AORN Journal
Volume 86, Supplement 1 , Pages S82-S84, December 2007

Preventing Health Care–Associated Infections

  • Joan Blanchard, RN, MSS, CNOR, CIC

      Affiliations

    • Joan Blanchard, RN, MSS, CNOR, CIC, is a perioperative nursing specialist in the AORN Center for Nursing Practice.

Article Outline

 

Statistics on health care–associated infections show that an estimated 1.7 million infections and 99,000 associated deaths occur each year in the United States alone.1 To provide safe patient care, implementing sound practices for infection prevention and control is essential, whether the procedure takes place in a traditional operating room, an ambulatory surgery center, or a physician's office. In today's perioperative setting, state-of-the art technology is available to assist the caregiver in providing safer care by protecting both the caregiver and the patient from contracting or spreading infection.

The chain of infection involves a microorganism, a reservoir or source where the pathogen can survive and multiply (eg, blood), a mechanism of transmission (eg, contaminated hands), and a way for that microorganism to enter someone who is susceptible (ie, the host).2 The principles of infection prevention and control encompass guidelines not only for preventing and controlling the transmission of pathogens that may cause infections, but also for selecting the equipment or supplies needed to accomplish this goal. Here are some specific ways selecting the right equipment can help perioperative nurses prevent infection in their facilities.

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Hand Hygiene 

Hand-washing is the single most important step in interrupting the chain of infection and stopping the spread of infection. Because hands are a major source of transient flora, they are a major vector in cross-contamination in health care. Hands may be decontaminated with plain or antimicrobial soap and water, or by using an antiseptic hand rub. If hands are not visibly soiled or contaminated, alcohol-based products are very effective for routine decontamination.3

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Water Supply 

The water supply in a health care organization can contribute to infection transmission if it is contaminated by the buildup of biofilm or corrosion of the water supply lines or the lining of the water tank.4 Something as simple as the water tap aerators can collect biofilm.5 Patients who are immunocompromised or immunosuppressed are most at risk, but any patient may be at risk if exposed to a high level of virulence.6 Filters that have a 0.2 micrometer filtration capacity can remove bacteria and are easily placed on faucets and shower heads.7

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Airborne Disease 

Airborne disease concerns have been heightened with the advent of extensively drug-resistant (XDR) tuberculosis (TB), which is a form of drug-resistant TB. Although TB is fairly rare, 49 cases of XDR-TB were reported in the United States between 1993 and 2006.8 TB can easily become resistant to first-line drugs if they are prescribed incorrectly or if the patient does not take them appropriately. Second-line drugs are given to patients who have developed multidrug resistance, but second-line anti-TB drugs take longer to be effective.9

Precautions should be taken to avoid prolonged close contact with a patient who has TB. Airborne precautions include placing a surgical mask on the patient during transport, using an airborne isolation room with special air handling, and providing ventilation for areas outside the surgical suite. Health care personnel should wear N95 filtration masks when caring for these patients.8, 10 Health care facilities that do not have airborne infection rooms in their perioperative suites can use portable anterooms that have high-efficiency particulate air (HEPA) filters and can keep TB contained. These can be moved to wherever they are needed.

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Seasonal Influenza 

Every year many people, including health care personnel, neglect to receive an influenza immunization. Keep in mind that adults can be infectious from the day before symptoms appear to five days after influenza begins. Children can be infectious for more than 10 days. Signs and symptoms of influenza include fever, muscle aches, headache, malaise, nonproductive cough, sore throat, and a runny nose. Droplet precautions to prevent the spread of influenza include placing the patient in a private room, requiring health care personnel and family members to wear a surgical mask when within three feet of an infectious patient, positioning the patient at a distance of at least three feet from other patients, and placing a surgical mask on the patient during transport.11 More information on influenza and the influenza vaccine may be found on the Web site of the Centers for Disease and Prevention at http://www.cdc.gov/flu/keyfacts.htm.

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Skin Damage 

Tape adhesives. Reducing the risk of infection due to skin damage from adhesives can be achieved by the use of appropriate tape and the proper removal of adhesives. Breaks in the skin can provide an entry for microorganisms to enter and cause infection. Choosing the tape for the correct site, patient condition, and characteristics of the particular type of tape is very important. Tape should be chosen with these factors in mind:

•area where tape is to be applied,

•activity in the area where tape is being applied,

•moisture at the site, and

•risk factors patient may have, such as diabetes.

Removing tape is just as important as choosing the right tape. Tape should be removed slowly at a 180° angle, in the direction of hair growth, and with support close to the skin where the tape is being peeled. Medical adhesive remover or moisturizer can be used if hair is adhering to the tape.12

Hair removal. AORN recommends leaving hair in place at the surgical site whenever possible. If hair must be removed, personnel skilled in hair removal techniques should perform the removal using an electric or battery-operated clipper with a disposable or reusable head that can be disinfected between patients. Depilatories can cause skin reactions in some patients; removing hair with clippers is the least irritating method. In general, hair removal should take place as close to the time of surgery as possible.13

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AORN's Recommended Practices 

The AORN Standards, Recommended Practices, and Guidelines book contains many recommended practices (RPs) that can assist health care personnel in infection prevention and control. These are a few of the RPs:14

•Cleaning and Processing Anesthesia Equipment explains how anesthesia equipment such as IV catheters, tubing, stopcocks, syringes and needles, and medication vials and containers can become contaminated and be implicated in an infection.

•Surgical Attire provides guidelines for selecting, wearing, and caring for personal protective attire. It also discusses the proper use of surgical gowns, gloves, eyewear, face shields, and headgear in the restricted and semirestricted areas of the surgical suite.

•High-Level Disinfection explains the Spaulding classification system, which is used to determine at what level of disinfection or sterilization an item needs to be. It also discusses the need for though cleaning and decontamination to remove biofilm.

•Cleaning and Processing Endoscopes addresses the care, cleaning, decontamination, maintenance, handling, processing, inspection, and storage of endoscopes and endoscope accessories. Incomplete cleaning and processing can result in poor outcomes for patients.

•Environmental Cleaning focuses on keeping perioperative personnel safe in achieving the goal of a clean environment, which in turn keeps patients safe. A clean environment keeps pathogens at bay.

•Selection and Use of Gowns and Drapes provides information for making good choices in the process of choosing barrier materials to maintain a sterile field.

•Surgical Hand Antisepsis explains the difference between hand hygiene and surgical hand antisepsis, describes the proper procedure for hand-washing, and offers guidelines for selection of hand hygiene products.

•Selection and Use of Packaging Systems explains how packaging materials should be sterilized and stored and describes the different types of materials that are appropriate for the perioperative setting.

•Skin Preparation of Patients explains how to prepare the surgical site in a safe and thorough manner to prevent surgical site infection. Steps in performing a surgical skin prep are outlined, and antiseptic choices are discussed.

•Care and Handling of Specimens provides guidance for the containment, identification, labeling, transfer, transport, and disposition of specimens, defined in this context as tissue, blood, body fluids, or foreign bodies removed from a patient for pathological, microbiological, or gross examination. It also addresses establishing, documenting, and maintaining chain of custody for tissue specimens and forensic evidence.

•Maintaining a Sterile Field details the aseptic practices that are key to preventing surgical site infections. These include maintaining constant observation of the field, labeling medications with sterile labels, and properly delivering medications and sterile solutions to the field.

•Sterilization in the Perioperative Practice Setting discusses preparation, packaging, processing, storing, handling, and transporting sterile items to be used in patient care. It also provides guidelines for the types of materials that are appropriate for various methods of sterilization.

•Surgical Tissue Banking discusses the guidelines of the American Association of Tissue Banks for handling tissues and maintaining tracking mechanisms for tissue banking. It also addresses requirements for determining donor suitability and retrieving tissue from a donor.

•Traffic Patterns defines the areas of the surgical suite—unrestricted, semirestricted, and restricted—to assist in determining the appropriate use of physical space to protect patients, personnel, supplies, and equipment from cross-contamination and security risks.

•Prevention of Transmissible Infections provides guidelines on caring for patients who are known or believed to have an infection. Standard precautions, contact precautions, droplet precautions, and airborne precautions are defined and presented to help caregivers safeguard patients and protect themselves.

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References 

  1. Estimates of Health Care Associated Infections  . Centers for Disease Control and Prevention Fact Sheet . http://www.cdc.gov/ncidod/dhqp/hai.html Accessed Oct 1, 2007.
  2. Infection Control in Dental Settings  . Guidelines for Infection Control in Dental Health Care Settings, 2003. Centers for Disease Control and Prevention . http://www.cdc.gov/OralHealth/infectioncontrol/guidelines/slides/008.htm Accessed Oct 1, 2007.
  3. AORN  . Recommended Practices for Surgical Hand Antisepsis/Hand Scrubs . In: Standards, Recommended Practices, and Guidelines . Denver, CO: AORN, Inc; 2007;p. 565–573
  4. Anaissie E , et al.   The Hospital Water Supply as a Source of Nosocomial Infections . Arch of Intern Med . 2002;162(13):1483–1492
  5. Trautmann M , et al.   Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism . Am J Infect Control . 2005;33(5):S41–S49
  6. Squire C , et al.   Waterborne Nosocomial Infections . Hosp Epidemiol . 2000;2(6):490–496
  7. Schraag J . Waterborne Pathogens: What's Lurking in Your Facility's Pipes? . Infect Control Today . 2005;9(7):14–19 http://www.infectioncontroltoday.com/articles/405/405_571Clinical.html Accessed Oct 1, 2007.
  8. Extensively Drug-Resistant Tuberculosis (XDR TB)  . Centers for Disease Control and Prevention. July 2007 . http://www.cdc.gov/tb/pubs/TBfactsheets.htm Accessed Oct 1, 2007.
  9. Frequently asked questions—XDR-TB  . World Health Organization . http://www.who.int/tb/xdr/faqs/en/index.html Accessed Oct 1, 2007.
  10. AORN  . Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting . In: Standards, Recommended Practices and Guidelines . Denver, CO: AORN, Inc; 2007;p. 707–717
  11. AORN  . Human and Avian Influenza and SARS Guideline . In: Standards, Recommended Practices and Guidelines . Denver, CO: AORN, Inc; 2007;p. 137–149
  12. LaVelle BE . Reducing the risk of skin trauma related to medical adhesives . Infect Control Today . 2004;4:56–65
  13. AORN  . Recommended Practices for Skin Preparation of Patients . In: Standards, Recommended Practices and Guidelines . Denver, CO: AORN, Inc; 2007;p. 653–657
  14. AORN  . Standards, Recommended Practices. and Guidelines . Denver, CO: AORN, Inc; 2007;

PII: S0001-2092(07)00709-0

doi:10.1016/j.aorn.2007.11.013

AORN Journal
Volume 86, Supplement 1 , Pages S82-S84, December 2007

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