Recommended Practice for the Prevention of Transmissible
InfectionsLisa Spruce, DNP, RN, ACNP, ACNS, ANP, CNOR
Director, Evidence-Based Perioperative Practice
Transmissible InfectionsRP Highlights
• Some new elements for standard precautions.
Standard Precautions
Standard Precautions
Environmental Control
• Environmental contamination was the major determinant of transmission to healthcare workers’ gloves or gowns. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission.
• ~Morgan (2012)
Respiratory hygiene/Cough etiquette
• Covering the mouth or nose with a tissue or sleeve.
• Wear a surgical mask if able.
• Stay at least 3 feet away from others
• Posting signs and providing instructions to patients and visitors.
• Single syringe, single needle, one time.
• Outbreaks of Hep C and B have been attributed to unsafe injection practices in multiple states.
• Health care textiles: change and launder after each patient use or when soiled.
• Launder in a health care-accredited laundry facility.
Standard Precautions
Contact Precautions
Contact with infected patients or contaminated surfaces leads to pathogen transmission 45% of the time.
Perioperative personnel should don PPE and:
• Wear gloves whenever touching a patient’s skin or items in close proximity to the patient.• Wear a gown when it can be anticipated that clothing will come into contact with the patient or contaminated environmental surfaces.
Make sure to discard PPE upon exiting the room!
Droplet/Airborne Precautions
Droplet• Place patient in a single
patient room before and after surgery.
• Special air handling and ventilation IS NOT required.
• Place at least 3 feet away from other patients.
• Place a mask on patient for transport.
Airborne• Patients should be placed in an
airborne infection isolation room.
• Special air handling and ventilation IS required.
• Do not place in the same room with other patients.
• Personnel should don a surgical mask or N95 respirator.
• Place a mask on patient for transport.
Intubation/extubation is a cough producing procedure!
After such procedures are performed, sufficient time should be allowed for 99% of airborne contaminants to be expelled before sterile supplies are opened for subsequent patients.
The OR doors are to remain closed.
Recovery should take place in an AIIR.
• If there is not AIIR- use a HEPA.
• Position near patient’s breathing zone.
• Switch the portable unit off during the surgical procedure.
• Provide fresh air according to ventilation standards for the OR.
HEPA filters
Environmental Cleaning
• Standard cleaning and disinfection procedures should be followed.
• Only perform after the appropriate amount of time for air ventilation.
• If room cleaning begins before the appropriate time has elapsed, cleaning personnel should wear N95 respirators or powered air-purifying respirators.
OSHA
Bloodborne Pathogen Standard
• PPE including surgical caps, hoods, shoe covers, or boots when gross contamination is anticipated.
• No eating or drinking in the semi-restricted or restricted areas.
• Gowns, gloves, masks, eye protection.
• Anticipate exposures!!
Prevention of Exposure
Controls
Engineering• Needleless systems
• Self-sheathing needles
• Sharps storage and disposal containers.
Work Practice• Prohibit risky handling of needles
and sharps.
• Prohibit recapping of needles by a two-handed technique.
• Using a neutral zone or hands free technique for passing sharps.
• Double glove for all surgical procedures.
Periop Actions
To prevent the transmission of health care-acquired infections
Surgical Site Infections
CDC: Atlanta, GA
SSI Statistics
• 500,000 annual SSIs
• 1.7 million HAIs
Sterile TechniqueThis is the foundation of infection prevention!
• Maintain a clean environment
• Wear clean surgical attire
• Perioperative skin antisepsis
• Hand hygiene
• Minimize traffic
• Adequate sterilization
Actions to Prevent SSI
Decolonization
• Collaborate with medical colleagues.
• Staph aureus has been found to be “the most powerful independent risk factor for SSI” in patients undergoing cardiothoracic surgery.
• Mupirocin ointment
• CHG
Antimicrobial Prophylaxis
Administer according to health care organization policy.
Critically timed adjunct therapy intended to reduce the microbial burden of surgical contamination to a level that cannot overwhelm the patient’s defenses.
• Improve hand hygiene practices
• Contact precautions until patient culture negative
• Managing vascular and urinary catheters
• Preventing lower resp tract infection in intubated patients
• Following the CDC Campaign to Prevent Antimicrobial Resistance
• Limiting and carefully selecting antimicrobial agents
MDROs
CLABSI
• Implement CDC Guidelines – Sterile technique
– Maximal sterile barrier• Hair covering
• Mask
• Sterile gown
• Sterile gloves
• Sterile full body drape
• Follow CDC guidelines– Insert only for medically indicated conditions
– Use only as necessary for surgical patients
– Document date and time of insertion
– Remove asap post-op (preferably within 24 hours)
– Strict aseptic technique
– Only allow trained persons to insert
CAUTI
Immunizations
CDC Recommendations
HCWs who get a flu shot decrease:
•transmission of influenza•staff illness and absenteeism•influenza-related illness and death, especially among patients
who are at increased risk
Health care personnel with Transmissible Infections
Restrict Activities
• Viral infections (flu)
• Purulent conjunctivitis
• Acute GI illness
• Asymptomatic carrier of diptheria
• Exudative lesions that cannot be contained
• Herpes simplex infections of the fingers or hands
• Pediculosis
• Scabies
• Meningococcal infection
• Work restrictions depend on several factors– Circulating viral burden
– Category of clinical activities
Consult with infection preventionist!
Bloodborne Infections
• AORN Surgical Wound Classification Decision Tree
• Helps perioperative nurses accurately identify surgical wounds
Surgical Wound Classification
AORN Decision Tree
AORN Decision Tree
Table