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CONTINUING EDUCATION
Clinical Issues
1.2
www.aornjournal.org/content/cme
SHARON A. VAN WICKLIN, MSN, RN, CNOR, CRNFA(E), CPSN-R, PLNC;
KERRIE CHAMBERS, MSN, RN, CNOR, CNS-CP;
SUSAN KLACIK, BS, CRCST, ACE, CHL, FCS
Continuing Education Contact Hours
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reading this article, reviewing the purpose/goal and objectives,
and completing the online Learner Evaluation at http://
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Event: #16506
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The CE contact hours for this article expire February 28,
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Conflict-of-Interest Disclosures
Purpose/Goal
To provide the learner with knowledge of AORN’s guidelines
related to using an automated washer or washer/disinfector
that includes a lubrication cycle to process implants, using
items packaged in impervious packages if dropped, using a
normal saline solution rather than sterile water to wipe instruments and flush lumens during surgical procedures,
wicking versus blotting excess skin antiseptics in a gel form,
and using silver-impregnated dressings in the OR.
Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA(E),
CPSN-R, PLNC; Kerrie Chambers, MSN, RN, CNOR,
CNS-CP; and Susan Klacik, BS, CRCST, ACE, CHL, FCS,
have no declared affiliations that could be perceived as posing
potential conflicts of interest in the publication of this article.
The behavioral objectives for this program were created by
Helen Starbuck Pashley, MA, BSN, CNOR, clinical editor,
with consultation from Susan Bakewell, MS, RN-BC, director,
Perioperative Education. Ms Starbuck Pashley and Ms Bakewell
have no declared affiliations that could be perceived as posing
potential conflicts of interest in the publication of this article.
Sponsorship or Commercial Support
Objectives
1. Discuss practices that could jeopardize safety in the perioperative area.
2. Discuss common areas of concern that relate to perioperative best practices.
3. Describe implementation of evidence-based practice in
relation to perioperative nursing care.
No sponsorship or commercial support was received for this article.
Disclaimer
AORN recognizes these activities as CE for RNs. This
recognition does not imply that AORN or the American
Nurses Credentialing Center approves or endorses products
mentioned in the activity.
http://dx.doi.org/10.1016/j.aorn.2015.12.011
ª AORN, Inc, 2016
www.aornjournal.org
AORN Journal j 241
CLINICAL
ISSUES
1.2
www.aornjournal.org/content/cme
THIS MONTH
Using an automated washer or washer/disinfector that includes a lubrication cycle to process
implants
Key words: surgical implants, lubrication, critical water.
Using items packaged in impervious packages if dropped
Key words: impervious package, dropped items, event-related sterility.
Using a normal saline solution rather than sterile water to wipe instruments and flush lumens during
surgical procedures
Key words: normal saline solution, sterile water, lumens, gross soil.
Wicking versus blotting excess skin antiseptics in a gel form
Key words: wicking, blotting, skin antiseptics.
Silver-based dressings and risk of patient injury if left in place during a surgical procedure
Key words: silver-based dressings, surgical procedures, patient injuries.
Using an automated washer or washer/disinfector that includes a
lubrication cycle to process implants
QUESTION:
Should implants, such as plates and screws, be processed in
an automated washer or washer/disinfector that includes a
lubrication cycle?
242 j AORN Journal
ANSWER:
Unless specifically directed to do so by the implant
manufacturer’s instructions for use (IFU), implants should
not be processed through the lubrication cycle of an
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February 2016, Vol. 103, No. 2
Some implant manufacturers address the need for using critical
water during the implant’s final rinse. Critical water is
extensively treated to help ensure that microorganisms and
organic and inorganic material are removed; a filtration system
may be part of the treatment process.2 Using critical water as
the final rinse helps prevent water contaminants (eg,
microorganisms, minerals) that may be present in tap water
from being deposited on the implants.2 Pyrogenic reactions
may occur in patients if contaminants remain on the
implant after processing.2
The importance of following the manufacturer’s IFU relative
to lubrication and using the correct type of rinse water parallels the AORN “Guideline for cleaning and care of surgical
instruments.”3 To prevent toxic anterior segment syndrome
(TASS), a complication of anterior segment eye surgery
most commonly associated with cataract surgery,
instruments should be thoroughly cleaned and rinsed in
accordance with the manufacturer’s IFU and professional
guidelines. Most instances of TASS have been associated with
www.aornjournal.org
Just as insufficient rinsing and residues that remain on eye
instruments after cleaning can lead to toxic reactions such as
TASS, there is a potential for toxic reactions in patients as a
result of lubricant residues remaining on items implanted
in patients.
Most automated washers and washer/disinfectors can be
programmed for customized cycles that exclude the lubrication cycle. The sterile processing team member responsible for
processing surgical implants should consult the manufacturer
or the manufacturer’s IFU to determine whether and how the
rinse cycle can be programmed to run without the lubrication
cycle and still meet the cycle parameters required for complete
cleaning action.
Susan Klacik, BS, CRCST,
ACE, CHL, FCS, is an International Association of Health Care
and Materiel Management representative for the Association for
the Advancement of Medical
Instrumentation (AAMI); president
of Klacik Consulting, Canfield, OH;
and Central Sterile Services
manager at St Elizabeth
Youngstown Hospital, OH.
print & web 4C/FPO
Instrument lubricants used in washers/disinfectors are steam
permeable and may be recommended by instrument manufacturers; however, some lubricants may be incompatible with
the implant material and adversely affect the implant.1
Cytotoxicity may ensue if the implant is placed into sterile
tissue, resulting in prolonged contact with lubricant residue;
neural and ocular tissues can be particularly susceptible to
cytotoxic reactions.1 Incorrectly diluting the lubricant by
having too much lubricant in the solution also can cause a
buildup of lubricant residue on the implant, increasing the
potential for a cytotoxic reaction.1 Implant manufacturers
may not recommend the use of lubricants on implants
because there are no validated data to support the use of
lubrication on implanted devices.
contaminated instruments,
contaminated ultrasonic cleaners,
detergent residues (eg, soaps, enzymatic cleaners) remaining
on instruments,
insufficient rinsing of instruments, or
endotoxin residues on instruments.3
Sharon A. Van Wicklin,
MSN, RN, CNOR, CRNFA(E),
CPSN-R, PLNC, is a senior perioperative practice specialist in
the Nursing Department at
AORN, Inc, Denver, CO.
AORN Journal j 243
print & web 4C/FPO
automated washer or washer/disinfector. Implants should
be free of contaminants and residues that could result in
adverse effects to the patient. The lubrication cycle often
is performed automatically as one of the final steps in an
automated washer or washer/disinfector cleaning process.
The processing of implants using the regular instrument
cycle with the instrument lubrication preceding the dry
cycle may result in the instrument lubricant remaining on
the implant. Certain lubricants that are manually applied
may create a film that is resistant to steam or ethylene
oxide penetration; thus, although subjected to a sterilization process, there may be lubricant remaining on the
implant when it is implanted into the patient.1
Clinical Issues
Van Wicklin et al
References
1. The optimal selection and use of surgical instrument lubricants.
Healthcare Purchasing News. 2008;May:34-37.
2. Association for the Advancement of Medical Instrumentation.
Technical information report 34: water for the reprocessing of
February 2016, Vol. 103, No. 2
medical devices. AAMI; 2014. http://my.aami.org/store/SiteContent/
previewfiles/TIR34_1409_preview.pdf. Accessed October 16,
2015.
3. Guideline for cleaning and care of surgical instruments. In: Guidelines
for Perioperative Practice. Denver, CO: AORN, Inc; 2016:773-808.
Using items packaged in impervious packages if dropped
QUESTION:
While opening a sterile item packaged by the manufacturer
in an impervious double-pouch configuration, I dropped
the inner package onto the floor without contaminating
the sterile field. After opening the dropped inner package
onto the sterile field, a colleague said that because the
package had touched the floor, it was contaminated and
should not be used. If true, is there any difference between
an item packaged by facility personnel and the manufacturer? What about double-wrapped items?
ANSWER:
No research evidence specifically addresses whether packaged
items dropped on the floor may be safely opened onto the
sterile field. Because wrapped items are not impervious, they
should not be used if dropped on the floor. Relative to
dropped items in impervious packages, Berry and Kohn’s
Operating Room Technique,1 a well-known, foundational
perioperative text, provides the following opinion:
A dropped package is considered contaminated on the outside.
If the wrapper is impervious and the area of contact is dry and
intact, the item may be transferred to the sterile field. Packages
that have been dropped on the floor should not be put back into
sterile storage.1(p261)
Although the 14th edition of Alexander’s Care of the Patient in
Surgery, another well-known, foundational perioperative text,
formerly provided a similar opinion,2 this is no longer the case.
The 15th edition of Alexander’s Care of the Patient in Surgery
does not provide an opinion specific to dropped items in
impervious packages.3
When making a practice decision regarding the safety of
opening dropped items in impervious packages onto the sterile
field, it may be prudent to contact the manufacturer of the
item. The sterility of the item in the package has been validated
by the manufacturer using a double pouch, and because of this,
the manufacturer may not consider the item to be sterile if the
inner pouch has been contaminated. Relative to facilityprocessed items in double pouches, contacting the pouch
manufacturer may provide a different answer because the
244 j AORN Journal
pouch manufacturer may consider the pouch to be impervious
and validated to provide an item that is sterile when opened.
Sterility is event related and depends on whether the integrity
of the package has been correctly maintained.4,5 The sterility
of an item does not change with the passage of time4 but may
be affected by particular events,5 such as being dropped on the
floor. According to the AORN “Guideline for environmental
cleaning,”6 floors in the perioperative practice setting and
items that contact the floor for any amount of time should
be considered contaminated at all times. Munoz-Price et al7
found that the OR floor was a potential reservoir for
microorganisms, and when patient care items (eg, IV tubing,
safety straps) inadvertently touched the floor, the items were
potentially contaminated and could transmit pathogens to
the patient if they were not disinfected before contact with
the patient.
If there is any doubt about the sterility of the item, it should
be considered contaminated and should not be used.1-4
Additionally, when making practice decisions where there is
no conclusive evidence to support or negate a specific practice,
perioperative RNs should determine actions based on careful
consideration of the benefits and potential harms. In this case,
the benefits are reduced time and money compared with the
risk of patient infection.
Sharon A. Van Wicklin, MSN, RN, CNOR,
CRNFA(E), CPSN-R, PLNC, is a senior perioperative
practice specialist in the Nursing Department at AORN,
Inc, Denver, CO.
References
1. Phillips NM. Principles of asepsis and sterile technique. In: Berry
and Kohn’s Operating Room Technique. 12th ed. St. Louis, MO:
Mosby Elsevier; 2013:252-266.
2. Nicolette LH. Infection prevention and control in the perioperative setting. In: Rothrock JC, ed. Alexander’s Care of the Patient
in Surgery. 14th ed. St. Louis, MO: Mosby Elsevier; 2011:
48-110.
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February 2016, Vol. 103, No. 2
3. Spry C. Infection prevention and control. In: Rothrock JC, ed.
Alexander’s Care of the Patient in Surgery. 15th ed. St. Louis, MO:
Mosby Elsevier; 2015:69-123.
4. Guideline for sterile technique. In: Guidelines for Perioperative
Practice. Denver, CO: AORN, Inc; 2016:65-94.
5. Guideline for sterilization. In: Guidelines for Perioperative Practice.
Denver, CO: AORN, Inc; 2016:823-850.
Clinical Issues
6. Guideline for environmental cleaning. In: Guidelines for
Perioperative Practice. Denver, CO: AORN, Inc; 2016:
7-28.
7. Munoz-Price LS, Birnbach DJ, Lubarsky DA, et al. Decreasing
operating room environmental pathogen contamination through
improved cleaning practice. Infect Control Hosp Epidemiol. 2012;
33(9):897-904.
Using a normal saline solution rather than sterile water to wipe
instruments and flush lumens during surgical procedures
QUESTION:
One of the surgeons I work with has requested that we not
keep sterile water on the field for the purpose of wiping
instruments and flushing lumens during the surgical procedure. The surgeon suggested that we use normal saline
solution rather than water to eliminate the potential for
using water rather than saline for irrigation. Is this
acceptable?
ANSWER:
According to the AORN “Guideline for cleaning and care of
surgical instruments,”
during the procedure, the scrub person should remove gross soil
from instruments by wiping the surfaces with a sterile surgical
sponge moistened with sterile water. Saline should not be used
p777)
to wipe instrument surfaces.1(
Likewise, the Association for the Advancement of Medical
Instrumentation (AAMI) states in its Comprehensive Guide to
Steam Sterilization and Sterility Assurance in Health Care Facilities that
instruments should be maintained as free of gross soil as possible
during the surgical or other health care procedure. A disposable
sponge moistened with water (not saline) should be used to wipe
gross soil from instruments . . . Water, and not saline, should be
used, as saline will corrode the instrumentation.2(p48,59)
Blood, organic material, debris, and saline are highly corrosive
to instrument surfaces and can cause corrosion, rusting, and
pitting when allowed to dry on surgical instruments.1,2 Saline
contains chlorides; if allowed to remain on the instruments
during the procedure, there is an increased potential for rust or
corrosion.2 Human blood also contains minerals such as
sodium, chloride, potassium, calcium, and magnesium.
When allowed to dry, these materials can be difficult to
remove from instrument surfaces and lumens during the
cleaning and decontamination process, potentially reducing
www.aornjournal.org
the efficacy of the subsequent sterilization.3-5 For this
reason, it is necessary for the scrub person to keep the
instruments free of blood and soil during the procedure by
irrigating the lumens and wiping instruments with a moist
sponge. Both AORN and AAMI agree that best practice is
to use sterile water for removing blood and gross soil from
instruments during a surgical procedure; however, whenever
there is a patient safety concern relative to a particular
recommended practice, the potential harms should be
weighed against the associated benefits.
The potential for sterile water, rather than normal saline, to be
inadvertently used as irrigation fluid during the procedure on
certain high-risk patients has been raised by the surgeon as a
patient safety concern. Notably, medications and solutions on
the sterile field should be labeled and the label confirmed by
both the perioperative RN and the scrub person.6 The
accidental use of sterile water as an irrigation fluid during
pediatric or neurosurgical procedures may have serious
consequences. There is also a risk of hyponatremia when
irrigation is performed with a large amount of sterile water.7
In situations in which there is an increased risk of irrigation
with sterile water, the scrub person should wipe the
instruments and flush lumens with normal saline solution to
help remove soil, understanding that this increases the
potential for instrument corrosion. The potential for patient
harm that might arise if the sterile water on the field was to
be used for irrigation purposes may outweigh the potential
risk of instrument corrosion that could arise from using
saline rather than water.
Leaders of the health care organization, in consultation with a
multidisciplinary team, should conduct a risk assessment to
further explore the potential benefits and harms surrounding
this practice question and to determine the processes that will
be followed at the facility. The multidisciplinary team should
include representatives from sterile processing, risk management, and infection prevention as well as surgeons, scrub
AORN Journal j 245
Van Wicklin et al
persons, perioperative RNs, and other involved personnel.
When the team has reached a decision, they should develop a
policy and procedure for standardized practices throughout the
facility. Perioperative educators should provide education
and competency verification activities for those who will be
affected by the new policy (eg, scrub persons, perioperative
RNs, sterile processing personnel). To determine the overall
effects of the multidisciplinary team’s decision, perioperative
team members should implement follow-up quality assurance
activities, such as monitoring the instruments for a specific
period of time, to determine if the change in practice has
resulted in increased amounts of corrosion on the
instruments.
Sharon A. Van Wicklin, MSN, RN, CNOR,
CRNFA(E), CPSN-R, PLNC, is a senior perioperative
practice specialist in the Nursing Department at AORN,
Inc, Denver, CO.
February 2016, Vol. 103, No. 2
References
1. Guideline for cleaning and care of surgical instruments. In: Guidelines
for Perioperative Practice. Denver, CO: AORN, Inc; 2016:773-808.
2. ANSI/AAMI ST79: Comprehensive guide to steam sterilization
and sterility assurance in health care facilities. AAMI; 2013.
http://my.aami.org/aamiresources/previewfiles/ST79_Wa4_1310_
preview.pdf. Accessed October 16, 2015.
3. AAMI TIR12: 2010 Designing, Testing, and Labeling Reusable
Medical Devices for Reprocessing in Health Care Facilities: a
Guide for Medical Device Manufacturers. Arlington, VA: AAMI;
2010.
4. Spry CC, Brooks Tighe SM. Care and handling of surgical instruments. In: Brooks Tighe S, ed. Instrumentation for the Operating
Room: a Photographic Manual. 8th ed. St Louis, MO: Elsevier/
Mosby; 2012:1-2.
5. Root CW, Kaiser N, Antonucci C. What, how and why: enzymatic
instrument cleaning products in healthcare environments. Healthcare Purchasing News. 2008;32(11):50.
6. Guideline for medication safety. In: Guidelines for Perioperative
Practice. Denver, CO: AORN, Inc; 2016:289-327.
7. Guideline for minimally invasive surgery. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016:589-616.
Wicking versus blotting excess skin antiseptics in a gel form
QUESTION:
What does AORN recommend about blotting excess skin
antiseptic when the antiseptic is in a gel form? Does AORN
recommend a specific skin antiseptic?
ANSWER:
AORN does not recommend the use of one specific skin
antiseptic product over another. According to the AORN
“Guideline for preoperative patient skin antisepsis,”
a multidisciplinary team including perioperative RNs, physicians, and infection preventionists should select safe and effective
antiseptic products for preoperative patient skin antisepsis. The
collective evidence indicates that there is no one antiseptic that is
more effective than another for preventing SSI.1(p47)
AORN recommends that perioperative team members follow
the manufacturer’s IFU when applying preoperative patient
skin antiseptics. When applying these antiseptics, perioperative
personnel should prevent the antiseptic solution from pooling
or soaking into linens or the patient’s hair by
using reusable or disposable sterile towels to absorb drips and
excess solution during application,
removing materials that are saturated with the skin antiseptic
before the patient is draped, and
246 j AORN Journal
wicking excess solution with a sterile towel to help dry the
surgical prep area completely.1
A wicking action uses absorbent material to draw off excess solution and to leave sufficient antiseptic on the skin to cover the
prepared area. A blotting action uses absorbent material to dry the
area, and this drying action might partially or fully remove the
product from the skin; therefore, a wicking action is preferred to a
blotting action. Excess skin antiseptics in gel form take longer to
dry and are not easily wicked. For this reason, gel products should
be applied in a thin, even layer without leaving large globules of
excess product on the patient’s skin. Allowing the antiseptic to
dry completely for the full time recommended by the manufacturer before sterile drapes are applied improves the safety and
efficacy of preoperative patient skin antisepsis.1
Sharon A. Van Wicklin, MSN, RN, CNOR,
CRNFA(E), CPSN-R, PLNC, is a senior perioperative
practice specialist in the Nursing Department at AORN,
Inc, Denver, CO.
Reference
1. Guideline for preoperative patient skin antisepsis. In: Guidelines for
Perioperative Practice. Denver, CO: AORN; 2016:41-64.
www.aornjournal.org
February 2016, Vol. 103, No. 2
Clinical Issues
Silver-based dressings and risk of patient injury if left in place during a
surgical procedure
QUESTION:
Do silver-based dressings present a risk of patient injury
when left in place during a surgical procedure?
ANSWER:
Silver-impregnated dressings are often seen on patients with total
joint knee or hip incisions, sternal chest incisions, and wounds
with large amounts of exudate and may be near the area requiring
surgery or an area where positioning devices are needed. The
perioperative team should weigh the risks and benefits of leaving
a silver-impregnated dressing in place during surgery. Some of
the risks associated with silver-impregnated dressings include
surgical site infection if removed and replaced, pressure ulcer
development if the dressing is between the patient and a positioning device, and potential burns if an electrocautery device is
used. Based on the perioperative assessment, the team may
decide to implement one of the following actions: removing the
dressing, replacing the silver dressing with a nonsilver dressing,
leaving the silver dressing in place, or leaving the silver dressing in
place and using a bipolar cautery unit.
The benefits of leaving the silver dressing in place may be that
silver has antimicrobial properties that may reduce the bioburden and associated endotoxins in wounds, according to
Abboud et al.1 Other benefits for the patient include avoiding
painful removal of the dressing and the expense of replacing
the silver dressing postoperatively.
Patient assessment should include determining if the silver dressing
will interfere with the surgical site (eg, during prepping, draping, or
incision). To minimize the risk of infection at the surgical site, the
nurse must ensure that the surgical site is clean and that no potential
contaminants (eg, silver dressing) are in or near the prepared area of
the surgical site. If the dressing is within the prepared area, the nurse
should remove the silver-impregnated dressing or replace the dressing with a smaller one that does not interfere with the surgical site.
Another key patient assessment the nurse should make is to
determine whether the dressing is in direct contact with any
patient positioning devices. The direct pressure of a patient
positioning device on a silver-impregnated dressing could lead
to pressure ulcers. The perioperative nurse may need to remove
the dressing and replace it with a nonesilver-impregnated
dressing or add a different type of padding (eg, instead of using
a Wilson frame alone, using a Wilson frame with gel padding if
the dressing interferes with the patient positioning device).
www.aornjournal.org
Silver dressings may conduct electricity and therefore may be
of concern when used near or around the anesthesia monitoring electrodes or the electrosurgical unit’s (ESU’s) dispersive
pad or active electrode for monopolar electrosurgery.1,2 The
location of a silver-impregnated dressing near these items
could provide the potential for an alternate current pathway.3
A review of the literature did not reveal any research studies
involving silver dressings and ESUs. It may be prudent for
the nurse to remove silver-impregnated dressings that are
located between the ESU’s dispersive pad and active
electrode to prevent the silver in the dressing from creating
an alternate path to ground and potentially causing an
electrical burn injury.
Additionally, silver-impregnated dressings have caused some
concern for patients undergoing magnetic resonance imaging
(MRI) because of silver’s electrical conductivity, leading to
the potential for activating the MRI’s radio frequency (RF) magnetic field and the potential for excessive tissue heating or image
distortion.4 Chaudhry et al4 studied silver-impregnated dressings
applied to the hind limb of euthanized pigs (with and without
pig skin) by using fluoroscopic temperature probes to measure
the tissue temperature changes when exposed to six standard
MRI sequencing patterns. This study found no significant tissue
temperature increase. Nyenhuis and Duan2 used a gelled saline
substance solidified with silver-impregnated dressings to mimic
a human torso and head. The researchers exposed the surrogate
human torso to MRI and measured the temperature inside the
surrogate while it was in the MRI equipment. The authors
concluded that the silver dressings they evaluated had
temperature increases that would be acceptable in human tissue.
Nyenhuis and Duan2 also evaluated image distortion caused by
silver dressings when exposed to standard MRI sequencing. The
authors concluded that the dressing showed little to no image
distortion greater than a 3-mm area around the dressing.
Chaudhry et al4 tested three silver-based dressings and found that
none produced moderate or severe image distortion after being
exposed to MRI scanning. A radiologist assessed all images and
found that some of the images with silver-impregnated dressings
showed minimal differences compared with those without these
dressings, but the findings were not clinically significant. In both
studies, the researchers concluded that silver dressings could be
used in the MRI environment without patient harm and that
future studies should be directed toward newer silver-based
products because a number of different dressings now are available
with different compositions of silver.2,4
AORN Journal j 247
Van Wicklin et al
February 2016, Vol. 103, No. 2
Kerrie Chambers, MSN, RN,
print & web 4C/FPO
CNOR, CNS-CP, is a perioperative nursing specialist in the
Nursing Department at AORN,
Inc, Denver, CO.
248 j AORN Journal
References
1. Abboud EC, Settle JC, Legare TB, Marcet JE, Barillo DJ,
Sanchez JE. Silver-based dressings for the reduction of surgical site
infection: review of current experience and recommendations for
future studies. Burns. 2014;40(Suppl 1):S30-S39.
2. Nyenhuis J, Duan L. An evaluation of MRI safety and compatibility of
a silver-impregnated antimicrobial wound dressing. J Am Coll
Radiol. 2009;6(7):500-505.
3. Guideline for electrosurgery. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016:119-136.
4. Chaudhry Z, Sammet S, Coffey R, Crockett A, Yuh WT, Miller S.
Assessing the safety and compatibility of silver based wound dressings
in a magnetic resonance environment. Burns. 2009;35(8):1080-1085.
www.aornjournal.org
LEARNER EVALUATION
Continuing Education:
Clinical Issues 1.2
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T
his evaluation is used to determine the extent to
which this continuing education program met
your learning needs. The evaluation is printed
here for your convenience. To receive continuing education
credit, you must complete the online Learner Evaluation at
http://www.aornjournal.org/content/cme. Rate the items as
described below.
5.
To what extent were your individual objectives met?
Low
1.
2.
3.
4.
5.
High
6.
Will you be able to use the information from this article
in your work setting?
1.
Yes
2.
No
7.
Will you change your practice as a result of reading this
article? (If yes, answer question #7A. If no, answer
question #7B.)
7A.
How will you change your practice? (Select all that
apply)
1. I will provide education to my team regarding why
change is needed.
2. I will work with management to change/implement
a policy and procedure.
3. I will plan an informational meeting with physicians
to seek their input and acceptance of the need for
change.
4. I will implement change and evaluate the effect of
the change at regular intervals until the change is
incorporated as best practice.
5. Other: __________________________________
7B.
If you will not change your practice as a result of
reading this article, why? (Select all that apply)
1. The content of the article is not relevant to my
practice.
2. I do not have enough time to teach others about the
purpose of the needed change.
3. I do not have management support to make a
change.
4. Other: __________________________________
8.
Our accrediting body requires that we verify the time
you needed to complete the 1.2 continuing education
contact hour (72-minute) program: ______________
PURPOSE/GOAL
To provide the learner with knowledge of AORN’s guidelines
related to using an automated washer or washer/disinfector
that includes a lubrication cycle to process implants, using
items packaged in impervious packages if dropped, using a
normal saline solution rather than sterile water to wipe instruments and flush lumens during surgical procedures,
wicking versus blotting excess skin antiseptics in a gel form,
and using silver-impregnated dressings in the OR.
OBJECTIVES
To what extent were the following objectives of this
continuing education program achieved?
1. Discuss practices that could jeopardize safety in the
perioperative area.
Low
1.
2.
3.
4.
5.
High
2.
Discuss common areas of concern that relate to perioperative best practices.
Low
1.
2.
3.
4.
5.
High
3.
Describe implementation of evidence-based practice in
relation to perioperative nursing care.
Low
1.
2.
3.
4.
5.
High
CONTENT
4.
To what extent did this article increase your knowledge
of the subject matter?
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AORN Journal j 249