4 Common IP Mistakes You are Likely Making

Infection prevention in the age of COVID-19 has led to new evidence on air routes for infection transmission.

One example comes from the World health Organization (WHO) when defining pathogen transmission by air. WHO has determined that particle size is no longer the only determinant. Instead, pathogens exist in a continuous spectrum of sizes and travel is dependent on environmental conditions such as ventilation, temperature, and humidity.

Heightened vigilance for other pathogens is also under greater scrutiny. Especially for high volume, high-risk procedures such as total joint replacement. While CDC data show SSIs for some total joint procedures are staying low, new numbers show that hip arthroplasty SSIs jumped 8%.

Know Infection Prevention Fixes for Today’s Risks

In the face of new infection risks and the evidence that’s been defined to prevent them, major guidance recommendations are changing transmission-based infection prevention practices. And AORN is adapting this guidance into updated perioperative-specific practices in AORN’s Guideline for Transmission-Based Precautions.

Guideline author Karen deKay, MSN, RN, CNOR, CIC, FAPIC, and Guidelines editor-in-chief Erin Kyle, DNP, RN, CNOR, NEA-BC, are putting finishing touches on the updated recommendations.

They shared four mistakes upping risks for infection transmission in the periop space in light of new infection concerns. They also explained evidence-based fixes for these mistakes found in multiple AORN guidelines, including in the update for Transmission-Based Precautions: 

Mistake # 1: Not implementing a patient-centered, bundled approach to SSI prevention.

Fix: Implement a comprehensive bundled approach to SSI prevention as an interdisciplinary team. This team must consider all intrinsic and extrinsic risk factors for infection, including environmental risks associated with environmental cleaning and air quality in the OR. “This might sound simple, but it’s not always easy,” Dr. Kyle notes. “Not all of the risk factors are modifiable, but many are —both intrinsic and extrinsic. Every patient deserves to have every modifiable risk factor addressed.”

She says certain SSI risk factors should be prioritized the moment a surgical procedure is indicated. Then preoperative optimization such as those described in Enhanced Recovery After Surgery (ERAS) protocols can be initiated. On the day of the procedure, here are a few of the many safety practices that should be included in a bundled approach:

• Ensure the OR or procedure room has been effectively cleaned and disinfected
• Perform effective surgical skin preparation
• Use reusable surgical instruments and other medical devices that have been effectively processed
• Follow strict adherence to all elements of sterile technique
• Maintain patient normothermia
• Select and apply a surgical dressing that protects the surgical incision
• Promote optimal after-care

Mistake #2: Not using an interdisciplinary team approach in implementing elements of SSI prevention bundles.

Fix: Brainstorm a cohesive approach to bring together all experts, including infection preventionists but also engineers with expertise in functions such as air exchanges and ventilation, deKay recommends. She also stresses the need for frontline staff to have a voice in SSI prevention efforts. “Involving staff in bundle decisions and showing them SSI rates or even stats on how guidelines aren’t being met can increase their acceptance.”

Mistake #3: Not staying current on infection prevention recommendations, technologies and preparedness strategies.

Fix: Know the importance of all guideline recommendations, not just transmission-based precautions, Dr. Kyle stresses. For example, she points to the forthcoming ERAS guideline from AORN slated for release this November, as well as current AORN guidelines covering patient skin antisepsis, hand hygiene, surgical attire, environmental cleaning, instrument/device cleaning, sterilization/packaging, and hypothermia prevention.

She also promotes the value of evaluating adjunct technologies such as those that can assist with OR room disinfection, team communication, and other infection prevention practices.

Mistake #4: Not properly donning and doffing personal protective equipment (PPE).

Fix: Follow evidence-based practices for surgical attire and leverage supporting competencies to preventing transmission-based infection, deKay suggests. Teamwork is also essential, she adds, such as “having a buddy system in place to observe for breaks in a colleague’s process for donning and doffing PPE.” 

PPE planning for emerging infectious diseases should also be on the radar. Such recommendations are outlined in the Center for Medicare an Medicaid’s most recent update to emergency preparedness.

Drive Evidence-Based Change

“It’s imperative that perioperative RNs lead the way when it comes to being informed about and implementing up-to-date evidence-based practices, including preparedness strategies, and technologies to support infection prevention efforts,” Dr. Kyle stresses.

This information is exactly what periop teams will find in the updated Guideline for Transmission-Based Precautions, deKay adds. For example, the update will include recommendations for preparedness for emerging infectious diseases and how to structure a preparedness plan. “It will also include elements that should be considered when conducting a risk assessment for airborne particle transmission based on new knowledge that we gained from the COVID-19 pandemic experience.”

Next month a first draft update of the Guideline for Transmission-Based Precautions will be released for public comment here. The final guideline is expected to publish early in 2025.

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