Sunday, March 28 to Thursday, April...

Sunday, March 28 to Thursday, April 1 1999

A number of education sessions were held during the 46th annual AORN Congres offering attendees numerous contact hours. A not many of the sessions are described here.

just discovered GUIDELINE FOR PREVENTING SURGICAL SITE INFECTIONS

The Hospital Infection superintend Panel Advisory Committee (HICPAC) of the Center for Disease command (CDC) has revised the comprehensive guideline for preventing surgical site infections (SSIs). During his education session, James side sheltered from the wind MD, PhD, FACS, one of the 12 members of the committee, discussed surgical site infections, guideline growth and current recommendations.

The terminus SSI refers not only to superficial or astute infections but also to organ and space infections. An SSI is caused by means of pathogens from a patient or environment that has undergone a questionable period of contamination. The goal during the average 74000 surgical actions performed each day in greatest in number hospitals is to complete the practice with such a low number of microbes that the patient's material part can protect itself. The multifactional cause-and-effect situation makes acquiring an SSI a network phenomenon and results in numerous opportunities for postoperative infections.

The CDC guideline includes recommendations for patient care that can be used according to every specialty or branch. The recommendations address diagnosis, prevention, and therapy. Dr side sheltered from the wind reviewed factors (eg, obesity, anemia, malnourishment) that previously were considered to state a patient at risk for SSI, if it were not that are not strongly supported by means of research.

He also reviewed the contented of the CDC guideline for 1999 in which recommendations are categorized (ie, vehemently encouraged, encouraged and should be done, unresolved) There are 58 recommendations that focus upon preoperative and intraoperative activities, and 21 recommendations that are either encouraged or unresolved

Surgical site infections are an issue flaw, which cannot be changed unles health care practitioners do something positive or adverse. Organized knowledge regarding SSI risk reduction exists, and it requires that perioperative promotes understand and practice consistent, standardized information of that kind as the CDC guideline for preventing SSI. The guidelines can be construct at www.cdc.gov/ncidod/hp.

BRENDA s GREGORY DAWES RN, MSN, CNOR EDITOR

VIDEO ASSISTED THORACOSCOPIC SURGERY

Pediatric patients who are born with spinal deformities now have the advantage of video assisted thoracoscopic surgery (VATS) for repair and correction. In their education session, Joan M Reicher, RN CNOR, and Kimberly A. McEvoy RN CNOR, described the management and outcomes of severe and rigid spinal deformities, scoliosis, or kyphosis.

The goal of VATS is to increase mobility and improve deformity correction from releasing the annulus fibrosis and anterior longitudinal ligament, insetting bone anteriorly, and immediately performing a posterior spinal fusion. Advantages of VATS include greater access to the upper thoracic spine, ability to access more horizontals decreased pain, shorter recovery time, and improved postoperative pulmonary function.

Thoracoscopy requires four wound sites (ie, one each for irrigation and suction, working channel, retraction, and camera placement). The speakers said implant arrangements for posterior fusion are a significant richness variable depending on surgeon choice experience with the system, and implant features. They neared a prospective review of 65 deeds performed between October 1994 and June 1998 They reviewed clinical results cost accounting, and relevant data about spinal fusions related to management strategies. Measured clinical issues included blood loss, chest tube drainage, continuance of hospital stay, and surgery times. They reported that patients were able to receive treatment with single in kind less surgical procedure, clinical results were not adversely affected, and the differences in richness were not remarkable as compared to other spinal measures They suggested health care providers decrease outlays and increase reimbursement by knowing the charge of procedures. This requires reviewing the richness of the entire hospital stay, initiating consignment masterys partnering with product representatives, and carving without reimbursement (ie, paying an amount more than the negotiated rate for contracts from payers). Reichner and McEvoy said identifying patient needinesss understanding the procedure, and outlay accounting allow the provision of quality patient care at a time when price is an issue.

BRENDA s GREGORY DAWES RN, MSN, CNOR EDITOR

CLINICAL WISDOM OF PERIOPERATIVE NURSES

worthy caring practices supported by research were at handed by Patricia Benner, RN, PhD FAAN, in the education session "From Novice to Expert: Discovering the Clinical Wisdom of Perioperative Nurses" Benner shared findings onward clinical wisdom and interventions of 48 critical care feeds who participated in an eight-year reflection She illustrated skill acquisition from beginning to adroit practices, demonstrating principles of practices at different evens Three habits of thought and action guide clinical practice, including clinical grasp, inquiry, and forethought, according to Dr Benner. She described the domains of practice and characteristics of individuals practicing in these domains of the like kind as managing breakdown, preventing hazards, and having leadership skills.