Wound Classifications
A patient is undergoing an elective total hip arthroplasty. There is no inflammation, no break in sterile technique, and the respiratory, gastrointestinal, and genitourinary tracts are not entered. How should this wound be classified?
A. Clean-contaminated
B. Contaminated
C. Clean
D. Dirty/Infected
What is clean?
A patient has a known allergy to chlorhexidine gluconate. The surgeon requests a CHG-alcohol prep because it is the department's standard. What would you do as the circulating nurse?
What is informing the surgeon of the patient's allergy to CHG and requesting an alternative FDA-approved antiseptic appropriate for the patient rather than using CHG?
This should always be completed before using any piece of surgical equipment on a patient.
What is inspecting the equipment to verify it is functioning properly and safe for use?
This is the single most effective intervention to prevent the transmission of microorganisms in the perioperative setting.
What is hand hygiene?
This must occur every time a medication is transferred from its original container into another container in the OR.
What is labeling the medication or solution immediately?
During a laparoscopic cholecystectomy, the surgeon enters the biliary tract under controlled conditions without spillage or infection. What is the wound classification?
A. Clean
B. Clean-contaminated
C. Contaminated
D. Dirty/Infected
What is clean-contaminated?
The prep solution has pooled beneath the patient's hip before draping. What are you going to do as the nurse in the room to advocate for your patient?
What is removing the pooled solution and allowing the prep to dry completely before draping to reduce fire and chemical injury risk?
Equipment begins malfunctioning during surgery, but a backup is immediately available. What are you going to do?
What is removing the malfunctioning equipment from service and reporting it according to facility policy?
You, the circulator, notice a scrub person has a 2-mm hole in their sterile glove while passing instruments. What is your priority?
What is changing the glove immediately using aseptic technique?
A sterile basin on the back table contains clear fluid with no label. What should you do?
What is discarding the unlabeled solution because it cannot be safely identified?
During a colon resection, there is significant fecal spillage into the surgical field. What is the appropriate wound classification?
A. Clean
B. Clean-contaminated
C. Contaminated
D. Dirty/Infected
What is contaminated?
This action should occur immediately before applying the skin prep if hair removal is necessary.
What is clipping the hair outside the OR or as close to the time of surgery as possible, rather than shaving?
Electrical cords cross a main walkway in the OR. What is the priority?
What is a trip hazard that should be corrected by securing or rerouting the cords?
This type of precaution should be used for every surgical patient, regardless of diagnosis.
What are standard precautions?
A medication syringe is prepared by one person and administered by another. What is the priority?
What is requiring verification according to facility policy, including confirming the medication label and intended use?
A patient presents with a perforated appendix and an intra-abdominal abscess requiring emergency surgery. The wound classification is:
A. Clean
B. Clean-contaminated
C. Contaminated
D. Dirty/Infected
What is dirty/Infected?
You discover the prep solution has not dried, but the surgeon wants to drape immediately. What are you going to do?
What is delaying draping until the prep has completely dried according to the manufacturer's IFU?
A nurse notices a frayed power cord on a sequential compression device after the patient has already entered the OR. The device still powers on normally. What are you going to do?
What is removing the device from service and obtaining a replacement before patient use?
You notice there are two intact tabs on the outside of a rigid container. The indicator on the outside of the tabs have no changed, indicating exposure to the sterilization process. What are you going to do?
What is send tray back down to SPD and obtain another one?
The surgeon requests "the usual antibiotic" but does not specify which medication or dose. What should you do?
What is clarifying the medication order before preparing or administering the medication?
A patient undergoes surgery for a perforated diverticulum with fecal peritonitis and an abscess. What is the wound classification?
What is dirty/Infected?
Infection and perforated viscera existed before surgery.
A patient is undergoing a below-the-knee amputation. The circulator preps from the incision site toward the foot, using a single applicator. After reaching the foot, the circulator returns to the incision site with the same applicator to "make sure it's well prepped." What is the problem here?
What is the applicator was taken from a more contaminated area (the foot) back to the cleaner incision site. Once an applicator reaches a more contaminated area, it should not be returned to the clean area. A new applicator should be used if additional prep is needed.
An ESU pencil has a cracked insulation jacket, but it still functions when tested.
What is removing it from service because damaged equipment should never be used?
The back table is set up, but no one remains in the room while the team transports the patient and the back table is not covered.
What is an unattended sterile field that should be considered contaminated according to AORN guidance?
A medication error is caught before reaching the patient. What is this considered and what are your next steps?
What is a near miss that should still be reported according to facility policy to prevent future errors?