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3 ways to make the OR an infection prevention ally

Publish Date: 8/14/2013

Controlling the OR environment to support infection prevention is not a simple task. A slight fluctuation in air flow, an increase in traffic, soiling on the floor, incorrect separation in movement of dirty vs. clean instruments—these factors can make the OR environment an enemy in the fight to prevent infection.

Maintaining a safe OR environment that supports infection prevention requires cross-departmental monitoring and collaboration, according to AORN Perioperative Nursing Specialists Byron Burlingame, MS, RN, CNOR, and Amber Wood, MSN, RN, CNOR, CIC, CPN.

They agree, the key to maintaining a safe OR environment that decreases infection risk is keeping your environmental “ducks” in a row, including:

  • cleaning
  • air flow, air pressure and temperature
  • humidity

“It comes down to knowing the rules and guidelines, being aware of what is happening in your periop settings and having a shared plan to maintain environmental norms,” Burlingame explains. “Planning for fluctuations shouldn’t necessarily be thought of as disaster planning, because changes in the OR environment can occur due to more common occurrences, such as an interruption in power.”

Burlingame is the lead author of the “Recommended Practices for a Safe Environment of Care, Part 2,” slated to be posted for public comment next month. Wood is the lead author of the updated “Recommended Practices for Environmental Cleaning in the Perioperative Setting” currently posted for public comment.

Burlingame and Wood provide a sneak peak at some of these updated practice recommendations that will help periop professionals ensure their ORs are allies in preventing infection:

  1. 1. Assess cleanliness before every case in ALL procedural areas

    “One of the biggest changes [in the updated RP on environmental cleaning] is related to the expansion of the scope of the document to perioperative areas beyond the OR,” Wood notes. She stresses that fomites (inanimate objects) near the surgical field in any procedural area may harbor bacteria and serve as a reservoir for wound contamination and SSI development.

  2. Updated practice recommendations for environmental cleaning suggest:

    • Terminal cleaning and disinfection of the perioperative environment should be conducted daily and after environmental contamination, like condensation from high humidity levels, to decrease the number of pathogens, dust and debris.
    • When cleaning the sterile processing areas, including satellite locations, clean work areas such as the packaging area and sterile storage area should be cleaned before moving to dirty work areas, such as decontamination, to reduce the opportunity for contaminating the clean areas.
    • A multidisciplinary team should reevaluate cleaning procedures in the perioperative areas periodically to determine if the cleaning plan needs adjustment based on activity.
  3. 2. Maintain current established environmental norms

    Burlingame stresses the importance of a properly functioning heating, ventilation and air conditioning system that minimizes the contamination of the sterile field and risk of infection to the patient by carrying away microbial-laden skin squames, dust and lint.

    “This collaborative team should also establish an action plan for addressing infection prevention plans in the OR that may include terminal cleaning when norms fall out of range,” he suggests.

    AORN recommends:

    • 4 minimum outdoor air changes per hour and 20 to 25 minimum total air changes per hour in the OR
    • humidity at 20% to 60% in the OR (CMS recently published a waiver for humidity below 35% in the OR, conditional based on state department of health rules)
    • temperature at 68o F to 75o F (20o C to 24?o C) in the OR
  4. 3. Consider infection prevention when planning and implementing construction or redesign plans
  5. “Correct design of the OR environment can support safer traffic patterns to reduce infection risk, particularly in restricted and semi-restricted areas,” Burlingame suggests.

    He highlights new practice recommendations in a safe environment of care, part 2 RP that address design specifications in perioperative sterile processing areas to separate decontamination and sterilization activity. This topic will also be addressed in an upcoming “Clinical Issues” in AORN Journal.

    Both RPs discuss specific preventative strategies that should be established by perioperative team members, the infection preventionist and environmental services to minimize OR contamination from the construction site.

Good traffic control is a tried and true way to reduce infection risk in the OR every day, Burlingame and Wood stress. “Standardized traffic control limited to essential personnel in appropriate attire is always important to reinforce, no matter how good compliance is.”

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