AORN 2019 Guidelines

New AORN Guidelines for 2019 To Reduce Surgical Infections The Association of periOperative Registered Nurses (AORN) has released its 2019 Guidelines for Perioperative Practice to provide healthcare facilities with guidelines and directions for improving patient care and reducing patients’ risk of contracting a surgical infection. Along with improving patient outcomes, the publication also provides guidelines that are intended to help improve workplace safety for all O.R. personnel. “These evidence-based guidelines are intended for use by perioperative professionals to promote safety and optimal outcomes for patients. The Guidelines are available for individuals or teams within facilities and multi-site health care systems. The best practices for evidence-based perioperative care should be your only practices.” ¹ A quick review of the 2019 Guidelines shows a significant number of new, evidence-based practices that reflect the latest research and input from healthcare professionals and healthcare facilities from around the country. Several time-honored clinical practices are being replaced with newly-proven, evidence-based practices. Far too many headlines and news reports over the past several years have highlighted the patient harm caused by reusable medical devices that remain contaminated after reprocessing. In an ongoing effort to help combat this problem, AORN's 2019 guidelines for sterilization and disinfection cover five key topics: Flexible Endoscopes, High-Level Disinfection, Instrument Cleaning, Packaging Systems and Sterilization. During the past year there has been a lot of increased emphasis and attention placed on pre-cleaning surgical instruments in the O.R. prior to transport to sterile reprocessing. This new, increased emphasis is coming from many sources and organizations, including the Joint Commission. Recommendation III in the 2019 Guideline states that instruments should be cleaned and decontaminated as soon as possible after use. Section III (a) in the Guideline discusses the need for cleaning instruments as soon as possible at the point-of-use. The goal of cleaning at the point-of-use is the removal of all gross bio-burden. Then, instruments are to remain moist (either from a water-soaked towel, enzymatic treatment or other method to maintain humid conditions) to prevent them from drying.² While the IFUs of most instrument manufacturers have for long recommended this, many operating rooms were not following that guidance. Thus, the new AORN guidelines for point-of-use instrument cleaning will mean a process change in the O.R. at many facilities in order to comply with these new requirements. If, however, surgical technologists get in the habit of cleaning instruments as the surgeon hands them back during the case, then cleaning at the end of the procedure will be significantly easier and the time required for cleaning will also be reduced. Another added benefit is increased longevity of instrument service life. More importantly, the risk of a contaminated instrument getting through the entire reprocessing cycle will be reduced as well. The 2019 Guidelines can be a great tool to increase communication and cooperation between CS/SPD staff and O.R. staff. We recommend scheduling a meeting between sterile processing and O.R. professionals to emphasize that the new guidelines state that instrument reprocessing begins with pre-cleaning at the point-of-use. The 2019 Guidelines contain a number of significant, evidence-based, major changes that will potentially impact you, your staff and your facility. A quick review of the more significant changes will help you and your staff prepare, in advance, for these new policies and practices. The following is a list of a few of the new changes in the 2019 Guidelines:

1. "Cover the sterile field.
2. Identify how traffic is limited in your OR.

• Cover the sterile field when not in use. Parts of the sterile field may also be covered during the procedure.
• Review how you cover your sterile field. The sterile field may be covered with the two-“cuffed”-drape method or with a drape designed for the purposes of covering a sterile field.
• Evaluate your process during delays. Constant monitoring of the covered sterile field during unanticipated delays is no longer required. See the guideline for suggestions on how to make your facility-based decision.

Then compare your list to the 14 new interventions for reducing door opening in the guideline.

3. Assess your air handling system.

Ask your facilities personnel to come to the OR to give an in-service on how your system works. Then compare your facility-specific information to the new interventions in the guideline. A new format for AORN guidelines is also making it easier to drill down into the guidelines for specific types of information. For example, specific activities and interventions are now called out in each guideline. Beyond the guidelines, new resources, including the Facility Reference Center, have launched to help educators, leaders, and staff nurses access guideline information on the run.”³ AORN’s 2019 Guidelines for Perioperative Practice is available with several different purchase options. Specifically, an on-line version is available for sale to individuals or to facilities. A print version is available along with ‘package options’ that allow you to bundle one or more AORN publications for additional savings. All of these various purchasing options are available on-line at AORN’s website.⁴ 1. AORN website: https://www.aorn.org/ 2. AORN’s “Guideline for Cleaning and Care of Surgical Instruments” Section III(a) 3. January 6, 2019 AORN blog post 4. AORN website  https://www.aorn.org/guidelines/purchase-guidelines