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

2. TransmissibleInfections
RPHighlights

3. • Some new elements for standard precautions.
Standard Precautions

4. Standard Precautions
Environmental Control
• Environmental contamination
was the major determinant of
transmission to healthcare
workers’ 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 patient’s 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 patient’s 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.

11. OSHA
Bloodborne Pathogen Standard

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.

14. PeriopActions
To prevent the transmission of health care-
acquired infections

15. Surgical SiteInfections

16. CDC: Atlanta, GA
SSI Statistics
• 500,000 annual SSIs
• 1.7 million HAIs

17. Sterile Technique
This is the foundation of infection prevention!

18. • Maintain a clean environment
• Wear clean surgical attire
• Perioperative skin antisepsis
• Hand hygiene
• Minimize traffic
• Adequate sterilization
Actionsto Prevent SSI

19. Decolonization
• Collaborate with medical colleagues.
• Staph aureus has been found to be “the most
powerful independent risk factor for SSI” in patients
undergoing cardiothoracic surgery.
• Mupirocin ointment
• CHG

20. Antimicrobial Prophylaxis

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 patient’s 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

23. CLABSI
• Implement CDC
Guidelines
– Sterile technique
– Maximal sterile barrier
• Hair covering
• Mask
• Sterile gown
• Sterile gloves
• Sterile full body drape

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 insert
CAUTI

25. Immunizations
CDC Recommendations

26. HCWs who get a flu shot decrease:
•transmission of influenza
•staff illness and absenteeism
•influenza-related illness and death, especially among patients
who are at increased risk

27. Health care personnel with
Transmissible Infections

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
– Circulating viral burden
– Category of clinical activities
Consult with infection preventionist!
BloodborneInfections

30. • AORN Surgical Wound Classification Decision Tree
• Helps perioperative nurses accurately identify
surgical wounds
Surgical Wound Classification

31. AORN Decision Tree

32. AORN Decision Tree

33. Table