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1

when are abx given prior to surgery

30min- 1hr

2

when is a fluoroquinolone or vancomycin given before surgery? why?

120 minutes to avoid an adverse reaction associated with rapid infusion.

3

the professional consensus supports using narrow-spectrum, first and second generation cephalosporins. why?

inexpensive, safe to use and bactericidal and have long half lifes

4

if a patient is hypothermic, how many times higher is their rate of infection

3 times higher and stayed in the hospital nearly 1 week longer than normothermic patients.

5

what percent of surgical infections are considered preventable

60%

6

how often is temperature measured

q15 minutes

7

when does the greatest decline in patient temperature occur

during the first hour of surgery

8

how do we keep the patient warm

forced warm air- bair hugger

9

HAI occur at what percent in hospitalized patients

10%

10

what is the failure rate of anesthesia providers not washing their hands

64-93%

11

The CDC and the National Nosocomial Infection System define SSIs by the following clinical criteria

4 things

A purulent exudate draining from a surgical site

A positive culture obtained from a surgical site that
was closed initially

A surgeon’s diagnosis of infection

A surgical site that requires reopening due to at
least one of the following signs or symptoms: tenderness, swelling, redness, or heat

12

what 3 things can CRNA's do to prevent infection

normothermia
timely abx
handwashing

13

surgical site infections are how common

2nd most common hai

14

how many days since surgery is considered a SSI

30days

15

The infection risk associated with primary hip and knee arthroplasty is approximately 1% and increases to 2% to 5% for arthroplasty revision. Explain why orthopedic infections are a grave concern

infection in the bones and joints is very difficult to treat and is associated with a lifelong recurrence risk of 10% to 20% When multi-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) infect a prosthetic joint, the treatment failure rate is 20% to 40%.
It is costly, and requires a new joint replacement, prolonged abx and rehab.

16

what do volatile and IV anesthetics and opioids do to thermoregulation

mpair thermoregulatory control by decreasing heat production and increasing cu- taneous heat loss through vasodilation

17

how does muscle relaxants impair thermoregulation

Muscle relaxants also compromise thermoregulatory control by preventing shivering

18

name the various adverse outcomes to a patient being hypothermic

increased blood loss (transfusion requirement)

prolonged postoperative recovery times

heightened post op pain

impaired neutrophil function

vasoconstriction leading to hypoxia

INCREASED INCIDENCE OF SSI

19

what precent of colorectal surgeries develop SSI

20%

20

how much longer did patients with hypothermia stay in the hospital

nearly 1 week longer

21

name some various risk factors for developing hypothermia

extremes of age
female
length and type of procedure
general and spinal anesthesia
ambient temp of OR
preexisting condition (BURNS, ENDOCRINE disorder, PREGNANCY, Large open wound)

22

what is deemed the gold standard for measuring temperature

no gold standard exist

23

what is the most reliable method to measure temperature

distal esophagus

24

what is the issue with using rectal temperature

it lags behind temperature measured in the esophagus and pulmonary artery.

fails to rip during MH!!

25

when is the greatest decline in patient temperature

occurs during the first hour of surgery

26

the association of operating room nurses recommends ambient temperature between what two degrees

20-25C

27

failure of hand hygiene is what percent range

64-93%

28

The 2009 WHO Guidelines on Hand Hygiene36 recommend that the healthcare provider engage in hand hygiene in the 4 following situations

1. visibly soiled or after using the toilet

2. exposure to spore forming (cdiff) patogens

3. Before and after touching a patient, if moving from a contaminated body site to another body site during the care of the same patient

4. Before handling medications or preparing food