Guideline Revisions for 2020: 7 Things to Know

With every guideline reformatted into the new evidence-rating model for easier implementation and six revised guidelines, it’s not too early to prepare your interdisciplinary teams to adopt new safety practices outlined in the 2020 edition of AORN’s Guidelines for Perioperative Practice. Preorder the 2020 edition and lock in 2019 pricing today.

Periop Today recently spoke with Amber Wood, MSN, RN, CNOR, CIC, editor-in-chief of AORN Guidelines for Perioperative Practice. Here are seven guideline updates she calls out that could influence your practice:

1. New format and evidence rating

   “The most striking change is the way we write the guidelines,” according to Wood who shares that each practice recommendation in the simplified format is sorted by topic, organized numerically as 1, 2, 3, 4 …., and written with action verbs for more seamless adoption into policies. “Every guideline in the 2020 edition has been updated to our new format that will be so much easier to use and implement.”

   A new evidence-rating model also has changed the process and language used for the evidence quality rating and for the recommended strength rating as: regulatory requirement, recommendation, conditional recommendation, and no recommendation, which will make it easier for interdisciplinary teams to assess and implement guidelines in their specific care setting, Wood says.



2. Surgical Attire

   Based on the release of several new published studies on surgical attire, AORN now recommends that some policy decisions for actions such as donning cloth caps* are now determined at the facility level. Other attire-related practice changes include a shift from arm covering in the restricted and semi-restricted areas to arms that may be covered during performance of preoperative patient skin antisepsis**. Another new recommendation states that beards be covered when entering the restricted areas and while preparing and packaging items in the clean assembly section of the sterile processing area.

   *AORN’s recommendation is to cover the scalp and hair when entering the restricted or semi-restricted areas. An interdisciplinary team, including members of the surgical team and infection preventionists, may determine the type of head covers that will be worn at the health care organization. The evidence does not demonstrate any association between the type of surgical head covering material or extent of hair coverage and the outcome of SSI rates.

   **In this guideline, there is no recommendation for covering the arms with long sleeves in the semi-restricted and restricted areas other than when performing preoperative patient skin antisepsis. A study by Markel et al (Markel TA, Gormley T, Greeley D, Ostojic J, Wagner J. Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants. Am J Infect Control. 2018;46(4):369-374.) found that wearing long sleeves specifically appeared to decrease the amount of Micrococcus in the environment and the researchers recommended wearing attire with long sleeves when performing the intraoperative patient skin prep. There is no recommendation for type of covering.



3. No more clear/colorless plastic tip protectors

   Revised recommendations in the Sterilization Packaging Systems guideline include a new recommendation based on evidence that colored plastic tip protectors be used to reduce the risk for a retained surgical item (RSI).

   “We are one of the first professional organizations to recommend this change, which reflects the unique perspective of the nurse’s focus to reduce the risk of RSI,” Wood notes.



4. Stronger support for double-gloving

   While previously recommended double-gloving to reduce the risk for sharps injury and potential exposure to bloodborne pathogens, the revised guideline for Sharps Safety strengthens this recommendation by citing a new systematic review of randomized controlled trials on double-gloving. The review includes evidence that glove perforations were reduced by 71% when wearing two pairs of gloves compared to wearing only one.



5. Temperature guidance changes for storing autologous tissue

   Storage temperature parameters for autologous skin and vessels are outlined in the revised guideline for Autologous Tissue Management. New evidence is described to explain temperature ranges and storage times used in the literature for cranial bone flaps and parathyroid tissue.



6. Segregated cleaning practices within the surgical suite

   The revised guideline on environmental cleaning recommends that cleaning equipment, tools, and materials used in the surgical suite should not be used outside of surgical suite because cleaning cart and equipment wheels could transfer soil and microorganisms to the surgical suite. A separate recommendation in the guideline states that a spray bottle should not be used when applying disinfectants to surfaces. 



7. Unplanned hypothermia risk assessment for all patients

   The revised guideline for Preventing Unplanned Perioperative Hypothermia recommends that a risk assessment be conducted for every patient during preoperative care because all surgical patients are at risk of developing hypothermia because anesthesia blocks the normal bodily reactions that prevent hypothermia and certain patient and procedural factors may increase the risk for hypothermia.

Leverage Implementation Support

With these guideline updates come new and revised implementation resources designed for interdisciplinary perioperative teams. For example, an updated gap analysis tool that accompanies the revised surgical attire guideline revisions will be “a great resource for nurses to facilitate a team-wide understanding of current attire practices,” Wood suggests.

Preorder the 2020 edition of Perioperative Practice Guidelines today and lock in 2019 pricing. AORN Members save an additional $50.