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Transmissible Infection Prevention - AORN Recommended Practices


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Learn about the newest updates to AORN's evidence-based Recommended Practices for the Prevention of Transmissible Infections. This is the presentation given in a live webinar with Lisa Spruce, RN, DNP, ACNS, ACNP, ANP, CNOR. The webinar is available for free replay at 1 contact hour is also available with this webinar replay. See more of AORN's webinars at

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Transmissible Infection Prevention - AORN Recommended Practices

  1. 1. Recommended Practice forthePrevention of Transmissible InfectionsLisa Spruce, DNP, RN, ACNP, ACNS, ANP, CNORDirector, Evidence-Based Perioperative Practice
  2. 2. TransmissibleInfectionsRPHighlights
  3. 3. • Some new elements for standard precautions.Standard Precautions
  4. 4. Standard PrecautionsEnvironmental Control• Environmental contaminationwas the major determinant oftransmission to healthcareworkers’ gloves or gowns.Compliance with contactprecautions and moreaggressive environmentalcleaning may decreasetransmission.• ~Morgan (2012)Respiratory hygiene/Cough etiquette• Covering the mouth or nose witha tissue or sleeve.• Wear a surgical mask if able.• Stay at least 3 feet away fromothers• Posting signs and providinginstructions to patients andvisitors.
  5. 5. • Single syringe, single needle, one time.• Outbreaks of Hep C and B have been attributed tounsafe injection practices in multiple states.• Health care textiles: change and launder after eachpatient use or when soiled.• Launder in a health care-accredited laundry facility.Standard Precautions
  6. 6. Contact PrecautionsContact with infected patients or contaminated surfaces leads topathogen transmission 45% of the time.Perioperative personnel should don PPE and:• Wear gloves whenever touching a patient’s skin or items in close proximityto the patient.• Wear a gown when it can be anticipated that clothing will come into contactwith the patient or contaminated environmental surfaces.Make sure to discard PPE upon exiting the room!
  7. 7. Droplet/AirbornePrecautionsDroplet• Place patient in a singlepatient room before andafter surgery.• Special air handling andventilation IS NOT required.• Place at least 3 feet awayfrom other patients.• Place a mask on patient fortransport.Airborne• Patients should be placed in anairborne infection isolation room.• Special air handling andventilation IS required.• Do not place in the same roomwith other patients.• Personnel should don a surgicalmask or N95 respirator.• Place a mask on patient fortransport.
  8. 8. Intubation/extubation is a cough producing procedure!After such procedures are performed, sufficient time should be allowed for99% of airborne contaminants to be expelled before sterile supplies areopened for subsequent patients.The OR doors are to remain closed.Recovery should take place in an AIIR.
  9. 9. • If there is not AIIR- use a HEPA.• Position near patient’s breathing zone.• Switch the portable unit off during the surgicalprocedure.• Provide fresh air according to ventilation standardsfor the OR.HEPA filters
  10. 10. Environmental Cleaning• Standard cleaning anddisinfection proceduresshould be followed.• Only perform after theappropriate amount oftime for air ventilation.• If room cleaning beginsbefore the appropriatetime has elapsed,cleaning personnelshould wear N95respirators or poweredair-purifying respirators.
  11. 11. OSHABloodborne Pathogen Standard
  12. 12. • PPE including surgical caps, hoods, shoe covers, orboots when gross contamination is anticipated.• No eating or drinking in the semi-restricted orrestricted areas.• Gowns, gloves, masks, eye protection.• Anticipate exposures!!Prevention of Exposure
  13. 13. ControlsEngineering• Needleless systems• Self-sheathing needles• Sharps storage anddisposal containers.Work Practice• Prohibit risky handling of needlesand sharps.• Prohibit recapping of needles bya two-handed technique.• Using a neutral zone or handsfree technique for passing sharps.• Double glove for all surgicalprocedures.
  14. 14. PeriopActionsTo prevent the transmission of health care-acquired infections
  15. 15. Surgical SiteInfections
  16. 16. CDC: Atlanta, GASSI Statistics• 500,000 annual SSIs• 1.7 million HAIs
  17. 17. Sterile TechniqueThis is the foundation of infection prevention!
  18. 18. • Maintain a clean environment• Wear clean surgical attire• Perioperative skin antisepsis• Hand hygiene• Minimize traffic• Adequate sterilizationActionsto Prevent SSI
  19. 19. Decolonization• Collaborate with medical colleagues.• Staph aureus has been found to be “the mostpowerful independent risk factor for SSI” in patientsundergoing cardiothoracic surgery.• Mupirocin ointment• CHG
  20. 20. Antimicrobial Prophylaxis
  21. 21. Administeraccording to health care organizationpolicy.Critically timed adjunct therapy intended to reducethe microbial burden of surgical contamination to alevel that cannot overwhelm the patient’s defenses.
  22. 22. • Improve hand hygiene practices• Contact precautions until patient culture negative• Managing vascular and urinary catheters• Preventing lower resp tract infection in intubated patients• Following the CDC Campaign to Prevent AntimicrobialResistance• Limiting and carefully selecting antimicrobial agentsMDROs
  23. 23. CLABSI• Implement CDCGuidelines– Sterile technique– Maximal sterile barrier• Hair covering• Mask• Sterile gown• Sterile gloves• Sterile full body drape
  24. 24. • Follow CDC guidelines– Insert only for medically indicated conditions– Use only as necessary for surgical patients– Document date and time of insertion– Remove asap post-op (preferably within 24 hours)– Strict aseptic technique– Only allow trained persons to insertCAUTI
  25. 25. ImmunizationsCDC Recommendations
  26. 26. HCWs who get a flu shot decrease:•transmission of influenza•staff illness and absenteeism•influenza-related illness and death, especially among patientswho are at increased risk
  27. 27. Health care personnel withTransmissible Infections
  28. 28. Restrict Activities• Viral infections (flu)• Purulent conjunctivitis• Acute GI illness• Asymptomatic carrier ofdiptheria• Exudative lesions thatcannot be contained• Herpes simplexinfections of the fingersor hands• Pediculosis• Scabies• Meningococcalinfection
  29. 29. • Work restrictions depend on several factors– Circulating viral burden– Category of clinical activitiesConsult with infection preventionist!BloodborneInfections
  30. 30. • AORN Surgical Wound Classification Decision Tree• Helps perioperative nurses accurately identifysurgical woundsSurgical Wound Classification
  31. 31. AORN Decision Tree
  32. 32. AORN Decision Tree
  33. 33. Table