Sterile Technique: AORN's Updated Guidelines Emphasize Air Quality for SSI Prevention

Understanding AORN's Latest Sterile Technique Recommendations

Sterile technique is the cornerstone of perioperative practice, serving as a critical defense against surgical site infections (SSIs). Recently, AORN released updated guidelines, and a key focus is on an often-overlooked element: air quality. In a recent discussion, Lisa Spruce and Erin Kyle from AORN highlighted the significant changes and the importance of this foundational practice.

Key Stakeholders in Sterile Technique Guideline Development

The development of these guidelines was a truly interdisciplinary effort. As Erin Kyle explained, "We had the usual suspects – perioperative registered nurses, of course, surgeons, surgical techs, anesthesia professionals, infection preventionists, and also sterile processing professionals." However, recognizing the importance of air quality, AORN also brought in experts from the Air Quality Engineering community, specifically ASHRAE 170 committee members. This collaboration ensured a comprehensive and harmonized approach to the guidelines.

The Critical Role of Air Quality in Maintaining Sterile Technique

One of the most significant updates revolves around air quality and its impact on SSIs. "We've known for some time that the longer a sterile field is open, the more prone it is to becoming contaminated," Erin stated. This isn't just about air filtration and exchanges; it's about airflow patterns and how people and equipment interact with them.

Navigating Challenges: Measuring and Implementing Air Quality for Sterile Technique

The challenge, however, lies in the lack of standardized metrics. Researchers haven't yet agreed on what to measure (particulate counts, CFUs, etc.) or what benchmark targets to aim for. Similarly, there's no consensus on the best sampling methods.

To address this, the guidelines recommend an interdisciplinary approach to design and implement an air quality management program. This team should consider various program elements outlined in the guidelines to minimize airborne environmental contamination.

Additional Updates to AORN's Sterile Technique Standards

While air quality takes center stage, other updates include:

• Language Changes: Aligning with CDC recommendations, the guidelines now use "put on" and "take off" instead of "donning" and "doffing" for gloves and gowns.
• Timing is Everything: There's a reinforced emphasis on the timing of opening sterile fields, supplies, and draping equipment. Contamination can occur quickly, so timing is crucial.
• Handling Sterile Supplies: Sterile supplies, instruments, medications, and solutions should be opened as close to the time of use as possible.

Effective Implementation of Sterile Technique Guidelines

Implementing these guidelines, especially the air quality recommendations, requires a team effort. "It's essential to include disciplines that have the necessary expertise around workflows and infrastructure," Erin emphasized. This may involve engaging HVAC engineers, a collaboration some facilities might not have considered before.

The primary challenge lies in the lack of universal benchmarks for air quality. Facilities will need to work together to establish their own targets based on available research and the guideline's rationales.

The Impact of Improved Sterile Technique on Patient Outcomes

The ultimate goal of these updated guidelines is to minimize the risk of SSIs. "We aim for zero surgical site infections," Erin stated. By implementing these recommendations, healthcare teams can take a significant step towards achieving this goal and improving patient outcomes.

AORN's updated sterile technique guidelines highlight the evolving understanding of infection prevention. By focusing on air quality and reinforcing established practices, these guidelines provide a comprehensive framework for creating a safer perioperative environment.

How to access the AORN Guideline for Sterile Technique?

AORN's updated guideline for sterile technique is a valuable resource for all members. The AORN guidelines offer evidence-based practice to standardize care and improve patient outcomes. The new ERAS guideline can be found in eGuidelines+, as well as the 2025 print guideline book and ebook.