Published on June 26, 2013
Recommended Practice forthePrevention of Transmissible InfectionsLisa Spruce, DNP, RN, ACNP, ACNS, ANP, CNORDirector, Evidence-Based Perioperative Practice
• Some new elements for standard precautions.Standard Precautions
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.
• 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
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!
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.
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.
• 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
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.
OSHABloodborne Pathogen Standard
• 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
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.
PeriopActionsTo prevent the transmission of health care-acquired infections
CDC: Atlanta, GASSI Statistics• 500,000 annual SSIs• 1.7 million HAIs
Sterile TechniqueThis is the foundation of infection prevention!
• Maintain a clean environment• Wear clean surgical attire• Perioperative skin antisepsis• Hand hygiene• Minimize traffic• Adequate sterilizationActionsto Prevent SSI
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
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.
• 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
CLABSI• Implement CDCGuidelines– Sterile technique– Maximal sterile barrier• Hair covering• Mask• Sterile gown• Sterile gloves• Sterile full body drape
• 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
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
Health care personnel withTransmissible Infections
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
• Work restrictions depend on several factors– Circulating viral burden– Category of clinical activitiesConsult with infection preventionist!BloodborneInfections
• AORN Surgical Wound Classification Decision Tree• Helps perioperative nurses accurately identifysurgical woundsSurgical Wound Classification
AORN Decision Tree
AORN Decision Tree
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