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 http://bit.ly/1243qQU. 1 contact hour is also available with this webinar replay. See more of AORN's webinars at http://bit.ly/16A2G9v.
1. Recommended Practice forthe
Prevention of Transmissible Infections
Lisa Spruce, DNP, RN, ACNP, ACNS, ANP, CNOR
Director, Evidence-Based Perioperative Practice
3. ⢠Some new elements for standard precautions.
Standard Precautions
4. Standard Precautions
Environmental Control
⢠Environmental contamination
was the major determinant of
transmission to healthcare
workersâ gloves or gowns.
Compliance with contact
precautions and more
aggressive environmental
cleaning may decrease
transmission.
⢠~Morgan (2012)
Respiratory hygiene/
Cough etiquette
⢠Covering the mouth or nose with
a tissue or sleeve.
⢠Wear a surgical mask if able.
⢠Stay at least 3 feet away from
others
⢠Posting signs and providing
instructions to patients and
visitors.
5. ⢠Single syringe, single needle, one time.
⢠Outbreaks of Hep C and B have been attributed to
unsafe injection practices in multiple states.
⢠Health care textiles: change and launder after each
patient use or when soiled.
⢠Launder in a health care-accredited laundry facility.
Standard Precautions
6. Contact Precautions
Contact with infected patients or contaminated surfaces leads to
pathogen transmission 45% of the time.
Perioperative personnel should don PPE and:
⢠Wear gloves whenever touching a patientâs skin or items in close proximity
to the patient.
⢠Wear a gown when it can be anticipated that clothing will come into contact
with the patient or contaminated environmental surfaces.
Make sure to discard PPE upon exiting the room!
7. Droplet/AirbornePrecautions
Droplet
⢠Place patient in a single
patient room before and
after surgery.
⢠Special air handling and
ventilation IS NOT required.
⢠Place at least 3 feet away
from other patients.
⢠Place a mask on patient for
transport.
Airborne
⢠Patients should be placed in an
airborne infection isolation room.
⢠Special air handling and
ventilation IS required.
⢠Do not place in the same room
with other patients.
⢠Personnel should don a surgical
mask or N95 respirator.
⢠Place a mask on patient for
transport.
8. Intubation/extubation is a cough producing procedure!
After such procedures are performed, sufficient time should be allowed for
99% of airborne contaminants to be expelled before sterile supplies are
opened for subsequent patients.
The OR doors are to remain closed.
Recovery should take place in an AIIR.
9. ⢠If there is not AIIR- use a HEPA.
⢠Position near patientâs breathing zone.
⢠Switch the portable unit off during the surgical
procedure.
⢠Provide fresh air according to ventilation standards
for the OR.
HEPA filters
10. Environmental Cleaning
⢠Standard cleaning and
disinfection procedures
should be followed.
⢠Only perform after the
appropriate amount of
time for air ventilation.
⢠If room cleaning begins
before the appropriate
time has elapsed,
cleaning personnel
should wear N95
respirators or powered
air-purifying respirators.
12. ⢠PPE including surgical caps, hoods, shoe covers, or
boots when gross contamination is anticipated.
⢠No eating or drinking in the semi-restricted or
restricted areas.
⢠Gowns, gloves, masks, eye protection.
⢠Anticipate exposures!!
Prevention of Exposure
13. Controls
Engineering
⢠Needleless systems
⢠Self-sheathing needles
⢠Sharps storage and
disposal containers.
Work Practice
⢠Prohibit risky handling of needles
and sharps.
⢠Prohibit recapping of needles by
a two-handed technique.
⢠Using a neutral zone or hands
free technique for passing sharps.
⢠Double glove for all surgical
procedures.
19. Decolonization
⢠Collaborate with medical colleagues.
⢠Staph aureus has been found to be âthe most
powerful independent risk factor for SSIâ in patients
undergoing cardiothoracic surgery.
⢠Mupirocin ointment
⢠CHG
21. Administeraccording to health care organization
policy.
Critically timed adjunct therapy intended to reduce
the microbial burden of surgical contamination to a
level that cannot overwhelm the patientâs defenses.
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 Antimicrobial
Resistance
⢠Limiting and carefully selecting antimicrobial agents
MDROs
24. ⢠Follow CDC guidelines
â Insert only for medically indicated conditions
â Use only as necessary for surgical patients
â Document date and time of insertion
â Remove asap post-op (preferably within 24 hours)
â Strict aseptic technique
â Only allow trained persons to insert
CAUTI
26. HCWs who get a flu shot decrease:
â˘transmission of influenza
â˘staff illness and absenteeism
â˘influenza-related illness and death, especially among patients
who are at increased risk
28. Restrict Activities
⢠Viral infections (flu)
⢠Purulent conjunctivitis
⢠Acute GI illness
⢠Asymptomatic carrier of
diptheria
⢠Exudative lesions that
cannot be contained
⢠Herpes simplex
infections of the fingers
or hands
⢠Pediculosis
⢠Scabies
⢠Meningococcal
infection
29. ⢠Work restrictions depend on several factors
â Circulating viral burden
â Category of clinical activities
Consult with infection preventionist!
BloodborneInfections