Observing Standard Precautions in the OR
By Kathy Dix
We all know that it is best to wear personal protective equipment and to handle sharps carefully in the operating room (OR), but oftentimes, precautions are set aside in the rush of day-to-day issues that are seemingly more important. But safeguards to protect healthcare workers (HCWs) are just as crucial as methods to save a patient; without them, there would be few HCWs left to help the patients.
The Association of periOperative Registered Nurses (AORN) has developed a set of recommended practices specific to the OR and other related arenas, as shown below.1 These guidelines are intended for the protection of patients and HCWs from exposure to both bloodborne and body fluid pathogens, and are partially based on recommendations by the Centers for Disease Control and Prevention (CDC), the "Guideline for Isolation Precautions in Hospitals."
- Standard precautions to prevent pathogen transmission should be used during all invasive procedures.
- Standard precautions should include use of protective barriers and prompt and frequent handwashing to reduce the risk of exposure to potentially infectious materials.
- Personnel should take precautions to prevent injuries caused by scalpels and other sharp instruments.
- Personnel should handle specimens as potentially infectious material.
- Work practices should be designed to minimize risk of occupational exposure to bloodborne and other potentially infectious pathogens.
- Personnel who have exudative lesions or weeping dermatitis should refrain from providing direct patient care or handling medical devices used in performing invasive procedures.
- Personnel who participate in invasive procedures are encouraged to voluntarily know their HIV and HBV antibody status and disclose a positive status to the appropriate facility authority.
- Guidelines of the CDC Advisory Committee on Immunization Practices regarding HBV immunization should be followed.
- Transmission-based precautions should be used in addition to standard precautions for patients who are known or suspected to be infected with epidemiologically important and highly transmissible pathogens. Types of transmission-based precautions include airborne, droplet and contact precautions.
- Policies and procedures that address occupational exposure to blood and bloody fluids and epidemiologically important microorganisms should be written, reviewed periodically and readily available within the practice setting.
The Most Important Principle
"I think handwashing is the most important principle," says Carolyn Ramsey, staff development educator at Trinity Mother Frances Health System in Tyler, Texas. "Everything kind of goes together, but the handwashing probably prevents more spread of infection than any of the other precautions." According to AORN, that precaution -- when followed as recommended -- can be "the single most important measure to reduce the spread of microorganisms."1
Reinforcing Forgotten Standards
Some principles are so simple that HCWs just don't think to do them. "The one thing that comes to mind is putting on gloves, then getting them contaminated and not changing them [like when you chart something] -- that's one thing I see happening pretty regularly," Ramsey underscores. "If you answer the phone, now you've contaminated the phone. It's the public, too; (such as when) they don't wash their hands, and then open the door or punch the elevator button."
Obviously, the public has no role in the OR, but there are still door handles and telephones in that environment. When those are contaminated, the responsibility of infection control falls upon the housekeeping department. "How often does anybody wipe down the buttons to the elevator, or the doorknobs?" Ramsey asks. Enforcing such simple cleaning precautions is essential to prevent the spread of infectious organisms.
Protecting Patients From Microorganisms on HCWs
There is much talk about shielding HCWs from the maladies of their patients, but what about the reverse? Especially during the upcoming cold and flu season, protecting both patients and HCWs is crucial. So what can HCWs do to save their patients from those extra germs?
"We don't (take special precautions during cold and flu season)," says Ramsey. "But certainly there would be room for improvement -- like taking sick days would help, but then if we did that there wouldn't be anybody to take care of the patients at all!" Extra safety measures could include greater vigilance in avoiding sick coworkers, the use of sick days when necessary and special attention to standard precautions.
Again, Ramsey reiterates, handwashing is the priority -- especially after a cold-related action such as blowing your nose. Standard precautions are intended to protect the HCW, Ramsey emphasizes. "But maybe because when you are scrubbed, you have all that protection on, you might become a little complacent when you're not scrubbed in. You have to remember, I don't have sterile gloves on, I need to wash my hands, and change my gloves when they're contaminated," she adds. HCWs may just need a reminder of the different rules that apply when they are not scrubbed in, she suggests.
"You're supposed to change your mask after every case anyway, but especially during those seasons, you should be reminded to change your mask when you sneeze. Even though you wear a mask, you don't want to wear it once it gets damp," she points out.
The intent of these protective guidelines is to create accountability for the HCW, foster a sense of responsibility (for the well-being of patients and fellow healthcare personnel), and to serve as an authority. It is crucial to review these policies regularly, in both orientation and continuing education, to ensure that patients receive the best possible quality of care.