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Infection Prevention: 8 too-common breaches

Publish Date: 2/6/2013
Everything perioperative professionals do in the OR or anywhere in a facility needs to focus on protecting patients, says Amber Wood, MSN, RN, CNOR, CIC, CPN, perioperative nursing specialist for AORN. A significant part of protecting patients is preventing them from receiving an infection that could affect their quality of life or even mortality.

"Nurses are the patient's advocate, and I think it is so important for us to always keep at the forefront of our mind that we're here to do no harm and that includes infection vigilance," Wood says. "But we're outnumbered by bacteria and microorganisms. With multidrug resistant organisms, the bugs are evolving and we're not evolving as quickly. This is a constant challenge we face."

Since it is critical for perioperative professionals to keep their practice on constant alert in order to prevent infection prevention breaches, it is helpful to understand where and why breaches occur. Wood identifies eight common lapses in following appropriate infection prevention procedures.

1. Inadequate hand hygiene. In the perioperative setting, there are many tasks to perform, and many areas that call for hand hygiene, Wood says. "The more tasks and exposures we have, the more likely it is that our hand hygiene will be inadequate."

It is important to remember that you should not use gloves to replace hand hygiene, she says. "Our hands should always be washed before and after wearing gloves. Especially if you're going from dirty site to a clean site, remembering to change the gloves and wash your hands is very important.

"Also, when washing your hands, if you don't always remove the jewelry, the rings and the watches from your hands, you can't always properly clean them," Wood continues. "We recommend you remove rings and watches when you wash your hands."

2. Surgical attire non-compliance. There are several common infection prevention breaches associated with surgical attire perioperative professionals need to watch out for. "Wearing scrubs and shoes in from the outside is a common breach, as is not completely covering the hair, especially with wearing skull caps," Wood says. "Skull caps do not completely cover the hair to the nape of the neck. Full coverage takes extra attention."

It also common to see improper wearing of masks, when the mask does not cover the entire face and nose, Wood says. "A lot of times it's under the nose. Pulling the mask off and letting it dangle around the neck contaminates the surgical attire since we always consider the filter portion of the mask contaminated. There may be some breaches there.

"That also comes into play when removing the mask," Wood continues. "You shouldn't be touching the filter portion. We should be handling the mask by the ties."

Another breach associated with surgical attire concerns bringing briefcases and backpacks into semi-restricted zones. "We cannot properly disinfect these soft surfaces, so they should not be in these areas," she says.

3. Incorrect personal protective equipment (PPE) usage. "Standard precautions tell us that when we anticipate exposure, we should protect ourselves," Wood notes. "If we anticipate exposure to a body fluid, then we should wear a gown, a glove, possibly eye protection if there's a splash that could incur. My motto: If it's wet and it's not yours, wear a glove."

4. Underutilization of sharps injury prevention methods. Wood says the most common cause of this breach is not following evidence-based methods to prevent injury, like abiding by a no-pass zone or using safety-engineered sharps devices. "I think a lot of those breaches occur because of our habits. There needs to be a change of practice, of habit for the perioperative staff, for the surgeons and the anesthesiologists, and sometimes we see a conflict there. Old habits are hard to break. But following evidence-based practices is so important. The evidence is there and we need to use it."

5. Rushed environmental cleaning. These breaches often occur because corners are cut to save time, especially during room turnover. "Time is money in the OR, but we cannot cut corners, and you can't start cleaning the room before the patient leaves," Wood says.

6. Traffic disruptions. Personnel traffic and conversations need to be kept to a minimum when procedures are in progress, Wood advises. "When there's a procedure going on, we should try to limit the amount of personnel in the room, limit the amount of conversation. The more we move around, the more we shed skin cells, and the more we talk, the more we spread respiratory droplets that can contaminate the environment, the sterile field and surgical wound."

Too much traffic and too many conversations during procedures may also lead to safety breaches unrelated to infection prevention and control. "They just add to general distraction in the room and distraction from patient care activities," Wood notes. "Sometimes we have so many personnel who are required to be in the room and it gets really crowded, but it's easy to forget when our part is over that we can leave the room. That's important as well."

7. Poor protection of the sterile field. These breaches occur primarily because of a failure to not constantly monitor the sterile field, Wood says. "While that may be difficult in certain procedures, we should always monitor the sterile field — never turn your back to the sterile field. Non-sterile personnel should not get too close to the sterile field or reach over the field. We don't want to contaminate the sterile field as that will go straight to the surgical wound.

"This also ties in with traffic control," Wood continues. "The more people involved, the more likely it is for the sterile field to be contaminated."

8. Improper instrument processing. "Always — carefully — follow those manufacturers' instructions for both decontamination and sterilization," Wood advises. "Sterilization is a highly complex process, and we sometimes overlook how complicated the decontamination process can be as instruments are increasingly complex in how they are constructed."

Wood says another cause of improper instrument processing is overutilizing of immediate-use steam sterilization, also called flash sterilization. "We should reserve that immediate-use steam sterilization for emergency use situations only. I think this primarily an education issue. We should continue working toward better compliance. Having a properly processed instrument greatly decreases the risk of infection to the patient."

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