I work as a Registered nurse in the department of Endocrinology. Endocrinology is a broad term for the body’s hormone regulation system and the organs that produce the hormones needed to sustain life. The majority of our patients are patients with type 1 diabetes, thyroid nodules, and hyper/hypo thyroidism. When a patient comes to our office for a thyroid nodule we perform an ultrasound on the thyroid. If a significant size nodule is found a thyroid biopsy is done. The nurse is responsible in preparing the patient for this biopsy which includes a passage of four needles into the thyroid using ultrasound guidance. Thyroid aspiration biopsies are performed on a daily basis. The guidelines for the perioperative procedure are as follows: THYROID ASPIRATION BIOPSY
1. Prepare patient with gown open to back
2. Remove all jewelry around neck
3. Place pillow on table for procedure mid back so neck is hyper-extended 4. Apply non-sterile gloves
5. Cleanse neck with Betadine (providone-iodine).
6. Rinse each syringe in cytolyte container 3 times. Apply sample to slide per MD instructions. 7. Place slides in cardboard holders and specimen bag
8. Make sure lab slip accompanies slides, cytolyte container 9. Take sample to 2nd floor pathology department at the end of the day. 10. After patient’s neck is cleansed with alcohol, apply Band-Aid. Current evidence-based practice uses chlorhexidine in place of Betadine for antiseptic skin preparation when an invasive procedure is to be performed. I will show through evidence-based practices that this is a valid change to this procedure. A2a.BASIS FOR PRACTICE
At Kaiser Permanente, procedures, protocols, and guidelines are researched, overseen, and implemented by the Nursing Education Department, the Risk Management Department, and the Patient Safety Department. Evidence-based practice was once in favor of cleansing the skin with Betadine as a skin antiseptic prior to an invasive procedure. According to the Center for Disease Control (2013),” Surgical site infections “(SSIs) remain a substantial cause of morbidity and has an associated mortality rate of 3% and 75% of the mortality rate has been directly related to a SSI. Surgical site infections (SSI) costs are in the millions and reducing these risks are imperative. A2b.RATIONALE
Betadine is a microbicidal and kills existing bacteria at the site. The use of Betadine to cleanse the neck area is practiced as a skin antiseptic for the destruction of microbes prior to an invasive procedure to reduce the incidence of post procedural infection. A2c.EXPLANATION
Evidence based practice has proven that cleansing the area before an invasive procedure reduces the risk of infection. Proper technique is emphasized in preparing a patient for a thyroid biopsy. Betadine (providone iodine) is a microbicidal agent that kills a broad spectrum of pathogens. Betadine when used topically on an area prior to a procedure reduces the risk of post-operative infection.
Darouiche, R. O., Wall, M. J., Itani, K. M., Olterson, M. F., Webb, A. L., Carrick, M. M., . . . Mosier, M. C. (2010, January). Chlorhexidine - Alcohol versus Providone - Iodine For Surgical - Site Antisepsis. New England Journal of Medicine, 362(1), 18-26. doi:10.1056/NEJMoa0810988 Hemani, M., & Lepor, H. (2009). Skin Preparation for the Prevention of Surgical Site Infection: Which Agent is Best? Reviews in Urology, 11(4), 190-195. Retrieved March 2013 Malwald, M., & Chan, E. (2012). The Forgotton Role of Alcohol: A Systematic Review and Meta-analysis of the Clinical Efficacy and Preceived Role of Chlorhexidine in Skin Antisepsis. PLoS One, e44277. Retrieved March 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC34342031 Noorani, A., Rabey, N., Walsh, S. R., & Davies, R. J. (2010, November). Systematic Review and Meta-analysis of Preoperative Antisepsis with Chlorhixidine versus...