By Kathy Dix
The practices review committee at the Association of periOperative Registered Nurses (AORN) has been busy reviewing updated guidelines for hand hygiene from the Centers for Disease Control and Prevention (CDC). What will their new recommendations for perioperative nurses include?
The committee set itself the task of reviewing the CDC guidelines to establish a new surgical prep/handrub policy based on those recommendations. The Proposed Recommended Practices For Surgical Hand Antisepsis/Hand Scrubs were posted on AORN’s Web site (www.aorn.org) for public comment through Nov. 21, 2003.
“The AORN recommended practices are posted on the Web site as ‘proposed’ to elicit comment and input from members and others,” says Dorothy M. Fogg, RN, BSN, MA, senior perioperative nursing specialist at the AORN Center for Nursing Practice. “When the deadline for comment is reached, the document is removed from the Web and the comments collected and reviewed. Comments appropriate to the document are included in the document as it is revised. After revision, the document is forwarded to the AORN board of directors for final approval. Following that approval, the document is published in the AORN Standards, Recommended Practices, and Guidelines, an AORN publication that is updated each year.”
The proposed recommended practices have not been approved by the board of directors at this time. However, Fogg says, “We anticipate that happening in the near future. The document is expected to appear in the 2004 recommended practices book unless the board voices a concern or requests changes.”
The document addresses both general hand hygiene in the operating room and the surgical scrub. The CDC guideline is a comprehensive document, addressing far more than hand hygiene in the operating room, Fogg points out.
“As an association of perioperative nurses, we try to limit our document to addressing issues of interest to perioperative nurses and to providing our members with recommendations for safe practice,” she says.
Fogg notes that the board of directors’ approval was expected by Jan. 1, 2004. “The actual book will be released upon publication and will be available at the AORN annual Congress in San Diego in March,” she says.
When asked how long it takes to review and integrate the public’s comments into a recommended practice document, Fogg explains that the time to review varies based on the document itself and the comments received in relation to it. “The turnaround could be as little as a couple of weeks or as long as several months,” she adds.
Accepted components commonly used as antimicrobial agents include the following:
However, each product has its bonuses and negatives. Alcohol, for example, is very effective, but has no residual activity. Other components are too irritating to use for hand hygiene.
The proposed recommended practices for surgical hand antisepsis and hand scrubs are relatively straightforward. Available at www.aorn.org/proposed/handscrub.htm, the draft of the recommended practices was posted online for comment until Nov. 21, 2003.
“These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice,” the Web site states. “Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.”
The settings in which these guidelines might be appropriate include:
Settings also include other areas where operative and other invasive procedures may be performed.
AORN observes that from the time of Semmelweis’ research, hand hygiene has been recognized as a crucial means of preventing the spread of infection from healthcare workers to their patients, and that hand hygiene in relation to patient care — both before and after care — “remains the most effective and least expensive measure to prevent and control the transmission of microorganisms and prevent healthcare- associated infection. Hand hygiene is the single most important step in the prevention of infections.”
Therefore, “It is of critical importance that the entire healthcare team routinely practice the basic tenets of hand hygiene. Basic hand hygiene/antisepsis refers to handwashing, antiseptic handwash, or use of an antiseptic hand rub,” the proposed guidelines read.
The guidelines make several recommendations that are hardly new, but certainly worth repeating:
The main points of the recommendations include the following:
Recommended Practice I
General Hand Hygiene and Surgical Hand Antisepsis Directives
|General hand hygiene|
|Visible soil||Wash hands with plain or antimicrobial soap and water.|
|No visible soil||Sanitize hands with an alcohol-based hand rub or wash with plain or antimicrobial soap and water.|
|Surgical hand antisepsis|
|Visible soil/no visible soil||Wash hands with soap and water, then use either a US Food and Drug Administration (FDA) compliant, antimicrobial scrub agent or an FDA-compliant, alcohol-based antiseptic hand rub agent that is cleared for surgical hand antisepsis and provides persistent and cumulative activity.|
Recommended Practice II
Recommended Practice III
Recommended Practice IV
Recommended Practice V
Recommended Practice VI