AORN Recommended Practices. AORN Practices. RPs Related to Environmental Services. Joan Blanchard, RN, MSS, CNOR, CIC September 10, 2008

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2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

AORN Recommended

Practices

Joan Blanchard, RN, MSS, CNOR, CIC September 10, 2008

AORN Practices

AORN Recommended Practices are AORN’s official position on aseptic technique and technical practices. This presentation will review some of the RPs that affect

the work that environmental services provides. The importance of collaboration between environmental

services personnel and staff in the perioperative areas provides enhances safe patient care.

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RPs Related to Environmental Services

• Attire

• High Level Disinfection • Environment of Care

• Environmental Cleaning in the Perioperative Setting • Hand Antisepsis

• Cleaning and Care of Instruments • Prevention of Transmissible Infections • Traffic Patterns

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RP Attire

• Surgical

scrub clothes should be low-linting

clean disposable or reusable

– fleece is not appropriate

– Does anyone know why you can’t wear fleece in the OR?

Surgical scrubs are changed daily and – when wet or

– when blood or body fluids contaminate them

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Attire

• The appropriate attire in the operating

room

– Cover jacket – Hair covering

– Masks- when sterile supplies are open – Shoe covers on some cases required – Eyewear

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

Attire

Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE)

• MRSA and VRE spread occurs from HCPs hands equipment clothes and surfaces • Staphylococcus aureus attaches to clothes

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RP High Level Disinfection

Keep chemical disinfectants covered with tight fitting lids in a well ventilated area.

Education and training should be done to help protect employees

Report spills

Wear eyewear, nitrile or butyl gloves, masks and skin protection when working with chemical disinfectants

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environment of Care

• The Health Insurance Portability Act of 1996 – Provide safe communication of patient

information

– Paper shredders should be used for disposal of patient information

- Clinical Alarms

• Do not disable

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environment of Care

• Potential hazards associated with electrical equipment

- Report any frayed cables or wires • Potential hazards with the HVAC system

- Report concerns with temperature/humidity - Keep operating room doors closed

- Keep equipment and supplies away from exhaust ducts

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RP Environment of Care

• Fire safety

– Take part in fire drills

– Remove any equipment that is smoking to a safe area

– Assist with fire as assigned Handle medical gases safely

– Keep in storage area that is secured

– Keep full cylinders separate from empty ones

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environment of Care

• Hazardous waste

– Chemicals- dispose of following MSDS and state law

– Flammable liquids- follow state and local law to dispose

– Cytotoxic drugs need to handled following federal state and local laws

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environmental Cleaning

• Preparation of the OR

– Damp dust all surfaces before first case – Clean equipment that will be brought into the

OR

– Do not use spray bottles – Wear gloves and a mask

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RP Environmental Cleaning

• Reestablish a clean environment after each case

– Mops used can be microfiber or string – Use clean mop and EPA registered solution – Mop the entire floor

_ Move equipment to mop – Mattresses

– Transport vehicles

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environmental Cleaning

– Receptacles – Laundry – Laundry chute – Tacky mats

– Neonatal incubators or bassinets

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environmental Cleaning

Contaminated disposable or reusable items

– Contaminated with blood and /or body fluids – Regulated waste storage and transport – Personal Protective Equipment

– Liquid waste disposed of according to state regulations

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RP Environmental Cleaning

• Terminal Cleaning Surgical and scrub/utility areas

– When to terminally clean

• Scheduled procedures are done • Each 24 hours during regular work week

– What to terminally clean

• Unused rooms cleaned during every 24 hour period • Walls and ceilings as needed

• All equipment and cabinets, sterilizers and warming cabinets • Wet vacuum floors

• Hallways and floors

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environmental Cleaning

• Clean according to established schedule

– Areas to clean

• Ventilation system • Pneumatic tube system • Clean and soiled storage • Refrigerators and ice machines • Scrub sinks

• Aerators on faucets

• Eye wash station cleaned and checked • Unrestricted areas

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Environmental Cleaning

• When to clean • Daily • Weekly • Monthly

• Provide checklist on items cleaned and by whom

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RP Environmental Cleaning

• Cleaning for CJD Case

– Use disposable linens

– Clean with Sodium hypochlorite (bleach) 1 part to 5 parts water or

– Clean with Sodium hydroxide (can be purchased already mixed)

– Wear PPE- single use impervious gown, gloves, eyewear and masks

– All disposable items are incinerated – Solidify and incinerate liquids 2008 ASHES Annual Conference

September 7-11, 2008 San Antonio, TX

RP Environmental Cleaning

• Cleaning an Airborne Disease case

– Wear a fit tested N95 mask until complete air exchanges are achieved

– An EPA registered germicide labeled for tuberculocidal activity

– Clean as usual

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Surgical Hand Hygiene

• Use hand hygiene before and after contact with patient items, after removing gloves, before and after eating, contact with blood or body fluids and after restroom use

• Finger nails- short and clean, nail polish, no acrylic nails • Have an assessment done if

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RP Surgical Hand Hygiene

• Lotions- what kind can you use? – What kind can’t you use?

FDA compliant hand antiseptic agent

– antiseptics need to reduce microorganisms, be nonirritating, broad spectrum, fast acting, have a residual effect

– Alcohol-based

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Cleaning and Care of Instruments

• Transporting soiled instruments

– Contaminated instruments must be contained to prevent exposure

– Sharps must be contained in a sharps container – Separate clean items from dirty area

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Transmissible Infections

• Droplet Precautions

– Wear a mask within 3 feet of the patient – Patient coughing, sneezing or talking – Diseases such as whooping cough flu mumps

• Airborne Precautions

– Patient is placed in an airborne isolation room – Room has special negative air handling – All personnel must be fit tested for an N95 mask – 28 minutes for 15 air exchanges before cleaning

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RP Transmissible Infections

• Contact Precautions

– Wear gloves gown and eyewear – Clean patient equipment thoroughly – Diseases such as MRSA VRE C difficile

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Traffic Patterns

• Unrestricted area

– Street clothes may be worn here – Movement of supplies occurs here – External shipping containers are removed

here

Semirestricted area - Surgical attire

- Post Anesthesia Care Unit

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

RP Traffic Patterns

• Restricted area

– Surgical attire

– Includes operating rooms procedure rooms and clean core area

– Scrub sinks

– Patients entering here need to have gown, clean linens and head covering

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What’s Wrong with this Picture?

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX

Summary

Working together Environmental Services and the Perioperative Team are a TEAM! Together we can keep patients and personnel safe. Continue the good work.

2008 ASHES Annual Conference September 7-11, 2008 San Antonio, TX Thank You! Joan Blanchard, RN, BSN, MSS CNOR, CIC jblanchard@aorn.org

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