Question: couple patients recently...

Question: couple patients recently experienced two separate incidents of septic joints put forward anterior cruciate ligament reconstruction with tendon allografts. The conducts were performed two days apart by the agency of different surgeons with different instruments. Different staff members participated in each action There was no commonality in organisms cultur from the joints. The solely common factor was the source of the graffs; the two grafts were obtained from the a certain number of tissue honk. Our facility epidemiologist worked with the tissue honk last discovered that the graffs were from a usual donor and that they hod been released for implantation without having received any kind of terminal sterilization. Is this often met with practice? Is there a requirement for donor screening for infectious diseases?

Answer: The US meat and Drug Administration (FDA) requires all tissue donors to be covered for HIV, hepatitis B, hepatitis C and other bloodborne pathogens. There are no requirements related to other infectious agents. (1) The American Association of Tissue Banks (AATB) publishes standards for obtaining and processing tissue for implantation. Guidelines address:

* donor screening;

* time limits for retrieval of easily moulded tissue;

* a measures for tissue preservation, sterilization, preparation, and evaluation; and

* tissue labeling.

Freezing or freeze-drying are the classifications most frequently recommended for tissue preservation. (2) The primary modes for sterilization are gamma irradiation or ethylene oxide (EO) most numerous tissue banks use gamma irradiation, on the other hand high doses of gamma irradiation can have an adverse efficiency on the graft. Ethylene oxide, forward the other hand, has limited ability to penetrate tissue, and adverse patient issues have occurred following implantation of EO-sterilized gratis. Musculoskeletal tissues (eg bone-tendon allografts) are being procur and courseed aseptically, but the tissues are not terminally sterilized because of disturbs about sterilization-related complications. The AATB standards require tissue banks to expand a list of organisms that require graft destruction, sterilization, or disinfection should they be cultur from procur tissue. All tissues, however, are not cultur and the AATB does not provide a list of of the like kind organisms. (3)

A further disturb is that close to one-half of existing tissue banks are not accredited by way of the AATB or inspected by the agency of state regulatory agencies. Only sum of two units states require licensing and inspection of tissue banks. Tissue banks that are not accredited or licensed ne not comply with external standards or quality requirements beyond donor screening for HIV and hepatitis as required at the FDA. (4) With the unfortunate infections experienced at your facility and the information gleaned on your epidemiologist, you might want to consider using a different tissue bank for coming needs. Talk with potential tissue bank partners in your area to determine their arrangements and practices, whether they are licensed or accredited, and, if in the same manner by whom.

Question: I am a perioperative feed at the breast educator responsible for two facilities in the same health care system. One of these facilities is in succession ambulatory surgery center. I would like to lay open end implement a policy for identifying the correct surgical site in the two facilities. We hove never hod onward incident, end nursing staff members in the facility where I work think it could in no degree happen here. They ore not interested in developing a protocol or operation for identifying the correct surgical site. We identify patients by means of asking them to state their name, extremity the surgical site is checked by the agency of looking et the OR schedule completion the surgical consent. Our circulating supply with nourishments think this is sufficient. Last year, I heard a hap about wrong site surgery, on the other hand I hove not heard anything lately. Does AORN support having a policy fall of the curtain procedure for correct site surgery or is this no longer a problem?

Answer: AORN does support each facility having a policy and practice for identifying the correct surgical site. Incorrect surgeries continue to be a serious point in dispute According to the Joint Commission onward Accreditation of Healthcare Organizations (JCAHO), the number of reported cases of improper site surgery (ie, the unsuitable surgery being performed or surgery being performed upon the wrong patient or the unfit site) has increased from 15 in 1998 to 150 in 2001 (5) Joint Commission statistics exhibit the following breakdown:

* orthopedics/pediatrics, 41%;

* general surgery 20%;

* neurosurgery 14%;

* urology 11%; and other, 14% in a variety of specialties.

Fifty-eight percent of incidents occurr in ambulatory surgery center 29% in inpatient ORs, and 13% in pass departments and/or intensive care units. Seventy-six percent of incidents involved surgery forward the wrong body part or site.

The Joint Commission has identified a number of risk factors contributing to guilty site surgery (ie, incorrect surgeries, incorrect patients, incorrect sites). These include:

* unforeseen occasion surgeries,