Not so Mnemonics
SSI
What is Surgical Site Infection?
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection. This definition suggests that the organisms causing postop infection were present in the operative field before the operation.
What is class 4 or dirty/infected?
A patient underwent a laparoscopic appendectomy with the diagnosis of acute appendicitis.
What is wound class 3 or contaminated?
Chronic Cholecystitis with Gall Stones
What is Class II/Clean Contaminated?
Might be unaware that wound classification is ultimately their responsibility.
Who is the surgeon?
HAI
What is Healthcare Associated Infection? HAI is a localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s)
Uninfected operative wound, no inflammation, respiratory, alimentary, genital or uninfected urinary tracts are not entered.
What is class 1 or clean?
A Hip Spica Cast application, MUA (manipulation under anesthesia), closed nasal fracture.
What is Not Applicable as no incision is made to facilitate procedure.
Patient had a open repair of umbilical hernia. In the Operative note indicates "stool was found that had eroded through the colon which was necrotic"
What is Class IV / Dirty Infected?
Happens towards the end of the surgical procedure when the Circulating RN confirms items such as wound class and procedure.
What is the debriefing?
LOI
What is lack of interest?
Respiratory, alimentary, genital, or urinary tract entered under controlled conditions and without unusual contamination.
What is class 2 or clean/contaminated?
C-Section
What is Class II or Clean Contaminated?
Patient had a laparoscopic appendectomy. It was noted in the physician operative note, that there was purulent fluid in the RLQ of the abdomen.
What is Class IV: Dirty/Infected
Tool utilized at SHMC to 'hand off' at breaks, lunches or time of permanent relief?
What is SWITCH?
SWITCH for OR Hand Off
S Surgical procedure
□ Diagnosis
□ Stage of procedure (i.e., beginning, middle, end)
□ Specific patient concerns (eg, allergies, implants, health status)
□ Imaging needed (eg, x-ray)
□ Incision type/dressings needed
□ Plan for postoperative patient disposition
□ Procedure to follow
W Wet (i.e., fluids)
□ Medications on the sterile field (i.e., type, amount)
□ Irrigation (i.e., type, amount)
□ Blood loss and blood products available
□ Urine out
□ Drains
I Instruments
□ Need to reprocess instruments for to-follow cases
□ Instruments on hold
□ Implants needed
T Tissue (i.e., specimen)
□ Specimen (i.e., name, source of specimen)
□ Grafts (i.e., type, source of graft, location of graft [eg, specimen refrigerator, dry storage cabinet])
□ Type of laboratory procedure (eg, frozen, touch prep)
C Counts
□ Sponges, needles, sharps and instruments
□ Items off the sterile field or in body cavities
H Have you any questions?
□ Status of charting?
CDC/NHSN
What is the Center for Disease Control/National Healthcare Safety Network?
Open, fresh accidental wounds; operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract and incisions with acute, non-purulent inflammation.
What is class 3 or contaminated?
A 2 year old is having myringotomy for purulent otitis media.
What is Class IV or Dirty Infected?
Patient had a Laparoscopic Cholecystectomy for acute cholecystitis.
What is Class III / Contaminated
Responsible for documenting the correct wound class by communicating with the surgeon at the end of the procedure.
Who is the circulating RN?
ERAS
What is Enhanced Recovery After Surgery. A set protocol to encourage and speed recovery while decreasing the possibility of post operative complications
A case that requires anesthesia but no incision is necessary.
What is an example of N/A ? (cast change or application, hip spica cast, manipulation under anesthesia)
A patient had a previous repair of a flexor tendon one week before presentation. During an altercation, the wound was "crushed" open and became covered in dirt and debris. The patient presented to the emergency department for evaluation and was taken to surgery the same day for washout and repair. There was no description of any necrotic or purulent tissue. The wound was left open after the surgery.
What is Class IV or Dirty / Infected?
Patient admitted with peripheral vascular disease and gangrene of the toes of the left foot. The patient undergoes a BKA.
What is Class I / Clean
Is a collaborative effort between surgeons and perioperative RNs.
What is wound classification, patient positioning, medications i.e., plan for surgery?