ACHCU 'Infection Prevention in the Surgery Setting' Webinar Q&A
ACHCU, the education division of the Accreditation Commission for Health Care (ACHC), recently hosted a webinar on "Infection Prevention in the Surgery Setting," presented by ICCS Founder Phenelle Segal, RN, CIC, FAPIC. Due to time constraints, Phenelle was unable to answer all the questions submitted by attendees and provide detailed answers to some questions she addressed briefly.
The following provides those questions and Phenelle's responses. Some questions have been slightly revised for clarity.
Q. Is there added value to using UV-C light as an additive disinfectant tool? If so, how frequently should we use it?
A. We have seen this technology used in perioperative environment facilities, primarily after terminal cleaning (frequency to be determined by company and facility), as an added step in disinfecting the environment. UV-C should not be used as the only method for environmental cleaning and disinfection. Failing to clean before using UV-C can hinder its disinfection process. Facilities should review the pros and cons when researching this technology.
Q. Should one-time use endotracheal tubes or intubation stylets be opened before they are going to be used to save time or " just in case" they are needed? Do these need to stay sterile prior to use?
A. High-level disinfected or sterile items should remain in their original sealed packaging until needed, unless patient safety is compromised by doing so. If a disposable item is opened and unused, it must be discarded. If a reusable item is opened and unused, it requires reprocessing as per instructions for use (IFU).
Q. A recent American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) study indicated that there was no significant impact on surgical site infections (SSI) for out-of-range humidity (p=0.15). There was a significantly higher SSI rate observed for out-of-range temperatures (p=0.04), more specifically low out- of-range temperatures (p=0.02). A sub-analysis was performed for low temperatures based on procedures by duration. The significance of the finding was lost when surgery duration was four hours or greater. Is there any thought to changing minimums?
A. We are required to follow "nationally recognized guidelines and standards," which includes, but is not limited to, Facility Guidelines Institute (FGI), ASHRAE, Association for the Advancement of Medical Instrumentation (AAMI), and Association of periOperative Registered Nurses (AORN). Temperature and humidity levels are not only standardized for the operating or procedure rooms, but sterile storage and reprocessing needs must be taken into consideration as well. We encourage perioperative staff to implement a system for updates from national associations and organizations. We are not aware of any recent changes.
Q. Regarding the safe injection practice one-hour rule cited from the APIC position statement (time from preparation to beginning administration), is there consideration for changing the recommendation to four hours given the USP 797 updated standards, which changed this recommendation from one hour to four hours?
A. This question relates to the USP 797 compounding of medications for immediate use update from one hour to four hours versus the Association for Professionals in Infection Control and Epidemiology (APIC) position paper on the one-hour rule recommendation for spiking IV bags. Spiking of IV bags for use within one hour has been a controversial topic, especially for members of the Association of Anesthesiologists (ASA) who maintain that USP 797 was misinterpreted and was never meant to include a non-compounded IV solution. The ASA points out that the updated USP 797 eliminates discussion around spiking IV bags.
We suggest a review of the 2023 updates of USP 797 and ASA literature for interpretation and decision-making within each facility.
Q. Do supplies stored in an operating room (OR) that are not being used for current cases need to be in an enclosed or covered space?
A. Yes. If supplies are stored in the OR, they should be placed behind closed doors (e.g., glass cabinets) or in fluid resistant containers with lids.
Q. What are the rules for anesthesia providers giving sedation? Can they leave a syringe with medication attached to an IV port or do they need to inject, disconnect and then start again by scrubbing the hub and reconnecting each time they give a medication?
A. We have not seen this practice in facilities for which ICCS oversees infection control and prevention, and we recommend conducting a risk assessment to see if this practice is occurring as we do not have evidence to refute or agree with it. In addition to a risk assessment, we encourage discussion with the anesthesia team and relevant committees at your institution. If your institution decides to implement or continue with this practice, a policy and procedure should be implemented.
Q. What is the recommendation for facilities that perform surgical procedures not included in the National Healthcare Safety Network (NHSN) manual for SSI surveillance? For example, gastroenterology ambulatory surgery centers (ASCs) are not able to use the NHSN definitions, and it's difficult to find a standard definition for postoperative complications.
A. We recommend reviewing the NHSN Outpatient Procedure Component Manual for procedure reporting to CDC and available definitions. Several procedures in the outpatient setting are not included in the CDC's SSI definitions.
In addition, we strongly recommend reviewing individual state requirements for reporting adverse events as several states (e.g., Pennsylvania) have requirements for reporting directly to them, including healthcare-associated infections events. Records should be maintained for internal benchmarking. Trends should be monitored and documented.
Q. If a doctor requests to adjust the room temperature off the range for a case and then we go back to a compliant environment after the case, is this an acceptable practice?
A. AORN recommends maintaining an operating room temperature between 68°F and 75°F, but the temperature can be raised higher if active skin warming is not possible. We encourage facilities to review the most recent standards. If you have an AORN membership, you can reach out to their nurse specialists who will answer questions regarding their standards.
Q. What are the rules for medication labeling on the sterile field?
A. Medications drawn up by the provider on or off the sterile field should be properly labeled. Proper labeling requires five elements for every medication used: name of drug, strength, date, time drawn and the initials of the person who prepared the medication.
Many facilities use preprinted labels with the common medications they use in the field. If the drug and strength are preprinted, the rest would be added by the scrub nurse. Sterile labels are available, and the markers in the case pack are sterile.
ICCS strongly recommends accessing the “Medication Safety” section of the 2024 AORN guidelines for further review as there is extensive relevant guidance on this topic.
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