Six Surface Disinfection Concepts
The puzzle of superior surface disinfection is never solved....
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By: Chris Hunt
Published: 3/9/2021
The pandemic has caused us all to re-examine our infection prevention strategies, including those related to personal protective equipment (PPE). Staff and physicians who properly wear PPE protect themselves from harmful pathogens and prevent accidental contamination of the sterile field, so it's baffling when they don't always comply with something as straightforward as surgical attire policies. There are many reasons this can occur: decades of individual practice, tradition, insufficient and sometimes conflicting research backing the importance of properly wearing PPE and professional disagreement.
You needn't look any further than the recent public debate between surgeons and nurses about the protection provided by surgical caps and bouffants to know head coverings are a hot topic. Some surgeons believe there's no reason to change what they've always worn, and some nurses believe the hot dog guy at Costco does a better job of covering his hair than do most surgeons.
In individual facilities, problems of PPE compliance often relate to ineffective governance and lack of oversight. What matters most is your team agreeing to an acceptable standard, then ensuring compliance to it — the mere existence of a strict policy is often not enough. Taking the following steps will help to ensure members of your surgical team are properly covered from head to toe.
A PPE policy should include the following mandates: Wear facility or professionally laundered scrubs; do not wear scrubs outside the facility; wear facility-dedicated shoes; cover hair on head completely, including visible facial hair; and always wear eye protection at the surgical field.
Clinical leaders should round on a regular basis to ensure surgical team members are wearing PPE properly. Consider having them conduct 10 observations a day and enter compliance data into a spreadsheet so you can track staff performance and monitor trends. Share and discuss the number of days your team achieves 100% compliance and make compliance data available as a dashboard for members of the surgical department to access as needed. Also consider displaying daily compliance rates on a prominent bulletin board or share them through regular email updates. Sharing transparent compliance data will help to ensure higher accountability among team members.
Individual preference and anatomy are highly variable, so ensuring staff have access to numerous sizes of PPE — such as larger head coverings for staff with long hair or tie caps for members of your team with a sensitivity to elastic bands — will help them comply with the standards you establish.
The few studies that have addressed the link between implementation of a strict surgical attire policy and rates of surgical site infections have reached conflicting conclusions. Many, if not all, are missing critical data measuring actual compliance to written policies. Having strict surgical attire protocols in place is not enough. Ultimately, your staff has to comply with them. OSM
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