Although your staff should already be familiar with these concepts, they may not fully understand where each zone begins and ends in your facility. Therefore, the facility manager should post "traffic signs" to clearly identify each zone.

4. Body adornments such as piercings and tattoos presents no additional infection risks to the patient or staff.
echo" Answer: ".strtoupper("b). False")."
"; Body adornments such as nose rings, tongue rings, eyebrow rings and tattoos represent a growing concern to infection control experts, according to Dr. Allen. Although there are no conclusive studies to day, the prevailing belief is that these adornments present at least a minor heightened risk of transmitting disease, as well as safety concerns.

A nose ring, for instance, could become dislodged and enter and remain in the surgical wound, although the likelihood of this is small. Conversely, if a surgical mask covers the nose ring, the ring rubs against the mask when the clinician talks. This presents the risk of dislodging dead skin that could enter the surgical wound.

All people entering restricted or semirestricted areas of the surgical suite should confine or remove all jewelry, according to the AORN's "Recommended Practices for Surgical Attire." Rings, watches and bracelets should be removed; other jewelry, such as earrings, should be removed or totally confined within the scrub attire. The same should go for other such "modern" accessories that younger staff members may sport.

A recent AORN Journal letter dealt with a question about a staff member whom recently got a nose piercing. AORN recommends that the staff member remove the nose stud while on the job. If the staffer is unable or unwilling to do so, it should confine it under the mask at all times, including when the person isn't scrubbed. The mask should be changed roughly every two hours, and the person assigned to procedures of shorter duration so the mask can be changed at appropriate intervals. What's more, if the pierced track has serous drainage or weeping, the employee should be excused from work until the drainage or weeping subsides.

When it comes to tattoos, different issues are prevalent. One key concern is infection with hepatitis B or C if the healthcare worker recently received the tattoo with a device that wasn't sterilized appropriately. The worker, who might develop a subclinical case of hepatitis, could then potentially transmit hepatitis to patients through blood contact.

5. All accredited ASCs are expected to install laminar flow rooms.
echo" Answer: ".strtoupper("b) False")."
"; Laminar flow rooms represent an area of continuing research. Dr Allen says, however, that there is some evidence that laminar flow rooms are effective in reducing transmission of infection during high-risk procedures, especially total hip and knee replacement surgery. If you install a laminar flow system, you also may want to take additional proactive steps to minimize contamination - for instance, providing clinicians with their own air supply.

Some feel, however, that laminar airflow rooms are not necessary. According to some studies, facilities that diligently tend to preventing environmental contamination have the same (low) infection risk as those who install a laminar system. The key preventative factors include limiting the number of people in the room, keeping talking to a minimum, ensuring that clinicians wear masks and surgical clothing appropriately, and keeping the door closed, says Dr. Allen.

Realize that opening the door too frequently can short-circuit positive pressure. Limit the number of people who enter or exit the room, and have everything needed for the procedure in the room before the procedure begins, if possible.

What's more, ordinary ventilation systems that are frequently monitored - with adequate air changes and where preventive maintenance is a top priority - usually can be effective in reducing transmission of infection.

A schedule of preventive maintenance is crucial, as is awareness by staff. For instance, Dr. Allen recommends educating staff to the fact that a dirty vent grill and visible particles from an exhaust fan are indications of potential environmental hazards.

Lastly, make sure your ASC has a mechanism for doing air surveys on a routine basis, says Joan Blanchard, RN, MSS, CNOR, CIC, perioperative nursing specialist, Center for Nursing Practice at AORN. If you outsource the surveys, inquire about where else the company has done the surveys and their reporting abilities. You may also want to double check to ensure that the techs that test your anesthesia machines check for leaks to ensure that they're operating within approved levels.

6. The optimal relative humidity in an OR is:
echo" Answer: ".strtoupper("d) 50% to 60%")."
"; Minimum air changes work in concert with other factors, such as the positive air pressure and relative humidity, according to Dr. Allen. Many don't understand the importance of the appropriate level of humidity. If the room is too dry, more dust can circulate around the room; if too moist, healthcare workers may perspire into the surgical wound. The optimal level is 50% to 60% relative humidity.

7. Between cases, you don't need to clean visible contamination in the OR.
echo" Answer: ".strtoupper("b) False")."
"; Your staff must clean any visible contamination between surgical cases to remove the hazard, according to Dr. Allen. The OR should never be turned over for the next case when there is visible contamination in the environment. This includes removing sutures from the floor, mopping any blood on the floor and changing sheets. While this concept should be self-evidence, sometimes people get lazy in the rush to keep the ORs moving.

The terminal cleaning at the end of each surgical day is also crucial, say the experts. Dr. Allen recommends starting from the room's ceiling and overhead lights, cleaning any visible dust and wash down the walls. Also clean any horizontal surfaces and wipe down any equipment that stays in the room. Other important steps to keep the OR environment clear of pathogens that can lead to infections:

• Perform flood mopping using a vacuum system. The agent should remain in contact with the floor for 10 minutes to be effective.
• Dissemble the cleaning equipment and clean it with an EPA-registered, facility-approved agent, then dry it before storing, notes the AORN's "Recommended Practices for Environmental Cleaning in the Surgical Practice Setting." This prevents growth of microorganisms during storage and prevents later contamination of the surgical setting.

Researchers have not established a significant link between dirty floors and infection transmission - obviously, feet don't come in contact with a surgical wound. Still, if dirt remains on the floor, particles could become airborne and enter the surgical field.

Shoe covers are not effective in preventing infection, says Dr. Allen. They do have a degree of validity as personal protective equipment. For instance, although unlikely, blood on the surgical floor could conceivably seep into a shoe and enter the body through a hangnail, causing infection to the clinician.

Finally, once a week or once a month, scrub the entire OR from to bottom, including the walls, even more thoroughly with an EPA-approved germicidal agent. Dr Allen says to pay special attention to corners, ledges, doorjambs and other hard-to-reach places.

8. Most facilities inform staff about the infection rate:
echo" Answer: ".strtoupper("d). Rarely, if ever.")."
"; It is not the norm to inform staff about the infection rate at the facility. Dr. Allen, for one, believes that it should be. Appoint a staff member to collect this data and report on it at staff meetings. It's not necessary to look at every case, but select cases to audit on a periodic basis and feed this data back to surgical and clinical staff. You might, for instance, look at hernia procedures during a three-month span.

On a related note, says Dr. Allen, you may want to incorporate evidence-based medicine into your quality improvement program to help control infection. With evidence-based medicine, you examine the research available to address a specific clinical question and use that information to change practice.

Your "infection czar" can rate the effectiveness of the research and incorporate recommendations from the better-controlled studies into your clinical practice.

9. What types of record keeping are helpful to control the OR environment?
echo" Answer: ".strtoupper("f) All of the above")."
"; Keep sterilizing logs to record any problems with autoclaves, if it was taken out of service, and the repair process, says Ms. Blanchard. It's also a good idea to maintain implant logs. If a recall occurs, you can determine which patients have the implants and notify their physician. Also keep any alerts, such as a suture manufacturer's alert to not use a certain lot number of sutures you might have received.

Maintain a second copy of operative records as a log for your procedures. Keep them for at least a year, recommends Ms. Blanchard. If questions arise about what happened in a case, you can consult these files. Finally, keep a copy of air exchange reports.