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CONTINUING EDUCATION
Clinical Issues
1.2
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AMBER WOOD, MSN, RN, CNOR, CIC;
SHARON A. VAN WICKLIN, MSN, RN, CNOR, CRNFA, CPSN-R, PLNC
Continuing Education Contact Hours
indicates that continuing education (CE) contact hours are
available for this activity. Earn the CE contact hours by
reading this article, reviewing the purpose/goal and objectives,
and completing the online Learner Evaluation at http://www
.aorn.org/CE. Each applicant who successfully completes this
program can immediately print a certificate of completion.
Event: #15520
Session: #0001
Fee: Members $9.60, Nonmembers $19.20
The CE contact hours for this article expire June 30, 2018.
Pricing is subject to change.
Purpose/Goal
To provide the learner with knowledge of AORN’s guidelines
related to the use of ultraviolet (UV)-cured nail polish in the
OR and handling Ebola-contaminated instruments and
laryngoscope blades.
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.
Accreditation
AORN is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center’s
Commission on Accreditation.
Approvals
This program meets criteria for CNOR and CRNFA recertification, as well as other CE requirements.
AORN is provider-approved by the California Board of
Registered Nursing, Provider Number CEP 13019. Check
with your state board of nursing for acceptance of this activity
for relicensure.
Conflict-of-Interest Disclosures
Ms Wood and Ms Van Wicklin 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
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.2015.03.004
ª AORN, Inc, 2015
www.aornjournal.org
AORN Journal j 701
CLINICAL
ISSUES
1.2
www.aorn.org/CE
THIS MONTH
Ultraviolet (UV)-cured nail polish
Key words: nail polish, UV-cured, ultraviolet, gel nails, gel polish, shellac, hand hygiene.
Handling Ebola-contaminated instruments and laryngoscope blades and handles
Key words: Ebola, hemorrhagic fever, decontamination, instruments, laryngoscope blades and
handles.
Ultraviolet (UV)-cured nail polish
QUESTION:
Can health care personnel wear ultraviolet (UV)-cured nail
polish (eg, gel, Shellac) in the perioperative setting?
ANSWER:
Ultraviolet (UV)-cured nail polish (eg, gel, Shellac) should not
be worn in the perioperative setting. There have been no
published research studies on the risks and benefits of health
care personnel wearing these types of nail polish. Because of
the lack of evidence on the potential patient harm that could
result from health care workers wearing these types of nail
polish, and because of their chemical similarities to artificial
nail compounds, an abundance of caution should be taken
702 j AORN Journal
until research is conducted that demonstrates whether these
products are safe to use in health care settings. Artificial nails,
including extensions or tips, gels and acrylic overlays, resin
wraps, or acrylic fingernails, should not be worn by perioperative personnel.1
There are various descriptions of nail coverings used in the
field of cosmetology, including UV gels (eg, premixed acrylic,
ultraviolet cured, ultraviolet gel artificial nails),2 artificial
nails (eg, liquid and powder, acrylic, porcelain, solar,
sculptured),2 nail wraps (eg, fiberglass, resin, no-light gels,
silk, paper),2 UV-cured nail lacquers,3 and nail lacquers3
(eg, nail polish). Shellac is considered a UV-cured
nail lacquer.
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References
1. Bryson PH, Sirdesal SJ. Chapter 27: Colored nail cosmetics and hardeners. In: Cosmetic Dermatology: Products and Procedures. Hoboken, NJ: Wiley-Blackwell Publications; 2010:
206-214.
2. Schoon D, Baran R. Chapter 10: Cosmetics: the care and adornment of the nail. In: Baran & Dawber’s Diseases of the Nails and Their Management. Hoboken, NJ: John Wiley & Sons,
Ltd; 2012:471-483.
Acetone soak for 10 minutes, then
removal with wooden stick
Soak off gel: acetone soak for 30 minutes
Traditional removal: filing
Acetone soak for 30 minutes,
then peel off nail
Acetone
Removal
No
Yes
No
Used to Extend the
Nail Plate?
Yes
Polymerization with exposure
to UVA light
Polymerization with exposure to UVA light
Solvent evaporation
Coating Created by
Polymerization
Methacrylate or acrylate
Urethane acrylate or urethane methacrylate
Resin/solvent
Chemical Formulation
Methacrylate
UV-Cured Nail Lacquer
Nail Lacquer
1,2
Table 1. Description of Nail Polishes
Clinical Issues
Polish Types
Artificial Liquid and Powder
Ultraviolet (UV) Gels
June 2015, Volume 101, No. 6
Nail lacquer contains various combinations of resins, solvents,
plasticizers, colorants, thixotropic agents that provide flow
control and maintain dispersal of the colorants, color stabilizers, and other minor ingredients (eg, vitamins, minerals).3 A
newer type of polish, which some classify as UV-cured nail
lacquers, is described by the manufacturers as chip resistant
and they claim that the lacquers can be worn up to two
weeks.2 Ultraviolet-cured nail lacquers contain many of the
same elements of regular nail lacquer. However, rather than
relying on solvent evaporation to harden, which occurs with
typical nail lacquers, UV-cured lacquers create the nail
coating by polymerization of a methacrylate or acrylate that
hardens when exposed to UVA light.3 It is not clear what
the ingredients of UV-cured nail polishes are because they
are often patented formulas, and not all products have the
same formulation. Table 1 contains a description of various
nail polishes, including common chemical formulations, how
the polish creates the nail coating, if they are used for
extension of the nail plate, and removal methods.
Removal of UV-cured nail polish is not performed in the same
manner as regular polish and can vary by the type and
manufacturer. Some UV gels, also known as soak-off gels, are
removed after a 30-minute soak in acetone.2 Traditional UV
gel polish is removed by filing with an abrasive file.2
Ultraviolet-cured nail lacquer (eg, Shellac) is removed with a
wooden stick after a 10-minute acetone soak.2
According to the Centers for Disease Control and Prevention
(CDC), pathogens harbored in subungual spaces and artificial
nails may render hand hygiene ineffective.4 The CDC explains
that health care personnel with artificial nails have been
implicated as an outbreak source in epidemiological studies.4
Thus, the CDC recommends that artificial nails or nail
extenders should not be worn when health care personnel
have direct contact with high-risk patients, such as patients
undergoing surgical or invasive procedures.4 Extending the
nail plate or sculpting the nail is the primary function of
“liquid and powder” artificial nails.2,3 Some UV gels can be
used to extend the nail plate, although UV-cured nail
lacquers cannot. Regardless of whether the nail plate is
extended, there is insufficient evidence that artificial nails are
safe for use in health care settings. The World Health
Organization also recommends that health care personnel do
not wear artificial nails or extenders and further advises that
nail polish should not be worn when performing surgical
hand preparation.5
The concern with wearing UV-cured nail polishes is that the
gaps that develop between the polish and the cuticle at the base
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June 2015, Volume 101, No. 6
Health care organizations should establish policies and procedures on the types of nail polish, if any, workers in patient
care areas are allowed to wear,5 and communicate the policies
to health care personnel. If certain types of nail polish are
allowed and others are not, oversight of policy compliance
may be difficult to manage because there is no visibly
distinguishable difference between nail lacquer and UVcured nail polishes. If nail polish is allowed, the AORN
“Guideline for hand hygiene” recommends that chipped nail
polish be removed before entering the restricted area.1
Chipped nail polish increases the number of microorganisms
on fingernails.1,4 The recommendation to remove chipped
nail polish may be difficult to achieve if UV-cured nail
polishes are allowed, as the removal process is complicated
and takes longer than removal of nail lacquer. When
developing policies and procedures, a guiding principle
should be the risk of infection transmission to patients and
health care personnel rather than cultural preference.5
References
1. Guideline for hand hygiene. In: Guidelines for Perioperative Practice.
Denver, CO: AORN, Inc; 2015:31-42.
2. Schoon D, Baran R. Cosmetics: the care and adornment of the
nail. In: Baran & Dawber’s Diseases of the Nails and Their
Management. Hoboken, NJ: John Wiley & Sons, Ltd; 2012:
471-483.
3. Bryson PH, Sirdesal SJ. Colored nail cosmetics and hardeners. In:
Cosmetic Dermatology: Products and Procedures. Hoboken, NJ:
Wiley-Blackwell Publications; 2010:206-214.
4. Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory
Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory
Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task
Force. Society for Healthcare Epidemiology of America/Association
for Professionals in Infection Control/Infectious Diseases Society
of America. MMWR Recomm Rep. 2002;51(RR-16):1-45. quiz CE
1-4.
5. WHO guidelines on hand hygiene in health care: first global patient
safety challenge clean care is safer care. Updated 2009. World
Health Organization. http://whqlibdoc.who.int/publications/2009/
9789241597906_eng.pdf. Accessed February 6, 2015.
Amber Wood, MSN, RN,
CNOR, CIC
Perioperative Nursing Specialist
AORN Nursing Department
Editor’s note: Shellac is a registered trademark of Creative Nail
Design, Inc, San Diego, CA.
Handling Ebola-contaminated instruments and laryngoscope blades and
handles
QUESTION:
How should perioperative and sterile processing team
members handle Ebola-contaminated instruments and
laryngoscope blades and handles?
ANSWER:
In the event that a patient with confirmed or suspected Ebola
virus disease undergoes a surgical procedure, perioperative and
sterile processing team members should handle contaminated
instruments using standard, contact, droplet, and airborne
704 j AORN Journal
precautions.1,2 Table 2 provides precautions to take when
handling Ebola-contaminated instruments and the sequence
for care of instruments from the point of use through
transport to the decontamination area. Laryngoscope blades
and handles used during the care of a patient with suspected
or confirmed Ebola should be handled similarly (ie, using
standard, contact, droplet, and airborne precautions.)1,2
Table 3 outlines necessary precautions when handling Ebolacontaminated laryngoscope blades and handles and the
sequence for care of these items from the point of use
through transport to the decontamination area. The
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of the nail could harbor microorganisms, in much the same way
bacteria collect in artificial nails that are worn for an extended
period, although this has not been investigated in the literature.5
Ultraviolet-cured nail polish has the potential for lifting, which
can occur when polish is applied over the cuticle, which
continues to grow. Cuticle growth lifts up the polish and
creates gaps that may harbor microorganisms, which cannot
be effectively removed with hand hygiene. Microfractures in
long-lasting nail polish are also a concern because of the
potential for the cracks to become a reservoir for pathogens.
June 2015, Volume 101, No. 6
Table 2. Precautions for Handling of Ebola-Contaminated Instruments
Clinical Issues
1-3
Care of Instruments From Point of Use and Transport to Decontamination Area
Have closed cart or secondary container in the ORa
Remove all filters and trash from the instrument sets and rigid containers, including labels. This reduces the amount of Ebolacontaminated waste in the decontamination area
Coat instruments with enzymatic cleaner
Put instruments inside their rigid containers and secure the lids
Place the instruments inside the cart or secondary container and close the door or lid
Push the closed cart or secondary container out of the OR to the personal protective equipment (PPE) doffing (removal) area
Remove PPE per facility-specific sequence with trained observer present and perform hand hygiene
Don a clean gown and double gloves
Disinfect the entire closed cart or secondary container, including the wheels
Remove PPE per facility-specific sequence with trained observer present and perform hand hygiene
Don a clean gown and double gloves
Transport the closed cart or secondary container to the decontamination area with a team member who is not wearing PPE who
can open doors. The person transporting the cart/container should not touch any objects except for the cart/container during
transport. Do not leave the cart/container unattended
On arrival at decontamination area, deliver the cart/container to sterile processing team member who is wearing Ebola-specific
PPE
Remove PPE per facility-specific sequence with trained observer present in the sterile processing doffing area and perform hand
hygiene
Care of Instruments in Decontamination
Don PPE per facility-specific sequence with trained observer present
Receive cart/container with Ebola-contaminated instruments from perioperative team member
Process Ebola-contaminated instruments separately from other instruments and disinfect sink and ultrasonic cleaner (if used)
after use
Follow manufacturer’s instructions for use (IFU) to brush, flush, clean, and rinse instruments. Avoid generating aerosols by
performing cleaning activities under the surface of the water. Also, avoid splashing and keep glove cuffs above the level of the
water to reduce the risk of exposure
If manually cleaned, disinfect instruments with 70% to 90% alcohol
Place instruments in automated washer per manufacturer’s IFUs
Disinfect the closed cart and secondary containers. Process in cart washer, if available
Disinfect any work surfaces that touched objects, such as handles, control panels, and equipment
Remove trash from the room per facility protocol
Disinfect the entire floor
Remove PPE per facility-specific sequence with trained observer present in the sterile processing doffing area and perform hand
hygiene
Care of Instruments in Clean Packaging Area
If processed
o in an automated washer, remove from the washer and package for sterilization
o by manual cleaning and disinfection with alcohol, handle instruments with gloves. Place the instruments inside the container.
Then, remove gloves, perform hand hygiene, place lid on the container without touching the contents, and continue
packaging for sterilization
a
Bringing the cart or container into the OR before the surgery begins, if there is sufficient room in the OR to maintain a safe environment of care,
may reduce the risk of exposure to additional personnel. The secondary container should be large enough to accommodate rigid containers
and instrument sets.
References
1. Infection prevention and control recommendations for hospitalized patients with known or suspected Ebola virus disease in U.S. hospitals.
Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html.
Updated January 9, 2015. Accessed January 16, 2015.
2. Guidance on personal protective equipment to be used by healthcare workers during management of patients with Ebola virus disease in U.S.
hospitals, including procedures for putting on (donning) and removing (doffing). Centers for Disease Control and Prevention. http://www.cdc
.gov/vhf/ebola/hcp/procedures-for-ppe.html. Updated October 20, 2014. Accessed January 16, 2015.
3. Guideline for cleaning and care of surgical instruments and powered equipment. In: Guidelines for Perioperative Practice. Denver, CO: AORN,
Inc.; 2015:615-650.
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June 2015, Volume 101, No. 6
Table 3. Precautions for Handling of Ebola-Contaminated Laryngoscope Blades and Handles
1-3
Care of Laryngoscope Blades and Handles From Point of Use and Transport to Decontamination Area
Used in OR during an invasive procedure
o Have secondary container or closed cart in the OR
o Place the laryngoscope blades and handles inside a primary container and close the lid
o Place the primary container inside closed cart or secondary container with instruments from the procedure (see Table 2)
Used in area outside the OR
o Have secondary container in the personal protective equipment (PPE) doffing (removal) area
o Place the laryngoscope blade and handle
- inside a primary container and close the lid, and then
- inside a secondary container or closed cart and close it
o Remove PPE per facility-specific sequence with trained observer present and perform hand hygiene
o Don a clean gown and double gloves
o Disinfect the exterior of the entire secondary container or cart
o Remove PPE per facility-specific sequence with trained observer present and perform hand hygiene
o Don a clean gown and double gloves
o Transport the secondary container or closed cart to the decontamination area of the sterile processing area with a team
member who is not wearing PPE and can open doors. The person transporting the container/cart should not touch any
objects except the container/cart during transport. Do not leave the container/cart unattended
o On arrival in the decontamination area, the secondary container or closed cart should be transferred to a sterile processing
team member who is wearing Ebola-specific PPE
o Remove PPE per facility-specific sequence with trained observer present in the sterile processing doffing area and perform
hand hygiene
Care of Laryngoscope Blades and Handles in Decontamination Area
Don PPE per facility-specific sequence with trained observer present
Receive cart/container with Ebola-contaminated instruments from perioperative team member
Process Ebola-contaminated instruments separately from other instruments and disinfect sink and ultrasonic cleaner (if used) after use
Follow manufacturer’s instructions for use (IFU) to brush, flush, clean, and rinse instruments. Avoid generating aerosols by
performing cleaning activities under the surface of the water. Also, avoid splashing and keep glove cuffs above the level
of the water to reduce the risk of exposure
If manually cleaned, disinfect instruments with 70% to 90% alcohol after manual cleaning
Place instruments in automated washer per manufacturer’s IFU
Disinfect the closed cart and secondary containers. Process in cart washer if available
Disinfect work surfaces and any touched object, such as handles and control panels, and equipment
Remove trash from the room per facility protocol
Disinfect the entire floor
Remove PPE per facility-specific sequence with trained observer present in sterile processing doffing area and perform hand hygiene
Care of Laryngoscope Blades and Handles in Clean Packaging Area
For sterilization
For high-level disinfection (HLD)
o If processed in automated washer, package for sterilization
o If processed in automated washer or automated washer/
as usual
disinfector, handle as usual
o If processed by manual cleaning and disinfection with
o If processed by manual cleaning and disinfection with
alcohol, handle laryngoscope blades and handles with
alcohol, handle items with gloves
gloves. Place the item inside the container or package for
o Place the laryngoscope blades and handles in the HLD
sterilization. Then, remove gloves, perform hand hygiene,
solution per manufacturer’s IFU
close the container without touching the contents, and
o After HLD, discard the HLD solution that the laryngoscope
continue packaging for sterilization
blades and handles soaked in and clean and reprocess the
solution containers
References
1. Infection prevention and control recommendations for hospitalized patients with known or suspected Ebola virus disease in U.S. hospitals.
Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html.
Updated January 9, 2015. Accessed January 16, 2015.
2. Guidance on personal protective equipment to be used by healthcare workers during management of patients with Ebola virus disease in U.S.
hospitals, including procedures for putting on (donning) and removing (doffing). Centers for Disease Control and Prevention. http://www
.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html. Updated October 20, 2014. Accessed January 16, 2015.
3. Guideline for cleaning and care of surgical instruments and powered equipment. In: Guidelines for Perioperative Practice. Denver, CO: AORN,
Inc.; 2015:615-650.
706 j AORN Journal
www.aornjournal.org
June 2015, Volume 101, No. 6
According to the CDC’s Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation
(PUIs) for Ebola Virus Disease (EVD) in US Hospitals, health care
personnel coming into contact with Ebola should wear personal
protective equipment (PPE) that covers all exposed skin.3
Although there have been no documented transmissions of
Ebola virus from environmental surfaces, contaminated
instruments, or laryngoscope blades and handles, the CDC
advises higher levels of precaution toward potentially
contaminated objects because of Ebola’s “apparent low
infectious dose, potential of high virus titers in the blood of ill
patients, and disease severity.”4 As a result of these heightened
precautions, perioperative and sterile processing team
members should receive repeated education and training for
Ebola-related infection control procedures, especially in
donning and doffing of PPE, and a system that uses trained
observers should be implemented to oversee PPE procedures.5
To further reduce the risk of Ebola exposure among personnel,
the perioperative and sterile processing team should limit
environmental surface contamination with blood, body fluids,
or other potentially infectious materials4 and follow
recommendations for sharps safety.6
1. Wood A. Ebola precautions in the OR; abdominal-perineal dual
prep; CHG-impregnated cloths; alcohol-based antiseptics
and hair removal. Clinical Issues. AORN J. 2015;101(1):
149-157.
2. Van Wicklin S, Wood A. Update on perioperative Ebola precautions.
Clinical Issues. AORN J. 2015;101(5):574-585.
3. Infection prevention and control recommendations for hospitalized
patients under investigation (PUIs) for Ebola virus disease (EVD) in
U.S. hospitals. Centers for Disease Control and Prevention. http://
www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recom
mendations.html. Updated January 9, 2015. Accessed January 16,
2015.
4. Interim guidance for environmental infection control in hospitals for
Ebola virus. Centers for Disease Control and Prevention. http://www
.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals
.html. Updated January 9, 2015. Accessed January 16, 2015.
5. Guidance on personal protective equipment to be used by health
care workers during management of patients with Ebola virus
disease in U.S. hospitals, including procedures for putting on
(donning) and removing (doffing). Centers for Disease Control and
Prevention.
http://www.cdc.gov/vhf/ebola/hcp/procedures-for
-ppe.html. Updated October 20, 2014. Accessed January 16,
2015.
6. Guideline for sharps safety. In: Guidelines for Perioperative Practice.
Denver, CO: AORN, Inc; 2015:365-388.
Amber Wood, MSN, RN,
CNOR, CIC
Perioperative Nursing Specialist
AORN Nursing Department
Sharon A. Van Wicklin,
MSN, RN, CNOR, CRNFA,
CPSN-R, PLNC
Perioperative Nursing Specialist
AORN Nursing Department
The CDC’s Ebola guidelines are changing and clinicians are
advised to consult the most recent CDC update for infection
prevention and control recommendations (http://www.cdc
.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations
.html).
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AORN Journal j 707
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This suggested handling sequence for instrument and laryngoscope blades and handles is based on expert opinion and is
intended to support clinical practice in the development of Ebola
protocols by health care organizations and individual facilities.
Variations in practice settings and clinical situations may limit
the degree to which this guidance can be implemented.
References
print & web 4C/FPO
handling of laryngoscope blades and handles may vary from
instrument handling depending on the location of use and
type of reprocessing procedures (ie, sterilization, high-level
disinfection). Using disposable laryngoscope blades, when
available, may eliminate the need to follow these precautions
for reprocessing, in which case the Centers for Disease
Control and Prevention (CDC) guidance for managing Ebolacontaminated waste should be followed in accordance with
local, state, and federal regulations.3 The US Department of
Transportation’s Hazardous Materials Regulations classifies
Ebola as a Category A infectious substance, and the handling
of this type of waste (eg, used health care products) must
comply with regulations for Category A infectious substances.4
Clinical Issues
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.aorn.org/CE. Rate the items as described below.
PURPOSE/GOAL
To provide the learner with knowledge of AORN’s guidelines
related to the use of ultraviolet (UV)-cured nail polish in the
OR and handling Ebola-contaminated instruments and
laryngoscope blades.
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: ________________________________
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.
3.
Discuss common areas of concern that relate to perioperative best practices.
Low
1.
2.
3.
4.
5.
High
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?
Low
1.
2.
3.
4.
5.
High
5.
To what extent were your individual objectives met?
Low
1.
2.
3.
4.
5.
High
708 j AORN Journal
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