Infection Control in Perioperative Clinical Setting

This essay discusses infection control in perioperative clinical setting, outlining the role of the nurse in ensuring adherence to effective and safe practices. It also covers risk assessment and management in infection control to ensure patient safety.

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INFECTION CONTROL IN PERIOPERATIVE CLINICAL SETTING
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Introduction
Perioperative nursing involves provision of care to the patients before, during and
after surgical procedures or interventions. It is categorised into pre-operative, intraoperative
and postoperative nursing. It is a multidisciplinary approach which is composed of the nurse
at the receiving and holding bay, anesthetic team, circulating nurse, scrub or instrument
nurse, surgeon, and the nurse at the post-anesthetic recovery room. This essay will discuss the
infection control in relation to risk management and patient safety. The essay will also outline
the role of the nurse in ensuring adherence to effective and safe practices in perioperative
care.
Infection control is one of the fundamental aspects of the role of the nurse and also the
responsibility of all other healthcare professionals in the perioperative clinical setting.
Infection control remains a key goal in all settings of healthcare and effective collaboration
and responsibility of all professionals ensures achievement of this fundamental goal.
Infection control is totally a collaborative approach (Steelman, Graling, & Perkhounkova,
2013).
In perioperative nursing, professional accountability is a very broad descriptor that
encompass a wide range of things starting from the dressing and grooming, values, moral
beliefs and ethics. Professional accountability is the cornerstone of perioperative nursing
clinical practice to ensure infection control and patient’s safety. Measures of infection
prevention can be applied preoperatively, intraoperatively, and postoperatively (Steelman et
al., 2013).
Pre-operatively, infections are frequently attributed to bacteria which are found on the
patient’s skin surface. Therefore, reduction of the number of the bacteria on the skin is one of
the commonly applied practice to ensure patient safety by staying infection-free through the

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entire surgical process for effective recovery and improved quality of life. Preoperative skin
preparation should include removal of hair through shaving the surgical site, proper cleaning
of the surgical sites and application of an antiseptic agent before making surgical intervention
to prevent infections (White, & Spruce, 2015).
Removal of hair using a clipper or razor may cause skin abrasion or nicks which can
result to the development of infections like pseudofolliculities which can subsequently result
in surgical site infection. For the positive patient outcome, the perioperative nurses should
take part to ensure effective preoperative preparation hence infection control. Preoperative
showers should be applied to reduce the likelihood of skin colonization by the staphylococci
bacteria. Various agents such as chlorohexidine, alcohol disinfectants and iodine can be used
in prevention of infection (Steelman et al., 2013).
Use of antibiotics before and during the surgical procedure is one of the key measures
of infection control. Antiobiotics are important in the prevention and treatment of bacterial
infections. Antibiotic resistance occurs following the bacterial change in response to the
administered medications. Failure to use medications in perioperative care may lead to
increased risk of development of infections which consequently results in increased duration
of hospitalization, high costs of medicine and healthcare, and increased rates of morbidity
and mortality (Spruce, 2014).
Appropriate handling of used and infection items is essential in minimizing the risk of
cross contamination and risk of infection development in the clinical setting. The healthcare
professionals should regularly change or remove used aprons and gloves and dispose them in
the appropriate linen bags or waste bins. In the perioperative settings, there should be strict
adherence to the waste segregation guidelines to ensure effective control of infections
(Berrios-Torres et al., 2017).

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Risk assessment and management in infection control to ensure patient safety
In perioperative clinical setting, infection control risk assessment provides the
foundation for infection surveillance, control, and prevention activities. It helps in
identification of the at-risk procedures and population in the setting. Additionally, risk
assessment and management help the management to focus their efforts of surveillance
towards the set goals of perioperative nursing and to meet the regulatory requirements for
patient safety (Simons et al., 2012).
Risk assessment in infection control puts more consideration of the potential hazards
and prioritizes them for establishment of goals and strategy development. Risks of infection
control stems from a wide range of areas and sections of the perioperative clinical setting and
most of them can cause significant harm to the patients. Some of these risks include lack of or
poor hand hygiene, unsafe practices of injections, inadequate cleaning of the environment and
unsafe waste segregation practices (Bates, Saria, Ohno-Machado, Shah, & Escobar, 2014).
Poor cleaning, sterilization, and disinfection scopes and instruments also pose a great
risk of infection in the perioperative settings of clinical care. Therefore, risk assessment is
very essential in order to identify the risks which have the greatest risk of infection in the
setting. On assessment, the management team involved should document the findings and
prioritize processes in for improved outcomes to ensure patient safety (Simons et al., 2012).
In the risk assessment and management, one should focus of key elements such as
weather, topography, population, patterns of communication, population of healthcare
employees or professionals, environment, competency and education evaluation. Other
important factors that should be considered in perioperative clinical setting to ensure patient
safety include cleaning, sterilization, disinfection, procedures, risk for infection, and
emergency management (Bates et al., 2014).

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There is wide range of major risks for infection in healthcare clinical settings which
should be mitigated to ensure patient safety. Some of these risks include diarrheal diseases
like clostridium difficile, significant microorganisms such as MRSA, post-surgical
pneumonia or sepsis, and surgical device-related infections. In the risk assessment, patient
demographics such as gender, age, socioeconomic status and other factors that may impact on
their health should be considered (Gregory, Bolling, & Langston, 2014).
Communication patterns and strategies in the perioperative setting should also be
considered since poor communication between the healthcare personnel contributes to risk of
infection hence corrupting the patient’s safety needs. In the clinical setting, thee should be
comprehensive plans on one to coordinate, communicate and work with third parties such as
emergency medical services, emergency management team, professional groups,
departments, and medical societies (Gillespie, Gwinner, Chaboyer, & Fairweather, 2013).
The perioperative department should gauge how the healthcare professionals manage
and provide healthcare services to the patients. There should be strict requirements and
guidelines on hand hygiene and close monitoring for compliance should be put in place for
effective and safe practices of infection control to ensure patient safety. The management
should also assess on whether the healthcare team complies to the sharps injuries protocols to
prevent unnecessary risks (Gregory et al., 2014).
There should be adequate space of disinfection, cleaning, and sterilization in the
clinical setting. The management should put in place procedures for monitoring the use of all
sterilizers, disposables, high-level disinfectants, and the steps that are taken following a
failure of the sterilizer or disinfectant. Additionally, there should be a log and a schedule for

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preventive maintenance on the surgical and other related equipment to maximize on the
efficiency (Barnes, Spencer, Graham, & Johnson, 2014).
Regarding environment, there should be adequate space, proper lighting and
ventilation, sufficient sterilization, cleaning, and disinfection resources, furnishings, and
scopes. A healthy and clean environment calls for better protocols of biohazard waste
management and upgraded systems of ventilation (Yokoe et al., 2014). Infections in the
perioperative setting can be associated with little knowledge or lack of competency by the
healthcare workers. Therefore, in risk assessment this should not be left out. To ensure
patient safety and ensure effective infection control, there should be regular training
programs and competency testing for all healthcare professionals and workers to enlighten
them on the effective measures of infection prevention and control to ensure patient safety
(Barnes et al., 2014).
Role of the nurse in ensuring adherence to effective and safe practices in perioperative
care.
The nurses can be categorised into a holding nurse, anesthetic nurse, scrub nurse,
circulating nurse, instrument nurse, and post-surgical recovery nurse. Preoperatively, the
nurse has two major roles that are important in enhancing patient safety. These roles include
education and patient evaluation (Lamberg, Salantera, & Junttila, 2013). The nurse is
responsible for the assessment of the patient while providing critical medical history to the
surgical team. This ensures effective familiarity of the patient by the surgical team. The nurse
also provides preoperative patient and family education to ensure that they are well informed
and demonstrates adequate preparedness for the surgical intervention (Gillespie et al., 2013).

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The holding bay or receiving nurse plays an essential role in infection prevention. He
or she is responsible for the care and admission of the patients who have been brought into
the pre-operative area. When attending to the patient, he or she should have protective
garments and other equipment such as gloves and face masks to prevent the spread of
infection. The nurse at this area is responsible for getting vital medical information that is
relevant in the preparation of the patients for the surgical procedure (Rauta, Salantera,
Nivalainen, & Junttila, 2013).
The holding bay nurse also controls the traffic by enlightening the family members of
the patient on the importance of traffic control in perioperative settings. This is because,
crowding may lead to spread of microorganisms from one individual to another especially
from the patient to the staff or the members. Therefore, to ensure effective infection control,
the nurse should be very strict to avoid crowding in the perioperative settings (Rauta et al.,
2013).
Upon obtaining the information, the receiving nurse should document and
communicate to the surgical team. Such information may include any known sensitivities or
allergies to food or medications, fasting and hydration status, pathology reports,
administration of medication, and radiological investigations that had been done for the
patient based on his or her diagnosis. This information helps the nurse and the entire team to
apply effective and appropriate techniques and practices in the perioperative settings to
ensure prevention and control of infections (Blomberg, Bisholt, Nilsson, & Lindwall, 2015).
The anesthetic nurse has a key role in the control of infections in the perioperative
clinical setting. He or she is well trained and has adequate expertise in the provision of
support to the anesthetist and the patient before and during the entire surgical procedure. He
or she assists the anesthetists in administering anesthetic during the surgical intervention. He

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or she is fully involved in the equipment preparation, monitoring the condition of the patient,
and reacting the instructions given by the anesthetic team (Blomberg et al., 2015).
He or she works under the instructions given by the anesthetist. The anesthetic nurse
may also assume some of the roles and responsibilities of the circulating nurse. To ensure
adherence to safe and effective practices for control of infection, the nurse should always
employ the aseptic technique in and every step taken in perioperative care. The nurse should
also ensure that the other members of the surgical team strictly adhere to the infection control
guidelines (Rauta et al., 2013).
Another important member of the surgical team in the perioperative settings is the
circulating nurse. He or she is responsible for provision of all the required surgical supplies to
the surgical team. He or she should ensure that the supplies are promptly and correctly
supplied to the operating theatres. To ensure effective infection control, the circulating nurse
should check all the surgical equipment and supplies for cleanliness, sterility and expiry. This
is because, use of dirty, non-sterile and expired supplies is a key contributor the development
of infections to the patient (Magill et al., 2014).
Other duties of the nurse in the perioperative settings include documentation and
management of surgical supplies, collecting patient specimens, verification of patient’s
consent forms, ensuring accuracy in the count of instrumentation, and predation of the
surgical equipment. He or she should ensure sterility in all these steps to ensure patient
safety (Olans, & DeMaria, 2015).
The instrument nurse is mainly responsible for all supplies used in the surgical
theatres and he or she is always in anticipation of the needs of the surgical team. For effective
infection control and prevention, the instrument nurse always ensure that the surgical

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instruments, equipment, and supplies are sterile and well-functioning. He or she remains
vigilant throughout the entire surgical procedure for early recognition of the changing
condition of the patient and the potential intra-surgical complications for initiation of
immediate and appropriate response to prevent the development of infections (Olans, &
DeMaria, 2015).
Not to forget, the scrub nurse is the core of infection control and prevention in the
perioperative clinical setting. He or she ensures readiness, cleanliness, sterility and adequate
supply of surgical instruments. When handling the surgical instruments, he or she ensures
strict adherence to the guidelines of aseptic techniques to control infections. He or she
monitors the other surgical team for sterility in the clinical setting. The scrub nurse responds
to the hand motions of the surgeon and assesses the condition and safety of the patient
(Anderson et al., 2014).
Conclusion
Infection control is a very essential aspect of ensuring patient safety in perioperative
clinical setting. Infection control is a collaborative and multi-disciplinary approach in clinical
setting. In risk assessment, elements such as disinfection, cleaning, risk for infections,
education and competency of personnel, environment, procedures, communication,
population, and weather should be considered. Nurses play a role in infection control through
adherence to aseptic techniques in all their activities. Use of antibiotics, hygiene, aseptic
techniques and proper communication are one of the key measures of infection control.

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