CON T I N U I N G EDUCAT ION
Perioperative Strategies for Surgical Site
Infection Prevention
1.1 www.aornjournal.org/content/cme
Marie A. Bashaw, DNP, RN; Kathy J. Keister, PhD, RN, CNE
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PURPOSE/GOAL
To provide the learner with knowledge of best practices related to
perioperative strategies for surgical site infection (SSI) prevention.
OBJECTIVES
1. Identify contributing patient factors related to SSI development.
2. Identify contributing procedural factors related to SSI
development.
3. Describe perioperative best practices to help decrease the inci-
dence of SSIs.
4. Describe two types of skin antiseptic agents that may be used
for perioperative skin preparation.
ACCREDITATION
AORN is accredited with distinction as a provider of continuing
nursing education by the American Nurses Credentialing Center’s
Commission on Accreditation.
68  AORN Journal 
APPROVALS
This program meets criteria for CNOR and CRNFA recertification,
as well as other CE requirements.
AORN is provider-­approved by the California Board of Registered
Nursing, Provider Number CEP 13019. Check with your state board
of nursing for acceptance of this activity for relicensure.
CONFLICT-­OF-­INTEREST DISCLOSURES
As a member of the AORN Guidelines Advisory Board and the
recipient of a grant from AORN of Dayton, Marie A. Bashaw, DNP,
RN, has declared affiliations that could be perceived as posing
potential conflicts of interest in the publication of this article. As a
recipient of an education grant from Sigma Theta Tau International,
Indianapolis, IN, and the Assessment Technologies Institute,
Leawood, KS, and payment for the development of educational
presentations from Florida A&M University, Tallahassee, Kathy J.
Keister, PhD, RN, CNE, has declared affiliations that could be per-
ceived as posing potential conflicts of interest in the publication of
this article.
The behavioral objectives for this program were created by Jocelyn
Chalquist, BSN, RN, CNOR, clinical editor, with consultation from
Susan Bakewell, MS, RN-­BC, director, Perioperative Education. Ms
Chalquist and Ms Bakewell have no declared affiliations that could
be perceived as posing potential conflicts of interest in the publi-
cation of this article.
SPONSORSHIP OR COMMERCIAL SUPPORT
No sponsorship or commercial support was received for this article.
DISCLAIMER
AORN recognizes these activities as CE for RNs. This recognition
does not imply that AORN or the American Nurses Credentialing
Center approves or endorses products mentioned in the activity.
http://doi.org/10.1002/aorn.12451
© AORN, Inc, 2019
 CLINICAL

Perioperative Strategies for Surgical Site

Infection Prevention
1.1 www.aornjournal.org/content/cme

Marie A. Bashaw, DNP, RN; Kathy J. Keister, PhD, RN, CNE

ABSTRACT
Surgical site infections (SSIs) are some of the most common and costly health care–associated infections. Although
the rate of SSIs has declined significantly in the past decade, patient safety remains at risk. Perioperative nurses
employ a variety of evidence-­based best practices to prevent SSIs and facilitate a safe surgical experience for
their patients, including hand hygiene, preoperative patient skin antisepsis, and antimicrobial irrigation. This article
explores the causes of SSIs, such as modifiable and nonmodifiable patient factors and preoperative, intraoperative,
and postoperative procedural factors, and discusses some of the specific recommended strategies related to the
prevention of SSIs that perioperative nurses can initiate in their workplace.

Key words: surgical site infection, health care–associated infection, surgical skin antisepsis, procedural factors,
contamination.

A ll surgical patients are at risk for developing a

surgical site infection (SSI). These infections
can develop on the superficial skin and subcu-
taneous tissue layers, in the deep layers of the tissue (eg,
muscles, fascia), in the space manipulated during the pro-
cedure, or in an organ.1 For patients, SSIs can result in pain
and discomfort, loss of income, and decreased quality of
life.2 These infections can range from a simple incision site
abscess with purulent discharge to a complex infection
that may contribute to a life-­threatening condition and
possible morbidity.
Perioperative nurses need to provide care to their patients
in a manner that minimizes these risks because SSIs are not
only patient safety concerns, but also affect the economic
well-­being of health care organizations. Surgical site infec-
tions are the most costly health care–associated infec-
tions (HAIs)3-5 and can lead to an increased hospital length
of stay by three to four days per occurrence. This increas-
es the hospital bill by an additional cost of $10,375 per
occurrence; when annualized, this results in a cost burden
of $16.6 billion.4,6 Furthermore, SSIs are a leading cause
of hospital readmissions. The 30-­day readmission rate for
patients with an SSI is 51.94 versus 8.19 readmissions per
100 procedures (odds ratio, 12.12; 95% CI; P < .001),6 and
the risk of mortality also increases 2- to 11-­fold.7
Perioperative personnel are involved in the infection pre-
vention process for every patient. Surgeons determine
the surgical approach to use and decide which skin anti-
septic methods and products should be used to provide
a microbial-­free or microbial-­reduced surgical field. When
the appropriate skin antisepsis is implemented, the risk for
an SSI or other HAI may be reduced.8 Perioperative per-
sonnel create and maintain the sterile field and perform
the skin preparation. After the perioperative nurse or des-
ignee completes the antimicrobial cleansing of the surgical
site, the scrubbed team members drape the surgical area
with sterile towels and sheets to provide a sterile area for
execution of the surgical procedure.9

http://doi.org/10.1002/aorn.12451
© AORN, Inc, 2019
AORN Journal  69  
Bashaw—Keister
FACTORS AFFECTING SSI DEVELOPMENT
Several studies indicate that SSIs are one of the most
common types of HAIs.3,10,11 These infections have been
reported to comprise 20%12 to 31%13 of all HAIs among
hospitalized patients. The World Health Organization14
indicates that antimicrobial resistance is a significant fac-
tor in the development of an SSI. Nearly 60% of microor-
ganisms isolated from infected surgical incisions exhibit a
pattern of antimicrobial resistance.15 Approximately half
of all SSIs can be prevented using evidence-­based inter-
ventions.1 Although the rate of SSIs has declined signifi-
cantly from 2008 to 2017,14 patient safety remains at risk.
Specific risk factors for SSIs are related to both patient
factors and process or procedural factors. Patient factors
include nonmodifiable variables, such as sex, age, and
previous skin or soft tissue infection, and modifiable vari-
ables, such as underlying health state and lifestyle behav-
iors, glycemic control, diabetic status, dyspnea and alcohol
and smoking status, obesity, and immunosuppresion.16,17
Lifestyle behaviors, including substance use (ie, alcohol,
tobacco, and illicit drug use), diet, and exercise, play a
major role in the development of SSIs.16
Procedural Factors
Procedural factors also may influence SSI development
and may occur before, during, or after a procedure.
Preoperative procedural factors include preoperative
bathing,18-20 surgical hand hygiene,18,20 hair removal,18-20
and antibiotic prophylaxis.18,20 At a minimum, preoperative
bathing should consist of a full-­body wash using antimi-
crobial soap the night before the planned surgery.21 Hand
hygiene with soap and water or with hand sanitizer should
be performed before and after each encounter with the
patient.1,11,22 Hair removal at the surgical site should occur
before entering the operating suite. Administration of
the appropriate antibiotic should occur so that the peak
efficacy of the medication is in the patient’s tissues and
bloodstream immediately before incision.1,11
Intraoperative procedural factors affecting SSI devel-
opment include surgical attire,16,20 hand scrubbing,16 the
specific surgical procedure,20 wound classification,16 the
duration and complexity of the surgical procedure,20 the
surgical technique (eg, open versus laparoscopic), the
use of antimicrobial sutures,16,20 and the type of anesthe-
sia.16,20,23 Perioperative personnel should wear clean sur-
gical attire daily; tops should fit close to the body or be
70  AORN Journal 
January 2019, Vol. 109, No. 1
tucked into the pants. Personnel should completely cov-
er their personal clothing with the scrub attire and, when
they are in the restricted area of the surgical suite, they
should cover their arms with a long-­sleeved jacket that
snaps or buttons closed.24 A study by Markel et al25 sug-
gests that long sleeves contain the skin cells and detritus
that are naturally shed from bare skin.
Intraoperative procedural factors affecting
SSI development include surgical attire, hand
scrubbing, the specific surgical procedure,
wound classification, the duration and
complexity of the surgical procedure,
the surgical technique (eg, open versus
laparoscopic), the use of antimicrobial sutures,
and the type of anesthesia.
Additional contributing factors to the development of an
SSI include the number of personnel involved with the
procedure present in the operating suite and the type of
microorganism and the path of transmission.26 When the
number of personnel in the perioperative suite increases,
the number of foreign pathogens also increases. Further,
each time the perioperative team members open the OR
doors during a surgical procedure, air turbulence increases,
moving pathogens through the air and escalating the risk
of exposing the incision site to these pathogens. Although
patients have their own unique normal flora and pathogens,
perioperative nurses must protect them from other outside
pathogens. When surgeons make a skin incision, they create
a portal for entry of foreign microbes into the patient that
can attack the patient’s immune system and cause an SSI.
Postoperative procedural variables include oxygenation,
hemostasis, glycemic control, and postoperative inci-
sion management.21 Studies have found that increasing
the fraction of inspired oxygen during surgery and in the
immediate postoperative phase in patients with normal
pulmonary functions reduces the risk of an SSI. Evidence-­
based practice recommendations for prevention of SSI
include maintaining perioperative glycemic control with
target levels less than 200 mg/dL for all patients, both
diabetic and nondiabetic.21 Finally, antimicrobial powders,
fluids, and gels should not be applied to the incision area
January 2019, Vol. 109, No. 1
in an effort to reduce SSIs.21 When foreign substances are
applied to the incisional area, there is an increased risk of
introduction of other microbial flora that can cause an SSI.
STRATEGIES TO PREVENT SSIs
Bacteria frequently associated with SSIs include Staphy­
lococcus aureus, coagulase-­negative staphylococci, Entero­
coccus spp, and Escherichia coli.27 These pathogens can be
transferred via direct or indirect contact. Perioperative
personnel may inadvertently touch door handles, surgical
patient carts, computer keyboards, or any other equipment
in the operating suite and transfer any microbial contam-
inants that are on those items to the patient. Therefore,
hand hygiene is of paramount importance when working
with the perioperative patient. Perioperative personnel
should wear latex-­free gloves whenever contact with
the patient’s mucous membranes or skin is anticipat-
ed. Before donning unsterile gloves, personnel should
apply an alcohol-­based hand sanitizer.28 At the end of the
patient contact, perioperative personnel should remove
their gloves and complete hand hygiene either with an
alcohol-­based hand sanitizer or via traditional hand wash-
ing.29 If the patient is on contact precautions, additional
hand hygiene measures (eg, washing hands with soap and
water) may be needed.18,30 Hand hygiene practices reduce
the risk of endogenous organism transmission from the
patient and exogenous organism transmission from other
patients, the health care team, and the OR environment.31
In addition to the risk of infection posed by nonscrubbed
team members, there also is a risk for transmission of
microbes through the sterile gloves of any surgical team
member that may cause an infection. Current evidence
supports surgical hand scrubs (preferably brushless)32,33 and
double-­gloving.34,35 Brushless hand-­scrubbing techniques
reduce the instance of microscopic cuts on the dermis and
the excessive defoliation of skin cells while cleansing the
skin surface of pathogens.32 Perioperative team members
completing surgical hand scrubs with a brush should use
running water, an antimicrobial scrub agent, and a non-
abrasive sponge for a minimum of three to five minutes.21
Surgical gowns also can become contaminated during sur-
gical procedures. Bible et al36 conducted a study in which
they cultured sterile gowns every six inches beginning 18
inches from the ground and found contamination at all
sites at a rate of 6% to 48%. They also found that the area
between the chest and the operative field had the lowest
Perioperative Strategies for SSI Prevention
rate of contamination. All other areas of the gown, including
the elbow creases, should avoid touching the sterile field
as much as possible.36 Further, scrubbed perioperative per-
sonnel should change their gowns when they notice they
have become heavily soiled with blood or other bodily fluids
during the procedure. Surgical gowns can become a source
of contamination when the gown sleeves and torso become
saturated after prolonged exposure to fluids. The wet areas
of the gown provide a vehicle for microbial contaminants to
move from the team member to the sterile field.
Finally, nasal cavities also were found to be sources of
infection for cardiac,37-39 orthopedic,38-40 abdominal,38 and
spinal41 surgery patients. A study by Kalmeijer42 about the
use of mupirocin nasal ointment from admission through
postoperative day one compared with a placebo did not
show a statistically significant reduction in the rate of SSIs.
However, topical applications of this ointment reduced the
microbial count, and when patients touched their mouths
and noses, there were fewer pathogens present to transfer
to the incisional areas.
Surgical Site Antiseptics Used for Skin
Preparation
When perioperative nurses prepare the surgical site with the
approved skin antiseptic using aseptic technique, microbi-
al contamination of the site can be reduced.43 Historically,
perioperative nurses decontaminated the skin using
povidone-­iodine (PI)–based scrubs and paint solutions.
However, this surgical preparation did not eliminate SSIs.44 A
meta-­analysis conducted by Lefebvre et al43 did not support
scrubbing then painting or painting alone for skin prepara-
tion; neither was statistically significant for a reduction in
SSI rates. Kunkel et al45 conducted a randomized controlled
trial comparing PI and chlorhexidine gluconate (CHG). The
results of this study demonstrated a seven times greater
incidence of positive cultures with PI versus the CHG group.
When perioperative nurses prepare
the surgical site with the approved skin
antiseptic using aseptic technique, microbial
contamination of the site can be reduced.
Subsequent evidence showed that antiseptic-­based liq-
uids, such as CHG in a 2% impregnated cloth or 4%
AORN Journal  71  
Bashaw—Keister January 2019, Vol. 109, No. 1

Key Takeaways
 Surgical site infections are a risk to every surgical patient and cause negative outcomes for both patients and
health care institutions.

 Both modifiable and nonmodifiable patient factors and preoperative, intraoperative, and postoperative pro-
cedural factors affect the development of surgical site infections.

 Perioperative nurses should use best practices for surgical skin antisepsis to prevent inadvertent transfer of
contaminants to patients throughout the surgical procedure.

 Perioperative nurses should follow the manufacturer’s recommendations for the use of antimicrobial agents
for surgical skin preparation and intraoperative irrigation.

solution, were successful in decontaminating the skin Antimicrobial Irrigation

against a broad array of pathogens.46 Additionally, pre-
operative bathing with 2% CHG–impregnated cloths
increased the CHG concentration to a level that inhibits or
kills skin contaminants (eg, S aureus). During a total body
skin cleansing, the patient’s own external normal flora is
reduced, thereby decreasing the risk of an SSI.21,43,47,48 The
residual efficacy of CHG is increased by repeated applica-
tion during the preoperative bath or shower followed by
skin preparation with a product containing CHG. However,
the evidence regarding the use of CHG washcloths is not
conclusive as to whether the antiseptic benefits for SSI
prevention outweigh the risks of skin rash, allergic reac-
tion, or skin dryness. Additionally, continued use of CHG
could kill beneficial bacteria as well as trigger resistance in
harmful bacteria.21
Another method that perioperative team members
should consider using to reduce the risk of SSIs is anti-
microbial irrigation. Surgical lavage has several ben-
efits to combat SSIs. First, surgical lavage will remove
any superficial or organ-­space contamination that has
occurred during the surgical procedure, which will aid in
the healing process. Second, irrigating the incision site
allows for a final examination of the area before closure,
thereby enabling the surgeon to address any small bleed-
ing vessels. Finally, irrigation hydrates the tissue, further
aiding in the healing process.51 The perioperative nurse
prepares the irrigation solution following strict aseptic
technique or preferably obtains the antimicrobial irriga-
tion from the pharmacy where it can be compounded in
a sterile hood.

Recent evidence advocates for dual-­agent skin antiseptics
(eg, CHG and PI) rather than a single agent.49 Antiseptic
agents in combination with alcohol were found to be the
most effective in reducing skin contaminants.9,21,48 A lit-
erature review by Privitera50 showed that skin preps that
included a combination of CHG and alcohol are effec-
tive because the alcohol is fast-­acting and the CHG pro-
vides a longer residual effect for reduction of microbes.
Perioperative personnel should always follow the man-
ufacturer’s instructions for application of the skin anti-
septic; this is extremely important when a combination
of alcohol-­based skin antiseptics is used because of the
flammability of alcohol.48 No current studies were found
in which povidone-­iodine and alcohol were used as dual
agents. It is important for perioperative personnel to note
the remaining need for well-­designed and powered com-
parative studies of skin solutions containing povidone-­
iodine plus alcohol and CHG plus alcohol.48
When surgeons cut through the skin at the beginning of
a procedure, bacteria residing in the skin layers may be
transferred to the surgical incision site.52 Irrigation fluids
that contain antimicrobial agents can help decrease micro-
bial contamination of both the skin and surgical site and
aid in the removal of surface and deep incisional contam-
inants, which reduces bioburden and facilitates healing.51
Surgeons may request irrigations that include regular nor-
mal saline or normal saline with an antimicrobial or anti-
biotic added. Antimicrobials that can be added to normal
saline include PI and 0.05% CHG solutions; however,
each irrigant comes with risks and benefits. Chlorhexidine
gluconate has the added benefit of both an inhibitory
and bactericidal effect on the tissues and implants, and
is becoming the irrigant of choice for surgical lavage.20
Additional studies need to be conducted to determine the
clinical efficacy of using CHG for irrigation, but initial stud-
ies have been promising.19

72  AORN Journal 
January 2019, Vol. 109, No. 1
Perioperative nurses should be aware of the different
types of dispensing systems available for the various
antiseptic agents regardless of whether they are used
for preoperative skin antisepsis or intraoperative irriga-
tion. Surgical antiseptic agents should come in single-­use
packages to prevent cross-contamination when multiple
products are being used.53 These agents should be stored
and maintained in a clean, dry environment that is close
to the perioperative field to facilitate the timeliness of
accessibility.19
Policy Development
Each perioperative department should use a multidisci-
plinary approach to develop policies and procedures that
incorporate the best practices discussed in this article.
Working together, the perioperative team can imple-
ment evidence-­based measures to provide a safe sur-
gical patient experience. Perioperative personnel can
reference the AORN “Guideline for preoperative patient
skin antisepsis”48 to guide safe perioperative practice and
develop policies and procedures to reduce SSIs in their
organizations.
CONCLUSION
Surgical site infections are detrimental to the health and
well-­being of patients and the institutions at which they
occur. Prevention of SSIs is an important part of perioper-
ative nursing practice. Every member of the surgical team
has a responsibility to the patient to follow evidence-­
based practices to prevent SSIs, including practicing good
hand hygiene, preoperative patient skin antisepsis, and
antimicrobial irrigation.
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42. Kalmeijer MD, Coertjens H, van Nieuwland-Bollen
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45. Kunkle CM, Marchan J, Safadi S, Whitman S, Chmait
RH. Chlorhexidine gluconate versus povidone iodine
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46. Donskey CJ, Deshpande A. Effect of chlorhexidine
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burden and environmental contamination: a review
of the literature. Am J Infect Control. 2016;44(5 suppl):
e17‐e21. https://doi.org/10.1016/j.ajic.2016.02.024.
47. Tokarski AT, Blaha D, Mont MA, et al. Peri­
operative  skin preparation. J Orthop Res. 2014;32
(S1):S26‐S30.
48. Guideline for preoperative patient skin antisepsis.
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gical site infection in cranial neurosurgery? Ann R Coll
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50. Privitera GP, Costa AL, Brusaferro S, et al. Skin
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introduce contamination despite standard antimicro-
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https://doi.org/10.1089/sur.2016.158.
53. U.S. Food & Drug Administration. FDA Drug Safety
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htm. Published November 13, 2013. Updated February
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Marie A. Bashaw, DNP, RN, is an associate professor
at Hartwick College, Oneonta, NY. She was an assistant
professor at the College of Nursing & Health in Dayton,
OH, at the time this article was written. As a member of the
AORN Guidelines Advisory Board and the recipient of a grant
from AORN of Dayton, Dr Bashaw has declared affiliations
that could be perceived as posing potential conflicts of inter­
est in the publication of this article.
Kathy J. Keister, PhD, RN, CNE, is the dean of Nursing
at Northwest Community College in Archbold, OH. She
was an associate professor at the College of Nursing &
Health in Dayton, OH, at the time this article was writ-
ten. As a recipient of an education grant from Sigma Theta
Tau International, Indianapolis, IN, and the Assessment
Technologies Institute, Leawood, KS, and payment for the
development of educational presentations from Florida A&M
University, Tallahassee, Dr Keister has declared affiliations
that could be perceived as posing potential conflicts of inter­
est in the publication of this article.
AORN Journal  75  
 E XA M I N AT I ON

Continuing Education
Perioperative Strategies for Surgical Site
Infection Prevention
1.1 www.aornjournal.org/content/cme

PURPOSE/GOAL
To provide the learner with knowledge of best practices related to perioperative strategies for surgical site infection (SSI)
prevention.

OBJECTIVES
.
1 Identify contributing patient factors related to SSI development.
2. Identify contributing procedural factors related to SSI development.
3. Describe perioperative best practices to help decrease the incidence of SSIs.
4. Describe two types of skin antiseptic agents that may be used for perioperative skin preparation.

The Examination and Learner Evaluation are printed here for your convenience. To receive continuing education credit,
you must complete the online Examination and Learner Evaluation at http://www.aornjournal.org/content/cme.

QUESTIONS
1. Development of an SSI is limited to certain types of 4. surgical hand hygiene.
patients. 5. obesity.
a. true b. false 6. antibiotic prophylaxis.
a. 1, 2, and 3 b. 1, 3, and 4
2. Patient risk factors affecting the development of an c. 2, 4, and 6 d. 2, 4, 5, and 6
SSI include
1. nonmodifiable variables, such as sex, age, and 4. Intraoperative procedural factors affecting the devel-
previous skin infection. opment of an SSI include
2. hair removal. 1. surgical site hair removal.
3. modifiable variables, such as health state, lifestyle 2. surgical attire.
behaviors, and glycemic control. 3. length of procedure.
4. substance abuse, diet, and exercise. 4. antimicrobial resistance.
a. 1 and 2 b. 2 and 3 5. use of antimicrobial sutures.
c. 2 and 4 d. 1, 3, and 4 6. wound classification.
a. 1 and 3 b. 2 and 4
3. Preoperative procedural factors affecting the devel- c. 1, 2, and 4 d. 2, 4, 5, and 6
opment of an SSI include
1. NPO status. 5. Postoperative procedural factors affecting the devel-
2. preoperative bathing. opment of an SSI include
3. smoking status. 1. oxygenation.

http://doi.org/10.1002/aorn.12451
© AORN, Inc, 2019
76  AORN Journal 
January 2019, Vol. 109, No. 1
2. hemostasis.
3. glycemic control.
4. fluid balance.
5. postoperative incision management.
a. 4 and 5 b. 1, 2, and 3
c. 1, 2, 3, and 5 d. 1, 2, 4, and 5
6. Antimicrobial powders, fluids, and gels should not be
applied to the incision area.
a. true b. false
7. Hand hygiene should be performed
a. before donning and after removing gloves.
b. only before donning gloves.
c. only after removing gloves.
8. _______ and ________ are preferred and supported by cur-
rent evidence.
Perioperative Strategies for SSI Prevention
a. Surgical hand scrub with brushless technique;
single-gloving
b. Surgical hand scrub using a brush; double-gloving
c. Surgical hand scrub with brushless technique;
double-gloving
d. Surgical hand scrub using a brush; single-gloving
9. In a randomized controlled trial, ______ skin antiseptic
agents demonstrated a greater incidence of positive
cultures.
a. povidone-iodine
b. chlorhexidine gluconate (CHG)
c. alcohol
10. Skin antiseptic agents that include alcohol and CHG are
effective because the alcohol is ______ and the CHG pro-
vides a ________ residual effect for reduction of microbes.
a. slow-acting; short b. slow-acting; long
c. fast-acting; long d. fast-acting; short
AORN Journal  77  
 L E AR N ER E VALUAT ION
Continuing Education
Perioperative Strategies for Surgical Site
Infection Prevention
1.1 www.aornjournal.org/content/cme
T his evaluation is used to determine the extent
to which this continuing education program met
your learning needs. The evaluation is printed
here for your convenience. To receive continuing edu-
cation credit, you must complete the online Examination
and Learner Evaluation at http://www.aornjournal.org/
content/cme. Rate the items as described below.
OBJECTIVES
To what extent were the following objectives of this con-
tinuing education program achieved?
1. Identify contributing patient factors related to SSI
development.
Low 1. 2. 3. 4. 5. High
2. Identify contributing procedural factors related to
SSI development.
Low 1. 2. 3. 4. 5. High
3. Describe perioperative best practices to help
decrease the incidence of SSIs.
Low 1. 2. 3. 4. 5. High
4. Describe two types of skin antiseptic agents that may
be used for perioperative skin preparation.
Low 1. 2. 3. 4. 5. High
CONTENT
5. To what extent did this article increase your knowl-
edge of the subject matter?
Low 1. 2. 3. 4. 5. High
78  AORN Journal 
6. To what extent were your individual objectives met?
Low 1. 2. 3. 4. 5. High
7. Will you be able to use the information from this
­article in your work setting?
1. Yes 2. No
8. Will you change your practice as a result of read-
ing this article? (If yes, answer question #8A. If no,
answer question #8B.)
8A. How will you change your practice? (Select all that
apply)
1. I will provide education to my team regarding why
change is needed.
2. I will work with management to change/imple-
ment a policy and procedure.
3. I will plan an informational meeting with physi-
cians to seek their input and acceptance of the
need for change.
4. I will implement change and evaluate the effect of
the change at regular intervals until the change is
incorporated as best practice.
5. Other: _______________________________________________________________________
8B. If you will not change your practice as a result of
reading this article, why? (Select all that apply)
1. The content of the article is not relevant to my
practice.
2. I do not have enough time to teach others about
the purpose of the needed change.
3. I do not have management support to make a
change.
4. Other: _______________________________________________________________________
http://doi.org/10.1002/aorn.12451
© AORN, Inc, 2019