Special Edition on Operating Room Imperatives Special Edition- Operating Room Imperatives | Page 29

¡ Surgical stewardship requires an intentional effort by the entire perioperative team to optimize the patient’s outcomes in preparation for surgery. a transparent CHG- impregnated occlusive dressing 35 and silver antimicrobial dressing. 36 The selection of post-op dressing material would benefit from a collaboration with surgeons, wound care professionals, infection preventionists, physician assistants and nursing. 37 In addition, patient satisfaction should be considered since occlusive dressings allow the patient to shower immediately after surgery, have better cosmesis when compared to staples, allow visualization of the incision to monitor for signs of infection and the dressings can be left in place for several post-op days to provide additional would protection. In conclusion, surgical stewardship requires an intentional effort by the entire perioperative team to optimize the patient’s outcomes in preparation for surgery. This process begins with the patient’s entry into the healthcare system and concludes when they have attained their optimal health upon discharge. It is those deliberate steps and actions which take place between entry and exit that every healthcare provider has an impact upon. Using a standardized bundled approach establishes a framework to begin upon. There are numerous guidelines out there that address SSI reduction. It is up to us to develop and deliver a surgical stewardship program that produces results for the patient and ultimately, for the entire healthcare system.  References: 1. Specht, et al. Patient experience in fast‐track hip and knee arthroplasty–a qualitative study. J Clin Nurs. 2016. 25(5-6): p. 836-845. 2. Hansen TB, et al. Preoperative physical optimization in fast-track hip and knee arthroplasty. Dan Med J, 2012. 59(2): p. A4381. 3. Best MJ, et al. Alcohol misuse is an independent risk factor for poorer postoperative outcomes following primary total hip and total knee arthroplasty. The Journal of arthroplasty, 2015. 30(8): p. 1293-1298. 4. Oppedal K, et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database of Systematic Reviews, 2012(7). 5. Singh JA, Smoking and outcomes after knee and hip arthroplasty: a systematic review. The Journal of rheumatology, 2011. 38(9): p. 1824-1834. 6. Bergin C, et al. Effect of preoperative incentive spirometry patient education on patient outcomes in the knee and hip joint replacement population. J PeriAnesthesia Nurs. 2014. 29(1): p. 20-27. 7. Jordan R, et al. Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review. Physiotherapy, 2014. 100(4): p. 305-312. 8. Louw A, et al., Preoperative education addressing postoperative pain in total joint arthroplasty: review of content and educational delivery methods. Physiotherapy theory and practice, 2013. 29(3): p. 175-194. 9. McDonald D, et al. An enhanced recovery program for primary total knee arthroplasty in the United Kingdom—follow up at one year. The Knee, 2012. 19(5): p. 525-529. 10. Wainwright TW, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta orthopaedica, 2020. 91(1): p. 3-19. 11. McGovern P, et al. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopedics. The Journal of bone and joint surgery. British volume, 2011. 93(11): p. 1537-1544. 12. Koc BB, et al, Effectiveness of early warming with self-warming blankets on postoperative hypothermia in total hip and knee arthroplasty. Orthopedic Nursing, 2017. 36(5): p. 356-360. 13. ECRI Institute. Forced-Air arming and Surgical Site Infections. Health Devices, 2013. April 2013. 14. AORN. Guideline for Prevention of Hypothermia in Guidelines for Perioperative Practice, R. Connor, Editor. 2019. 15. Albrecht MB, et al. Forced-air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room. AJIC: American Journal of Infection Control, 2011. 39(4): p. 321-328. 16. McGovern PD, et al. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopedics. The Journal of bone and joint surgery. British volume, 2011. 93(11): p. 1537-1544. 17. Paulson DS, et al. Efficacy and safety of a novel skin cleansing formulation versus chlorhexidine gluconate. Am J Infect Control. 2018. 46(11): p. 1262-1265. 18. Dumville JC, et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. The Cochrane database of systematic reviews 2015(4): p. CD003949. 19. Barnes S, et al. Surgical wound irrigation: A call for evidence-based standardization of practice. Am J Infect Control, 2014. 42(5): p. 525-9. 20. USP, Pharmaceutical Compounding – Sterile Preparations, in USP 797. 2019, USP. 21. Soper L. Our Journey to Reduce Mixing and Compounding Medications by bthe Circulator in the OR, in AORN Expo and Congress. 2019: Nashville, TN. 22. Leaper D, et al. Antimicrobial sutures and prevention of surgical site infection: assessment of the safety of the antiseptic triclosan. International Wound Journal, 2011. 8(6): p. 556-566. 23. Ford H, et al. Intraoperative Handling and Wound Healing: Controlled Clinical Trial Comparing Coated VICRYL® Plus Antibacterial Suture (Coated Polyglactin 910 Suture with Triclosan) with Coated VICRYL® Suture (Coated Polyglactin 910 Suture). Surgical Infections, 2005. 6(3): p. 313-321. 24. Uchino M, et al. The Efficacy of Antimicrobial-Coated Sutures for Preventing Incisional Surgical Site Infections in Digestive Surgery: a Systematic Review and Meta-analysis. J Gastro Surg. 2018. 22(10): p. 1832-1841. 25. Ban KA, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. Journal of the American College of Surgeons, 2017. 224(1): p. 59-74. 26. Berríos-Torres SI, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery, 2017. 152(8): p. 784-791. 27. Mangram AJ, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999. 20(4): p. 250-78; quiz 279-80. 28. Myers B. Wound Management Principles and Practice. 2008, Upper Saddle River, NJ: Pearson Prentice Hall. 29. Basha SL, et al., Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol. 2010. 203(3): p. 285.e1-285.e8. 30. Tuuli MG, et al. Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery: A Systematic Review and Meta-Analysis. Obstetrics & Gynecology. 2011. 117(3): p. 682-690. 31. Smith TO, et al. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ, 2010. 340: p. c1199. 32. Eickmann T and Quane E. Total Knee Arthroplasty Closure with Barbed Sutures. J Knee Surg, 2010. 23(03): p. 163-168. 33. Levine B, et al. Use of a barbed suture in the closure of hip and knee arthroplasty wounds. Orthopedics, 2011. 34(4): p. e473-5. 34. Blondeel PNV, et al. Closure of long surgical incisions with a new formulation of 2-octylcyanoacrylate tissue adhesive versus commercially available methods. Am J Surg. 2004. 188(3): p. 307-313. 35. ReliaTect® Post-Op Dressing with CHG Instructions for Use. 2016. 36. Cai J, et al. Aquacel Surgical Dressing Reduces the Rate of Acute PJI Following Total Joint Arthroplasty: A Case-Control Study. J Arthro. 2013. 29(June 1, 2014): p. 1098-1100. 37. Dumville JC, et al. Dressings for the prevention of surgical site infection. Cochrane Database of Systematic Reviews, 2011(7). www.healthcarehygienemagazine.com • Operating Room Imperatives 2020 29