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

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1 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. 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

The importance of collaboration between environmental services personnel and staff in the perioperative areas provides enhances safe patient care.

2 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 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 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 made of acrylic and polyester fabric

covering Masks- when sterile supplies are open Shoe covers on some cases required Eyewear Attire Methicillin-resistant Staphylococcus aureus (MRSA) and

3 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 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 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

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

4 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 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 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

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

5 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 Receptacles Laundry Laundry chute Tacky mats Neonatal incubators or bassinets 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

Tacky mats Neonatal incubators or bassinets Contaminated disposable or reusable items Contaminated with blood and /or body

6 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 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 When to clean Daily Weekly Monthly Provide checklist on items cleaned and by whom

Hallways and floors Clean according to established schedule Areas to clean Ventilation system Pneumatic tube system Clean and soiled storage Refrigerators and ice

7 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 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 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 you have cuts, abrasions, lesions Jewelry- rings, other jewelry

exchanges are achieved An EPA registered germicide labeled for tuberculocidal activity Clean as usual RP Surgical Hand Hygiene Use hand hygiene before and after contact with patient items, after

8 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 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 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

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 RP Transmissible

9 RP Transmissible Infections Contact Precautions Wear gloves gown and eyewear Clean patient equipment thoroughly Diseases such as MRSA VRE C difficile 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 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

containers are removed here Semirestricted area - Surgical attire - Post Anesthesia Care Unit RP Traffic Patterns Restricted area Surgical

10 What s Wrong with this Picture? Summary Working together Environmental Services and the Perioperative Team are a TEAM! Together we can keep patients and personnel safe. Continue the good work. Thank You! Joan Blanchard, RN, BSN, MSS CNOR, CIC jblanchard@aorn.org

Baseline assessment checklist for the AICG recommendations

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