AORN Guidelines: Five Changes Leaders Need to Know

Has your team adapted to these important practice updates?

The Association of periOperative Registered Nurses (AORN) has released six updated guidelines since April 2024, with more updates on the way in the coming months.

Erin Kyle, DNP, RN, CNOR, NEA-BC, editor-in-chief of AORN’s Guidelines for Perioperative Practice, says there is much for surgical teams to discuss.

When discussing implementation of the changes to the guidelines, leaders should emphasize teamwork.

“Just as safe surgeries require interdisciplinary collaboration, implementing current evidence-based perioperative practices must include a cohesive team — and this requires high-performing perioperative leadership,” says Dr. Kyle.

Where to start

For teams gathering information and looking for ways to implement practice changes based on AORN’s updated guidelines, Dr. Kyle suggests focusing on five key changes as a starting point.

Change #1: Create an Air Quality Management Program

The Guideline for Sterile Technique update published in April 2024 includes a new recommendation (see recommendation 9.5) that describes how a perioperative air quality management program may be used to reduce the risk of airborne environmental contamination in any room where invasive procedures are performed.

Leaders can look to this guidance to assemble a team for the development and implementation of a perioperative air quality management program. Personnel from multiple disciplines should bring their expertise and authority to analyze data and make decisions for air quality improvement.

The evidence-based benefits of an air quality management program can help leaders communicate the rationale for changes in practice among the team. For example, the AORN guideline references a 2020 study that showed how the behavior of perioperative staff could result in increased air microbial contamination, such as when staff do not follow best practices for minimizing OR door openings, or when they exceed the maximum number of staff members who are allowed to be in the room at the same time.

Change #2: Plan Emergency Water Supply for Sterile Processing

“Don’t overlook being prepared when a utility, especially water, is interrupted,” Dr. Kyle cautions. “More and more we are seeing extreme weather impacting water supply across the country.” The Guideline for Sterilization update published in October 2024 includes a new recommendation (see recommendation 12.8) for leaders to plan for a disruption in water supply by ensuring access to safe water for sterile processing.

A valuable resource for building this strategy can be found in a 2023 article on maintaining water supply quality for sterile processing. One helpful approach is to have a process in place to measure quality parameters for water hardness, pH, conductivity, chlorides, bacteria and endotoxins, and to empower sterile processing personnel to raise concerns when these parameters reach unsafe levels.

Change #3: Assess Risks for Infective Airborne Particles and Plan for Emerging Infectious Diseases

Two new sections in the Guideline for Transmission-Based Precautions update, published in January 2025, reflect extensive new evidence produced during the COVID-19 pandemic.

The new Section 6 of the guideline addresses Infective Particle Risk Assessment, including recommendations on how to convene an interdisciplinary team to determine an organizational risk assessment framework for infective airborne particles as part of your respiratory protection program (see recommendation 6.1).

One essential action of this team is to determine individualized interventions that are tailored to a patient’s situation. A valuable article cited in the guideline to explore this is a 2022 study by Silvers et al. The authors discussed how the CDC/NIOSH Hierarchy of Controls should be incorporated in plans to reduce airborne particle exposure. They emphasized infectious particle removal through improved ventilation strategies, protection through immunization and effective personal protective equipment.

Section 7 of the guideline discusses the regulatory requirements to incorporate managing emerging infectious disease (EID) as part of your emergency preparedness program. Specifically, it emphasizes that perioperative teams should be actively involved in interdisciplinary planning for far-reaching perioperative impacts of an infectious disease pandemic, such as supply shortages and surgery cancelations.

Change #4: Support Patient Normothermia With a Patient Temperature Management Plan

New studies cited in the Patient Temperature Management guideline update published in December 2024 demonstrate significant variability in methods to reduce inadvertent perioperative hypothermia. Notably, variation is common in patient temperature monitoring methods across the phases of surgical care, says Dr. Kyle.

To counter these inconsistencies, a new recommendation in the guideline update (see recommendation 1.1) recommends shaping an interdisciplinary team with experts representing each phase of care, as well as quality and informatics experts. Actions to be addressed should include standardized temperature monitoring, standardized hypothermia risk assessment and the use of safe and effective warming methods. One example of standardized temperature monitoring improvement cited in the guideline update is a 2018 study by Sims et al that discusses selection of the most accurate thermometer devices for pediatric patients.

Dr. Kyle says the ultimate goal should be to establish a coordinated effort among the entire perioperative team that continues through all phases of care with minimal interruption because “the evidence shows this consistency is best to support patient normothermia and the improved outcomes associated with it.”

Change #5: Improve Sharps Safety Through an Organizational Program

The Guideline for Sharps Safety update published in January includes a new recommendation (see recommendation 1.1) to organize a formal program for reducing sharps injuries in the perioperative setting. Given the widespread impact of sharps use, sharps injuries and sharps reporting, this team should reflect broad expertise. Perioperative team members as well as experts in occupational health, infection prevention and risk management should be included.

Advanced work around a culture of safety should be a central focus for this team to improve awareness around sharps safety practices. “This culture shift starts with clear commitment from organizational leaders,” Dr. Kyle stresses. For example, leaders need to look at ways to create a non-punitive environment to support consistent reporting of sharps injuries.

Sharps injuries are drastically underreported. A good study to help teams understand the need to create a better sharps injury reporting culture is a 2021 systematic review that found that nearly 60% of global sharps injuries in health care are not reported. OSM

GET INVOLVED

Be Part of Guideline Changes

Perioperative professionals and leaders have the opportunity to provide input about AORN guidelines that are under development when they are published for public comment.

In addition to public comment, Erin Kyle, DNP, RN, CNOR, NEA-BC, editor-in-chief of AORN’s Guidelines for Perioperative Practice, says it’s important to know which new guidelines and guideline updates are coming soon.

One to watch is a completely new Guideline for Artificial (or Augmented) Intelligence that is planned for e-release in 2026 and print in 2027.

“We are seeing that there are not consistent patterns being used for AI adoption in health care and that there are significant quality and safety concerns that need consideration when approaching AI of all kinds that touch perioperative practice,” says Dr. Kyle.

Follow developments with AORN guidelines at aornguidelines.org.