The Guideline for Transmission-Based Precautions

Outbreaks of infections such as Ebola have provided a wealth of new evidence to drive safer use of personal protective equipment (PPE) and other practices to reduce the risk of infection transmission in perioperative care.

This research is incorporated into AORN’s updated guideline for Transmission-Based Precautions, which publishes electronically Dec. 1 and will be published in the 2019 edition of Guidelines for Perioperative Practice.

“Understanding current evidence supporting actions such as how to safely remove contaminated PPE and which PPE to select for the situation can empower perioperative nurses with the knowledge to provide optimal care for patients and patient visitors under standard and transmission-based precautions,” says Amber Wood, MSN, RN, CNOR, CIC, FAPIC, AORN Guidelines editor-in-chief and lead author of the guideline.

Actions to Reduce the Spread of Transmission-Based Infections

Wood acknowledges that changes with selecting and managing PPE can take time to standardize. She gives a preview of several important updates from the forthcoming guideline to start considering now for practice implementation.

1. Take specific and standardized steps to don and doff PPE

   Personal protective equipment should be removed in a sequence that prevents the wearer from touching the contaminated portion of the PPE where exposure was most likely to occur, such as outside of the gown and gloves, front of the eye protection, or the front of the mask or respirator. The guideline outlines a preferred order with three steps for removing soiled gloves.



2. Select gown and mask type according to task and degree of anticipated exposure

   The level of protection provided by the isolation or surgical gown may be stated on the product label as ANSI/AAMI PB70 barrier performance levels and associated test methods, with higher barrier levels providing more protection to the wearer.

   Specific to the isolation or surgical gown, it should fully cover the wearer’s torso from the neck to the knees and the wearer’s arms to the end of wrists and should wrap around the back. Coverage of the gown cuff should be maintained to protect the wearer from exposure at the wrist. To support this, a gown with a thumb loop may be worn under the glove to secure the gown sleeve. Also, gloves with extended cuffs may be worn to maintain coverage of the gown cuffs.

   Specific to masks, the level of protection provided by the surgical mask may be determined by the ASTM barrier level as stated on the product label, with higher barrier levels providing more protection to the wearer.



3. Wear PPE during patient transport activities

   Contact, droplet, and airborne precautions should be taken as necessary during patient transport to reduce the risk for contaminated the care environment. This PPE requirement should be outlined in organizational policy and implemented when direct contact with the patient is necessary during transport, such as for an intubated patient.

   During transport, the contaminated PPE, such as gown and gloves, should not be worn to touch doors, elevator buttons, identification badges, or environmental surfaces during transport.




4. Require visitors to wear PPE when visiting patients under contact, droplet, or airborne precautions

   Common areas such as waiting rooms can pose a risk for contamination if visitors who visit patients under standard or isolation precautions are not also protected. That’s why perioperative patient visitors should follow transmission-based precautions and perform hand hygiene, Wood explains.

Specifically, the guideline outlines how perioperative personnel should instruct visitors to wear PPE in the patient’s room and to perform hand hygiene upon entering and exiting the room, according to specific precautions:

• For contact precautions, the visitor should wear a gown and gloves.
• For droplet precautions, the visitors should wear a mask.
• For airborne precautions, the visitor should wear a mask. The visitor may wear an N95 respirator, although the respirator is most effective when the mask is fit tested and the wearer is trained in respirator use.

“It’s important for a healthcare organization to address their specific barriers and educational needs to ensure correct practices in many different aspects of transmission-based precautions,” Wood says. She also suggests the importance of engaging in multidisciplinary discussion to understand how specific PPE needs can be met with the appropriate products and how access to these products can be supported team wide.

FREE RECOURCES FOR MEMBERS

Learn more from Wood about these and other updates to this guideline in a Dec. 5 webinar, free for members only.

Guideline Essentials: Easily implement the new and revised recommendations for the guideline on Transmission-Based Precautions with easy-to-use tools, including:

• Quick Views: photos, illustrations, videos, and an overview of the guideline.
• Gap Analysis Tools: Tools to assess areas in which your facility may not be compliant with the guidelines.
• Policy & Procedure Templates: Ready-to-use customizable templates for developing your facility’s policies and procedures.
• Competency Verification Tools: Ready-to-use customizable templates for verifying competency to meet facility requirements.