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AORN Blog - The Periop Life

19 AORN Guideline Changes for Safer Care

Surgeon and Periop Nurses working in operating room.
January 16, 2022

The new year is bringing major changes to AORN Guidelines for Perioperative Practice that will impact nursing practice. For the first time ever, AORN now recommends adjunct technologies to account for surgical sponges, because new evidence shows manual counting alone remains fallible.

New findings have shown incorrectly positioned patient radiation shields can actually amplify exposure risk.

On the surgical smoke safety front, recent investigations of surgical smoke exposure risks reveal that vaporized liver tissue produce the greatest fine and ultrafine particle concentration in the OR. 

To learn more about new practice recommendations in the 2022 edition, we asked Guidelines Editor-in-Chief Erin Kyle, DNP, RN, CNOR, NEA-BC, to share some key changes to prepare for.

Key Practice Changes in the 2022 Guidelines

“Guideline for Preventing Unintentional Retained Surgical Items”

  • Use adjunct technology to reduce the rate of count discrepancies.
  • Prevent retained foam pieces from negative-pressure wound therapy devices.
  • Inspect all intravascular devices before and immediately after use at the point of care to reduce the risk of retained fragments.

“Guideline on Radiation Safety”

  • Consult with the radiation safety professional in the room on the use and placement of protective shielding or garments between the patient and the source of radiation.
  • Perform a radiation safety timeout before the start of surgical procedure or as part of the procedural timeout to verify safety measures being employed correctly.
  • Implement enhanced recommendations for radiopharmaceutical safety and emergency response.

“Guideline for Preoperative Patient Skin Antisepsis”

  • Form an interdisciplinary team to design a preoperative decolonization program.
  • Implement the latest recommendations on preoperative bathing and surgical site hair management.
  • Follow new safety practices for selecting, applying, handling, and storing antiseptics.

“Guideline for Complementary Care”

  • Read the new comprehensive literature review on a wider range of holistic methods for reducing the patient’s experience of pain and anxiety and increasing a sense of well-being.
  • Review new sections on assessing the patient and selecting and planning interventions.
  • Learn about emerging research in complementary interventions for stress diversion, visualization, electrical stimulation, and biofield interventions.

“Guideline for Care of the Patient Receiving Moderate Sedation/Analgesia”

  • Review new evidence on the effects of cannabis and opioid use on moderate sedation.
  • Implement additional assessment of pediatric and older adult patients receiving moderate sedation.
  • Consider new language emphasizing perioperative nurses administering propofol for moderate sedation/analgesia be fully dedicated to patient monitoring.

“Guideline for Surgical Smoke Safety”

  • Make sure surgical smoke safety practices align with the hierarchy of controls from the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health.
  • Review new ways to establish a smoke-free environment.
  • Implement new recommendations on filtration for smoke evacuation.
  • Make sure respiratory protection is not relied upon as a primary line of defense against surgical smoke but is used as secondary protection.

“Perioperative RNs can be confident they are delivering the best care possible when they understand the latest evidence driving safe practice updates,” Kyle says.

Together with the guideline authors and clinical research librarian, she will be sharing more about the evidence-based 2022 Guidelines updates at AORN Global Surgical Conference & Expo 2022. Don’t miss their education session on “AORN Guidelines Updates.”

New this year, individuals can also subscribe to the electronic version of Guidelines to access search capability for questions on the go. Order your copy of the 2022 Guidelines for Perioperative Practice. Plus, registration opens Monday, January 17 for AORN’s new RSI prevention education and recognition program. Facilities will receive recognition as an AORN Center of Excellence in Surgical Safety for implementation of this innovative surgical team-based program to prevent retained surgical items (RSI). Learn more at

AORN Global Surgical Conference & Expo. March 19-23, 2022 - New Orleans, LA. Register Now