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Social determinants of health (SDOH) are the conditions that people are born into and live under that affect their health. Nurses are responsible for addressing these determinants when possible. Perioperative nurses encounter the effects of SDOH when patients express concern about surgery scheduling times, transportation, child care, and other support‐related issues during the perioperative period. Some SDOH are related to social identity (eg, race, ethnicity, sexual orientation) as a result of the oppression and discrimination that some groups experience. Perioperative nurses can establish trust with their patients by identifying their needs and partnering with community‐based organizations to address some of those needs (eg, transportation, legal assistance), which may help relieve stress for their patients and promote better postsurgical outcomes. Although health care workers can assist individual patients to address the effects of SDOH on their health and life, policy change is needed to ensure long‐term benefits.

Pressure injury prevention is essential to patient safety in the perioperative setting. Perioperative nurses should be knowledgeable about the risk factors for pressure injury and the safety precautions that can be taken to prevent this injury from occurring. Perioperative nurses should be able to identify patients who are at high risk for developing a pressure injury. Perioperative patients are at risk for developing pressure injuries because they can experience intense or prolonged pressure during lengthy surgical procedures, may have increased pressure on bony prominences from positioning, are exposed to friction or shear during transfer to the OR bed and positioning, and often have significant comorbidities. This Back to Basics article examines the risk factors for pressure injuries in the perioperative patient population and discusses screening and prevention measures that can be implemented.

The health care system can address health disparities by improving equitable access to health care and creating solutions that involve multiple sectors to improve health status, such as access to other social services as needed (eg, community gardens, income support programs, transitional housing), transportation, and healthy food.5 Moreover, the health care system provides a chance to mitigate the indirect effects of poor health related to worsening social status.4 KNOWLEDGE CHECK Ms M is a 55-year-old female patient who presents to the preoperative clinic four weeks before her elective surgery. Discrimination, stigma, and restricted access to health care services contribute to increased rates of mental health issues, substance abuse, HIV, and AIDS in these groups.\" To effectively tackle health disparities, a holistic approach that aims to diminish social inequalities and enhance access to necessary resources and opportunities is needed. [...]efforts to eradicate discrimination and advance cultural competence within health care systems are crucial in mitigating health disparities across various populations.8 Nurses can directly observe the effects of social and economic inequalities on their patients' health. [...]nurses play a crucial role in identifying and addressing the root causes of poor health, whether at the individual or population level, to prevent additional decline.!° Perioperative nurses are in an ideal position to assess the factors that negatively affect their patients.

The American Nurses Association (ANA) indicates that nurses should advocate for themselves to address workplace fatigue and sleepiness, which may affect patient care.5 However, results of a 2021 survey of nurses on fatigue showed that almost half of the 405 respondents were unable to self-assess their fatigue level.6 Leaders should consider their facility's characteristics (eg, type, location, services provided) and patient population when creating or revising a staffing plan that involves on-call requirements.1 Staff members may prefer to work 12-hour shifts, but these may be associated with adverse patient events and worker injuries. In 2018, results of a comparison of outcomes (eg, clinical incidents, personal injuries) associated with 8- and 12-hour shifts in an intensive care unit in Wales, United Kingdom, showed no significant differences.7 Plans for on-call staffing should \"not require perioperative team members to work in direct patient care for more than 12 consecutive hours in a 24-hour period and not more than 60 hours in a sevenday work week. KNOWLEDGE CHECK Leaders of a small, rural community hospital with six ORs are experiencing a staffing shortage. Examples of competency assessment methods include direct observation, patient documentation review, simulation scenarios, continuing education with an outcome activity (eg, quiz), and peer review.8 The AORN Perioperative Nursing: Scope and Standards of Practice9 includes official competency statements that explain the duties of all perioperative RNs and reflect the values and goals of the profession.

During the past five years, dissemination of information on the health hazards of surgical smoke has helped perioperative nurses and members of the public increase their awareness of the topic.1-4 Surgical smoke contains ultrafine particles,5,6 a variety of toxic gaseous compounds7 (eg, benzene, formaldehyde, cyanide8), bioaerosols,8 dead and live cellular material,8 and viral DNA.9 Additionally, surgical smoke may contain mycobacteria10 and nonviable particles known as lung-damaging dust measuring between 0.5 and 5.0 micrometers.11

The role of the perioperative nurse related to preoperative patient skin antisepsis is both essential and multifaceted.1 Not only do perioperative nurses participate in policy development for preoperative decolonization and bathing, they also facilitate site preparation, including removing hair when necessary and selecting and applying skin antiseptics. Preoperative patient skin antisepsis involves removing soil and transient microorganisms at the site of surgery and reduces the risk of the patient developing a surgical site infection (SSI).1 Skin antiseptics are designed to rapidly and persistently remove transient microorganisms and reduce resident microorganisms to minimal levels.2 This article reviews basic concepts related to decolonization and skin antisepsis based on the recently revised AORN \"Guideline for preoperative patient skin antisepsis,\"1 which perioperative nurses should review in its entirety.

Perioperative team members should share specimen information (eg, name, type, source) and use the readback method when planning for procedures and during the specimen hand-over process.4 Study results show that anesthesia professionals who used the read-back method were 8.27 times more likely to recall the information than those who did not provide a verbal response.5 During the procedural debriefing process, perioperative team members should inspect labeled specimen containers and verify that * the specimen is in the container (ie, by visual inspection); * the patient information on the label and requisition form is accurate, complete, and legible; * the specimen information, including laterality on the label and requisition form, is accurate, complete, and legible; * the number and type of specimens (eg, permanent, frozen section) is accurate; * the indicated preservation solution was used (when applicable); and * all pertinent information (eg, documentation of suture tags) is complete.4(p903) Perioperative personnel should protect the specimens from contamination and damage before transferring them from the sterile field.4 Measures to protect specimens include * minimizing handling, * protecting tissue from crushing or damage, * keeping the specimen moist, * containing or covering the specimen, * labeling the specimen, and * placing the specimen in a secure location on the sterile field.4(p903) When surgeons obtain specimens from a patient with a suspected or known surgical site infection, perioperative personnel should handle the specimens with designated instruments that will not be used for any other purpose during the procedure.4 Perioperative personnel should complete the specimen transfer process as soon as feasible after excision, maintain sterile technique, use standard precautions to protect the staff members from exposure to blood and other body fluids, and prevent damage to the specimen.4 Errors can occur from improper specimen collection and may include * failing to place specimens in the container, * inadvertently discarding specimens, * placing multiple specimens in the same container, * using incorrect or no solution, and * using incorrect specimen containers.1 When using the read-back method with the surgeon to prevent specimen collection errors, perioperative personnel should confirm the information on the specimen label, on the pathology requisition form, and in the patient record before transferring the specimen from the sterile field.4 There are a variety of specimen examination methods, including fresh, permanent, frozen section, or grossonly, and each requires a different handling process. To establish policies and procedures for specimen handling, facility leaders should assemble an interdisciplinary team that includes one or more of the following: pathologist, surgeon, perioperative RN, and infection preventionist, as well as quality and risk management personnel (when available).4 This interdisciplinary team should review (and improve, when applicable) the following: * quality control methods (eg, verification and standardized team communication tools); * collection processes (eg, review labeling and forms); * clinical documentation support and alerts; * alarms on the specimen refrigerator, if applicable; and * transport and storage logbooks. Containment, Labeling, and Transport Planning for containment of specimens before the procedure begins helps to improve efficiency, prevent harm or loss of the specimen, and reduce door openings.4 Perioperative personnel should select puncture-resistant and leak-proof specimen containers that will prevent staff member exposure to blood and other body fluids or other potentially infectious materials. After receiving a specimen from the sterile field, the RN circulator should contain and label the specimen immediately.4 Study results show that specimen errors (eg, lost or misplaced specimens) can occur when personnel do not immediately place the specimen in a container.1 Personnel should place the specimen container in a specimen bag when the exterior of the specimen container becomes contaminated during handling.4 When specimens contain biohazardous materials, perioperative personnel must affix a biohazard label-an orange or orange-red label with the biohazard symbol and contrasting lettering-to the specimen container.6 Perioperative personnel also must verify that containers filled with formaldehyde-containing solutions include a label with the following information: DANGER FORMALDEHYDE-CONTAMINATED [CLOTHING] EQUIPMENT MAY CAUSE CANCER CAUSES SKIN, EYE, AND RESPIRATORY IRRITATION DO NOT BREATHE VAPOR DO NOT GET ON SKIN.7 In addition to regulatory information, the RN circulator should label the container with * two patient identifiers (eg, patient name, medical record number, date of birth); * the specimen name; * the specimen site including laterality, if applicable; and * the date of excision.4(p909) Specimen labeling errors have been reported to comprise 49% of all surgical specimen-related errors.1 Rather than prelabeling specimen containers, the RN circulator should label one specimen container at a time when the specimen is transferred from the sterile field.4 The RN should use dark, indelible ink for both the label and the requisition forms and securely attach the label to the container without overlapping the edges and obscuring the specimen information.