Observing Standard Precautions in the OR

Observing Standard Precautions in the OR

By Kathy Dix

We all know that it is best to wear personal protective equipment and tohandle sharps carefully in the operating room (OR), but oftentimes, precautionsare set aside in the rush of day-to-day issues that are seemingly moreimportant. But safeguards to protect healthcare workers (HCWs) are just ascrucial as methods to save a patient; without them, there would be few HCWs leftto help the patients.

The Basics

The Association of periOperative Registered Nurses (AORN) has developed a setof recommended practices specific to the OR and other related arenas, as shownbelow.¹ These guidelines are intended for the protection of patientsand HCWs from exposure to both bloodborne and body fluid pathogens, and arepartially based on recommendations by the Centers for Disease Control andPrevention (CDC), the "Guideline for Isolation Precautions inHospitals."

• 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 CarolynRamsey, staff development educator at Trinity Mother Frances Health System inTyler, Texas. "Everything kind of goes together, but the handwashingprobably prevents more spread of infection than any of the otherprecautions." According to AORN, that precaution -- when followed asrecommended -- can be "the single most important measure to reduce thespread 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 themcontaminated and not changing them [like when you chart something] -- that's onething I see happening pretty regularly," Ramsey underscores. "If youanswer the phone, now you've contaminated the phone. It's the public, too; (suchas when) they don't wash their hands, and then open the door or punch theelevator button."

Obviously, the public has no role in the OR, but there are still door handlesand telephones in that environment. When those are contaminated, theresponsibility of infection control falls upon the housekeeping department."How often does anybody wipe down the buttons to the elevator, or thedoorknobs?" Ramsey asks. Enforcing such simple cleaning precautions isessential 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 theirpatients 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 -- liketaking sick days would help, but then if we did that there wouldn't be anybodyto take care of the patients at all!" Extra safety measures could includegreater vigilance in avoiding sick coworkers, the use of sick days whennecessary and special attention to standard precautions.

Again, Ramsey reiterates, handwashing is the priority -- especially after acold-related action such as blowing your nose. Standard precautions are intendedto protect the HCW, Ramsey emphasizes. "But maybe because when you arescrubbed, you have all that protection on, you might become a little complacentwhen you're not scrubbed in. You have to remember, I don't have sterile gloveson, I need to wash my hands, and change my gloves when they'recontaminated," she adds. HCWs may just need a reminder of the differentrules that apply when they are not scrubbed in, she suggests.

"You're supposed to change your mask after every case anyway, butespecially during those seasons, you should be reminded to change your mask whenyou sneeze. Even though you wear a mask, you don't want to wear it once it getsdamp," she points out.

The intent of these protective guidelines is to create accountability for theHCW, foster a sense of responsibility (for the well-being of patients and fellowhealthcare personnel), and to serve as an authority. It is crucial to reviewthese policies regularly, in both orientation and continuing education, toensure that patients receive the best possible quality of care.