management in mask-ventilated patients who are at risk of aspiration. Providers may apply cricoid pressure during induction and intubation if they expect a difficult intubation or if the patient has a high risk for regurgitation. Although the application of cricoid pressure has been accepted as a standard practice worldwide, controversy persists because pulmonary aspiration can occur even when cricoid pressure is applied. The perioperative nurse should have thorough knowledge of the anatomy of the upper respiratory and gastrointestinal tracts, be able to demarcate the surface landmarks of the neck, and be skilled in applying cricoid pressure properly and safely. This article discusses cricoid pressure in the context of safe airway management as well as the perioperative nurse's role as an assistant to the anesthesia professional when applying cricoid pressure.

Linen: The New Frontier in Infection Control and Prevention.

Personnel follow hospital policies and regulatory guidelines to prevent surgical site infections. However, a potentially contaminated item may be overlooked-the linen. When perioperative team members transport patients to the OR, the linen on the beds and transport carts can contain a variety of microorganisms. Textile surfaces can serve as reservoirs for microorganisms that can be transferred to health care providers, patients, and the environment. These pathogens may then infect patients, particularly those who are immunocompromised or have direct portals of entry (eg, catheters, incision sites). This article provides an overview of how microorganisms that cause health care-associated infections can survive and thrive on hospital linen and related equipment; discusses the linen laundering, transport, and storage processes and best practices; and discusses antimicrobial interventions-including a silver-ion laundering additive that was added as an infection prevention measure to the laundry production cycle at a medical center's contracted laundry facility.

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part II: Implementation.

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive procedure used to treat peritoneal carcinomatosis, which is either primary or secondary to other cancers (eg, ovarian, colorectal, appendiceal) that have metastasized to the peritoneum. Morbidity, mortality, and quality of life have improved for patients selecting CRS with HIPEC as a cancer treatment. At Holy Name Medical Center in Teaneck, New Jersey, an interdisciplinary team was established to plan and coordinate performing this new procedure in the OR. The team created a written protocol for implementing CRS with HIPEC before patients were scheduled for surgery. This article explores the perioperative facets of implementing CRS with HIPEC and discusses care of the patient undergoing CRS with HIPEC, with a focus on perioperative nursing considerations.

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part I: Introduction and Indications.

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal carcinomatosis, which often is secondary to gastrointestinal and ovarian cancers. During CRS, the surgeon resects cancerous tumors from the peritoneal cavity. During HIPEC, a chemotherapy agent is introduced into a solution that flows in and out of catheters in the abdominal cavity for approximately 90 minutes. The chemoperfusate is heated to 42° C (107.6° F), which kills cancer cells but is nonthreatening to normal cells. A primary goal of combining CRS with HIPEC is to apply targeted regional chemotherapy directly to the peritoneum to destroy residual micrometastatic disease while the tumor burden is minimal and before cancer cells become entrapped by the body's wound-healing processes. Although HIPEC usually is not curative, it can extend a patient's life expectancy three to five years. This is the first article in a two-part discussion of CRS with HIPEC.

Diphallia, Double Bladder, and Two Hemiscrotums: A Case Report.

Complete diphallia, a rare urogenital congenital anomaly in which a male is born with two fully formed phalluses, occurs in one out of every five to six million live births. The condition is characterized by two separate phalluses, each of which comprise a pair of corpora cavernosa and one corpus spongiosum with an orthotopic urethra. Approximately 100 cases have been reported worldwide, and it is thought that each case is unique. This article discusses diphallia, urethral duplication, and bladder duplication and concludes with a case study involving a three-year-old male born to consanguineous parents from a small, remote community in Ecuador who underwent surgery for correction of a complete coronal penile and bladder duplication. After consultation, the patient was scheduled for a right penectomy and cystoplasty.

Body Art and the Perioperative Process.

Body modification, also known as body art, has been a common cultural practice for thousands of years and includes body piercings, transdermal and subdermal implants, tattoos, scarification, body stretching and sculpting, dental grills, and nail art. Perioperative nurses must learn more about body art to provide nonjudgmental, nonprejudicial care and to ensure patient safety when they prepare patients for surgery. A welcoming environment engages patients and fosters communication so that patients are more likely to share hidden body art. It is also necessary for the preoperative nurse to communicate with the perioperative team about patients' body art to avoid airway complications, tissue trauma, pressure ulcers, burns, postoperative surgical site infections, or distorted fluoroscopy or magnetic resonance images. Identifying patients' body art in advance allows the perioperative team to be better prepared to deliver safe care.

Ghost Surgery: A Frank Look at the Issue and How to Address It.

Ghost surgery occurs when a physician assistant, a surgical assistant, an RN first assistant, a resident, or another surgeon assists on or performs an operative or other invasive procedure without the patient's knowledge, regardless of whether the surgeon who obtained the consent was scrubbed in or not. This practice denies patients important information, eliminates their ability to provide informed consent, and represents an ethical issue that nurses must deal with when working with peers and patients. The American Nurses Association developed the Code of Ethics for Nurses to help guide nursing practice, and the provisions within the code embody the ethical issues that should guide nurses' practice in advocating for patients.

Introducing AORN's new model for evidence rating.

Nurses today are expected to implement evidence-based practices in the perioperative setting to assess and implement practice changes. All evidence-based practice begins with a question, a practice problem to address, or a needed change that is identified. To assess the question, a literature search is performed and relevant literature is identified and appraised. The types of evidence used to inform practice can be scientific research (eg, randomized controlled trials, systematic reviews) or nonresearch evidence (eg, regulatory and accrediting agency requirements, professional association practice standards and guidelines, quality improvement project reports). The AORN recommended practices are a synthesis of related knowledge on a given topic, and the authorship process begins with a systematic review of the literature conducted in collaboration with a medical librarian. At least two appraisers independently evaluate the applicable literature for quality and strength by using the AORN Research Appraisal Tool and AORN Non-Research Appraisal Tool. To collectively appraise the evidence supporting particular practice recommendations, the AORN recommended practices authors have implemented a new evidence rating model that is appropriate for research and nonresearch literature and that is relevant to the perioperative setting.

Biomarkers: an overview for oncology nurses.

OBJECTIVES: To provide an overview of the basic principles of biomarker use in clinical oncology practice and discuss the range of biomarker forms (from genes to constitutional characteristics), biomarker functions (both disease- and drug-related), modalities (protein expression patterns to patient history), the criteria for biomarker validation, and the integral role of bioinformatics. DATA SOURCES: Published nursing and medical literature. CONCLUSION: The premise of nursing assessment is the same as that of biomarker use - biological variables that appear at one level of biological organization (eg, molecule, organelle, cell, tissue, organ, and organism) correspond to processes or events occurring at other levels of biologic organization. The advent of genomic technologies has logarithmically increased the volume of biomarkers, which are expected to provide new insights that improve patient care. IMPLICATIONS FOR NURSING PRACTICE: Nurses and patients will benefit greatly from the incorporation of molecular biomarkers into patient care. Nurses will be able to better assess (and anticipate) patient needs with the new insights that are available in the post-genomic, personalized medicine era of health care. Although the rapid rate of technological changes and new discoveries will require continuing concerted educational efforts, the improved quality of patient care will be rewarded by better outcomes.