prevention infection

1. Critical Observations for the
Infection Preventionist in the
Operating Room and Central
Sterile Processing
Rebecca Alvino RN, MS, CNS, CIC
Infection Control Practitioner
UCSF Health

2. Financial Disclosures
 I have no financial interests or
disclosures to report.

3. If you’re new to the operating room (OR)
environment, it may seem like this…

4. Central/sterile processing (C/SP) also has
a lot of simultaneous activities that can be
overwhelming, if you don’t know what to
look for.

5. OBJECTIVES
As an infection preventionist (IP) observing in the OR
and C/SP, you will be able to:
 Identify at least five critical observations you can make
in the OR
 State two staff safety strategies for the IP and personnel
in these areas
 Describe at least two critical observations you can make
in the C/SP

6. Labor and delivery
operating room
Operating room suite
Ambulatory surgery center

7. BEFORE YOU GO INTO THE OPERATING ROOM…
Does your plan include observing a surgery inside the
OR?
Some surgeries may create non-infectious exposure
opportunities that all persons need to protect
themselves from.
Know what kind of surgery you will be observing.
If you are not sure of special equipment with specific
personal protective equipment (PPE) requirements that
could be used, ask before you’re exposed.
Even as IPs, you need to
protect yourself from exposures!

8. When entering the OR or C/SP, dress for the occasion!

9. TECHNOLOGIES USED THAT REQUIRE
SPECIAL PERSONAL PROTECTIVE EQUIPMENT
 Will lasers be used?
OSHA and CDC HICPAC (2003) require at minimum N95 or
even N100 respiratory protection in most surgical settings when
lasers are used.
Also, be sure to wear special laser safety goggles!

10. TECHNOLOGIES USED THAT REQUIRE
SPECIAL PERSONAL PROTECTIVE EQUIPMENT
Will sources of radiation be used
(such as x-ray or radiation implants)?

11. AS YOU WALK INTO THE
SEMI-RESTRICTED AND RESTRICTED AREAS
Take a look around the environment. What do you see?

12. YOU’VE ARRIVED TO THE OPERATING ROOM
YOU WILL OBSERVE
Look in the window into the OR. Are there sterile
supplies open?
◦ Use the non-corridor entry, if available
◦ Enter the room slowly, but do not hold the door
open unnecessarily
◦ If the OR is small, be aware of where sterile
supplies are opened relative to your entry point

13. SIMULTANEOUS ACTIVITIES YOU MAY OBSERVE
IN THE OR
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Photo</a>
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123RF Stock Photo</a>1

14. TAKE A LOOK AROUND THE OR
 Does the room look big enough to accommodate all of
the equipment and safe movement around the sterile
field?
◦ Newer ORs are likely to be larger, whereas older ORs may be
smaller.
 Does the room appear clean?
◦ ORs should be clean before supplies for upcoming procedures
are moved in.
◦ Often overlooked places to assess include on the surfaces of OR
spotlights, between the OR bed mattress pads and table, and
equipment used in each surgery.

15. TAKE A LOOK AROUND THE OR
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16. Hand Hygiene Inside the OR
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123RF Stock Photo</a>

17. Sterile PPE donning and behaviors

18. Preoperative Skin Antisepsis
Copyright: <a href='http://www.123rf.com/profile_edwardolive'>edwardolive / 123RF Stock Photo</a>

19. SHARPS SAFETY
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20. Surgical Instrument Quality

21. Management of surgical dressings and
devices
At the end of the
procedure, WHEN are
dressings applied?
How is the urinary
drainage bag emptied?
After insertion of
IVs or central lines,
how are these
accessed and
managed in
surgery?

22. Cleaning of the Operating Room
Source: ecolab.com. Retrieved January 2017.
Source: ecolab.com. Retrieved January 2017.

23. Terminal Cleaning of the Operating Room
What is your facility’s policy for terminal cleaning of operating rooms?
AORN (2017) defines their recommendation to be daily, but provides these
considerations for facilities when developing policies around terminal
cleaning:
• Room occupancy
• Time of room occupancy
• Activities inside the restricted and semi-restricted areas
What exactly does a terminal clean of the OR include?
AORN (2017) Guideline for Environmental Cleaning, Recommendation IV:
• Disinfection of all floors, moving from clean to dirty, perimeter to center,
with all mobile equipment moved
• Cleaning and disinfection of all exposed surfaces, including wheels and
casters, anesthesia equipment, OR equipment, storage cabinets, light
switches, and more.

24. The C/SP Environment of Care
Source: medline.com. Retrieved January 2017.
What are the attire requirements for C/SP (all areas)?
• The same standards for surgical attire in the semi-restricted areas of
the OR, plus covering of arms with long sleeves, apply for C/SP.

25. Comparison of Two Environmental Standards for C/SP
Temperature, Relative Humidity, and Air Handling Requirements for
C/SP Areas: AAMI ST79, 2013
Area of C/SP Temperature
(degrees F/C)
Relative
Humidity
(%)
Air
Pressurization
to Adjacent
Areas
Air Exchanges per
Hour (all air
exhausted directly
outdoors)
Decontamination 60-65 F/16-18 C 30-60% Negative 10 (Yes)
Preparation and
Packing, Sterilizer
Loading/Unloading
68—73 F/20-23 C 30-60% Positive 10 (No)
Sterilizer
Equipment Access
Room
75-85 F/24-29 C 30-60% Negative 10 (Yes)
Sterile Storage 68-75 F/20-24 C 30-70% Positive 4 (No)
Temperature, Relative Humidity, and Air Handling Requirements for
C/SP Areas: ANSI/ASHE/ASHRAE Standard 170-2013
Area of C/SP Temperature
(degrees F/C)
Relative
Humidity
(%)
Air
Pressurization
to Adjacent
Areas
Air Exchanges per
Hour (all air
exhausted directly
outdoors)
Decontamination 72-78 F/22-26 C 30-60% Negative 6(2)
Preparation and
Packaging
72-78 F/22-26 C 30-60% Positive 4(2)
Sterilizer
Equipment Access
Room
N/A N/A Negative 10(none)
Sterile Storage 72-78 F/22-26 C 30-70% Positive 4 (2)

26. C/SP Decontamination Area: Critical
Observations

27. C/SP Decontamination Area: Critical
Observations

28. C/SP Clean Assembly: Critical
Observations

29. C/SP Sterilization and High-Level Disinfection: Critical
Observations

30. C/SP Sterile Storage: Critical Observations

31. To recap…
 Make a plan: Disclose your plan and
intentions to your OR or C/SP
colleagues.
 Dress for the occasion!
 Look up, look down, look all around…
 Practice, practice, practice!

32. Any questions, comments, or
concerns?
Rebecca Taylor Alvino RN, MS, CNS, CIC
UCSF Health
San Francisco, California 94117
415.353.8976
Rebecca.Alvino@ucsf.edu