Can You Pass This Infection Prevention Quiz?

Test your knowledge on surface disinfection, skin prepping, PPE, hair removal and more.

From meticulous surface disinfection policies to rigorous skin prepping protocols, surgical leaders have their hands full when it comes to making sure their facilities’ infection prevention efforts are up to snuff.

But with potentially life-threatening surgical site infections (SSIs) at stake, it’s critical for facility leaders get it right.

Test your knowledge on the diverse world of infection prevention. Take Outpatient Surgery Magazine’s latest quiz on the subject and see where you excel and where you might need to improve.

1. The Association of periOperative Registered Nurses (AORN) recommends that when hair removal is indicated, shave the patient’s hair at the surgical site as close to the start of surgery as feasible in a location outside the OR or procedure room.

• a) True
• b) False
• Reveal

  • Answer: False
    Trick question! Everything about this statement is true except for a single word: “shave.” Based on available evidence in the literature, AORN recommends that hair at the surgical site either be clipped or removed by depilatory methods in a manner that minimizes injury to the skin. “When hair removal is necessary, hair removal by clippers may be associated with lower risk of SSI (surgical site infection) than hair removal by razors,” states the 2023 edition of AORN’s Guidelines for Perioperative Practice.
    Regarding depilatory creams, the evidence is a bit more ambiguous. AORN cites one study that found no difference in SSI rates between clipping and chemical depilation, but that study noted the need for further research.
    A separate systematic review cited by AORN concluded that clipping is more effective in reducing SSIs than both shaving or using depilatory cream.
    AORN states there is consensus among professional associations to recommend hair removal with clipping rather than shaving with a razor. Other associations that agree are The American College of Obstetricians and Gynecologists, American College of Surgeons and Surgical Infection Society, Centers for Disease Control and Prevention, National Association of Orthopaedic Nurses, the National Institute for Health and Care Excellence, Society for Healthcare Epidemiology of America/Infectious Diseases Society of America and the World Health Organization.
    And like AORN, all those associations also recommend avoiding hair removal entirely unless it interferes with the surgery.
    Close

2. An ASC wants to make sure its staff is using PPE properly, but hiring a staff infection preventionist (IP) isn’t in the budget. What’s the next best move?

• a) Assign the task to the busiest person in the room. That’s who will get it done the quickest.
• b) Take a stand and present your case at the next board meeting to hire a full-time IP.
• c) Pay for certification training for a new nurse who is eager to advance.
• d) Call your local hospital to see if their staff IP needs a side hustle.
• Reveal

  • Answer: d.
    Perhaps surprisingly, a simple call to the hospital in the same community as you might be the most expedient solution. That’s that Orange County Digestive Center in Irvine, Calif., did in 2020, with impressive results, says Managing Director Nicole Christ, RN, the center’s managing director.
    In addition to observing how the staff was using PPE and offering suggestions on how to improve, the hospital’s staff infection preventionist offered a wide array of help in other areas as she happily accepted the moonlighting gig.
    “The best part about the arrangement is the convenience of it,” says Ms. Christ. The IP has a master’s degree in epidemiology and is more than qualified for the position. Getting information about whether a new state regulation applies to the center, for example, could likely be answered with a quick phone call to her. If it does, she can provide and action plan in a week. This is infinitely better than an ASC staff member spending two hours researching the new reg.
    The consultant also performs annual assessments for things such as tuberculosis and aerosolized transmissible diseases, as well as quarterly infection control audits, which includes observing our hand hygiene, surface cleaning and sterile reprocessing practices. She also does an annual inspection and provides links to relevant training videos.
    Close

3. Modern adhesive dressings have improved so much that old-fashioned egg crate foam is no longer an inexpensive viable option to prevent pressure injuries.

• a) True
• b) False
• Reveal

  • Answer: b.
    Adhesive dressings work well when padding patients and old tables with hard edges. But despite advances that make them tougher and with more stretch than ever, egg crate foam remains a versatile option to for ASCs on a budget that realize that patients are in danger of developing pressure ulcers even during short-in-duration elective same-day surgeries.
    For example, when a patient arrives in pre-op with a pressure injury on their heel, the heel should be padded and elevated from the operating table when possible, according to Joyce Black, PhD, RN, FAAN, associate professor in the College of Nursing at the University of Nebraska Medical Center in Omaha, Neb.
    “It comes in a big brick,” says Dr, Black. “People tend to do is break it in half, but you’re better off leaving it as one piece and use it as a cushion under the calf of the patient so that their heels float off the end of it on the operating table.
    Breaking off a piece of the foam brick is an effective way to pad a patient’s elbow or shoulder to guard against pressure injuries from contact with a table, especially when the procedure calls for the patient to be in the prone position. The correct amount to break off and use based on their body habitus, says Dr. Black.
    Close

4. When conducting internal audits of your facility’s skip prepping procedures to identify gaps in compliance and best practices, the minimum number of procedures recommended in the Agency for Healthcare Research and Quality’s (AHRQ) Surgical Skin Preparation Audit Tool is:

• a) 5
• b) 15
• c) 10
• d) 25
• Reveal

  • Answer: c.
    While the AHRQ tool recommends auditing a minimum of 10 procedures, it also makes it clear that the more cases you observe, the better. In fact, the tool specifically points out that “the more patients you review, the more likely you are to identify opportunities to improve the adequacy of surgical skin preparation.”
    Of course, the AHRQ Audit Tool is only one of several proven tools facility leaders can use to guide their skin prep protocols.
    When observing the OR team’s prep practices, Helen Boehm Johnson, MD, a Fla.-based physician and medical writer, recommends that auditors pay particularly close attention to the prepping of specific body areas. “For example, before shoulder surgery, ensure the axilla, an area of higher microbial colonization, is prepped last,” says Dr. Johnson. “In abdominal procedures, ensure the umbilicus is prepped first in order to avoid splashing debris from the umbilicus onto the prepped abdomen.”
    She also recommends that audits are performed randomly and across a variety of procedures to achieve a more global assessment of compliance.
    Close

5. A 55-year-old female presented for a revision of a 5-inch vertical laceration on the anterior aspect of the lower left leg that was initially repaired in an emergency department. The repair was performed at an ASC, where the provider utilized black, non-absorbable nylon surgical sutures and sterile dressing. After two days, the patient noticed swelling, which prompted her to see a surgeon. The surgeon noticed a hematoma, so he scheduled her for revision. During the revision, the surgeon noticed there was no deep closure performed in the initial repair, so he drained the hematoma and debrided necrotic tissue at the suture line. The skin was closed with absorbable sutures in a subcuticular fashion and the surgeon used liquid adhesive, thin adhesive bandages, knitted cellulose acetate mesh, absorbent gauze 4x4 gauze and self-adherent elastic wrap to complete the revision. The patient presented three days after the revision with a chief complaint of surgical site pruritus, but on postoperative day five, the patient experienced edema of their left foot, ankle and calf with vesicle formation and hyperpigmented urticaria around the laceration. What is preventing the wound from healing properly?

• a) The patient was not given proper instructions on how to care for her wound.
• b) The wound was never properly cleaned and repaired in the ER.
• c) The patient is allergic to adherent materials.
• d) The wound wasn’t closed correctly.
• Reveal

  • Answer: c.
    You may think asking your patients to disclose their known allergies is sufficient, but what if they have an allergy or hypersensitivity to certain surgical supplies?
    Although rare, allergies to materials such as adhesive, tape and liquid medical adhesive can cause adverse effects such as itchiness, swelling and discomfort that can delay the healing process and lower your patient’s overall satisfaction.
    The patient was diagnosed with having a type IV hypersensitivity reaction to liquid adhesive, which was treated with a prescription for a tapered two-week regiment of prednisone and diphenhydramine. “This case study stresses the importance of preoperative history-taking, especially regarding allergies such as reactions to adhesives, tape, liquid adhesive,” says Nicholas F. Cozzarelli, BS, a medical student at Hackensack Meridian School of Medicine in New Jersey. “Surgeons have preferences for how they decide to close and dress incisions, but these preferences must match patient needs to ensure safety,” he says.
    Utilizing a checklist to ask specifically about known allergies to surgical supplies that are planned to be used by the surgeon can help avoid scenarios like above. “This was an eye-opening experience that something innocuous like liquid adhesive could have such a prolific surgical impact,” recalls Mr. Cozzarelli.
    Close

6. Items located centrally to the core of the room are more likely to be rated as not clean than those further from the core.

• a) True
• b) False
• Reveal

  • Answer: False.
    While equipment and surface location in the OR have potential to impact terminal clean effectiveness, items located centrally to the core of the room such as mayo stands, back tables and procedure tables are often rated as clean. Items that were noted to be in the periphery of the room had lower instances of achieving a clean rating, included door handles, telephones, IV poles and light switches. In a study conducted by Brandon Feusner, BS, T-CHEST, Infection Prevention Coordinator AND Disinfection & Sterilization at UofL Health in Louisville, Ky., pre-selected surfaces were marked in randomly selected rooms utilizing a fluorescent marking method prior to terminal cleaning.
    Terminal cleaning was performed by environmental service technicians and the evaluation of terminal clean was conducted by trained members of the Infection Prevention team. Items were noted as “clean” if there was no residual fluorescent marking and “not clean” if residual was found.
    A total of 83 ORs were audited, with 561 items marked. “Of these items, 33% (184/561) were rated as clean,” notes Mr. Feusner. “The surfaces rated as cleaned most frequently were mayo stands (58%), followed by back tables (49%), procedure tables (40%) and overhead lights (31%). Items that were noted to be in the periphery of the room had lower instances of achieving a clean rating. These included door handles (29%), telephones (27%), intravenous (IV) poles (21%) and light switches (17%).
    This study demonstrates that equipment and surface location in the OR can impact terminal clean effectiveness,” he says. “Attention should be provided to all areas of the OR and reinforced through education, competency and training,” notes Mr. Feusner. OSM
    Close