Preparing for Ebola in the Operating Room

As hospitals and healthcare systems across the country evaluate their infection prevention practices for Ebola safety, medical specialties are providing their practitioners with recommendations to prevent contamination and spread of the disease.  To date none of the patients treated in the U.S. have required surgical treatment, however, perioperative RNs should be prepared to meet this patient need should it arise.

The Association of periOperative Registered Nurses (AORN) recommends that airborne precautions be taken when caring for an Ebola patient in the surgical setting in addition to standard, contact, and droplet precautions. The AORN Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting provides detailed guidance to perioperative RNs for implementing standard precautions and transmission-based precautions (i.e., contact, droplet, airborne).

Airborne precautions are necessary in the OR because an aerosol-generating procedure is highly likely to occur. According to the Centers for Disease Control and Prevention (CDC) airborne precautions should be taken when an aerosol-generating procedure (eg, intubation and extubation, open suctioning of airways) is performed on a patient with Ebola. An airborne infection isolation room should be used if available during surgery and postoperative recovery. If no airborne infection isolation room is available, a portable anteroom system (PAS)-high-efficiency particulate air (HEPA) combination unit may be used. Use of certain air purifying respirators in the OR is under evaluation by OSHA and NIOSH, but the issue remains unresolved. AORN recommends that facilities conduct a risk assessment in consultation with the organization’s infection preventionist when selecting respirators to be used the OR.

According to Amber Wood, MSN, RN, CNOR, CIC, AORN, environmental cleaning team members should follow CDC recommendations when cleaning the OR after a patient with Ebola. The CDC advises higher levels of precaution toward potentially contaminated surfaces because of Ebola’s apparent low infectious dose and disease severity.

Contaminated instruments should be placed in puncture and leak-proof containers and transported to the decontamination area as soon as possible after completion of the procedure. Sterile processing team members should follow standard precautions and wear personal protective equipment (PPE) including:
• a fluid-resistant gown with sleeves,
• gloves (i.e., general purpose utility gloves with a cuff that extends beyond the cuff of the gown),
• a mask and eye protection or a full face shield, and
• shoe covers or boots designed for use as PPE. 

Wood recommends a review of AORN’s Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment for detailed guidance for the safe handling and decontamination of soiled surgical instruments.

According to Wood, all perioperative team members should limit the amount of surface contamination with blood and body fluids from the patient and follow AORN’s Recommended Practices for Sharps Safety to minimize the risk of injury from a contaminated sharp device.

AORN has provided more detailed information for perioperative personnel in the online edition of the association’s Journal, with Ebola: Perioperative Considerations, an open access Special Feature on the AORN Journal home page.

Source: AORN