FUNCTION:  Surveillance, Prevention, Control of Infection

 

TITLE:  Infection Control - Operating Room

_________________________________________________________________

 

PURPOSE:

 

To provide guidelines for effective infection control in the surgical suite

that are consistent with quality care of the patient.

 

POLICY:

 

I.   ENVIRONMENT

 

     A.   Air Exchanges

 

          1.   Air exchanges in the standard operating room/units are

               controlled at approximately 20 exchanges per hour with one

               hundred percent controlled, filtered air flow from ceiling to

               floor.

 

          2.   Air exchanges in the clean air room are approximately 450 times

               per hour in the enclosure area.  Air filters there provide a

               minimum efficiency of 99.9% for particles as small as 0.3

               microns.

 

          3.   Annual check shall be made to verify appropriate air exchange

               and assure positive pressure of air flow in the Surgical Suite

               by the Maintenance Department.

 

     B.   VENTILATION AND HUMIDITY

 

          1.   Routine system check per maintenance

          2.   Air filter changes as required

          3.   Maintain humidity at 50-60%

          4.   Maintain temperature at 65ø - 75ø F

          5.   Report variance in #3 or #4 so constancy is maintained.

 

II.  OR PERSONNEL

 

     A.   Health

          1.   Free from infection or contagious diseases

          2.   skin intact

          3.   body cleanliness

          4.   clothing in the OR (see policy)

          5.   wear disposable hats, shoe covers and masks

               (a)  masks are changed between cases

               (b)  masks are not worn around the neck when not on the face

          6.   movement and conversation kept to minimum during operative

               procedure.

 

III. PATIENT

 

     A.   Bath prior to surgery

     B.   Hair incorporated into disposable cap

     C.   Transported on clean linens

     D.   Skin shave in holding area

     E.   Placed on clean linens on the operating table

     F.   Soiled linens and gown removed and replaced with clean prior to

          transport to PACU

 

IV.  ASEPTIC TECHNIQUE

 

     A.   Each OR suite is germicidal wiped prior to start of surgery

          (surgical lites, view boxes)

     B.   Sterile supplies

          1.   disposable linen packs, drapes, gowns and gloves

          2.   disposable supplies one time use per patient and discarded

               after each case used or unused

          3.   instruments are in container system; small items are processed

               according to SPD policy

          4.   all pre-sterilized items expiration dates are event related

               unless specified otherwise (i.e., manufacturer's expiration

               date)

          5.   flash sterilization is in emergency event only, i.e.,

               contamination during a procedure or for an item of questionable

               sterility

               (a)  in the event flash sterilization is necessary the

                    following steps are necessary:

                    (1) Refer to appropriate policies

               (b)  if implants must be sterilized the following steps are

                    necessary.  Refer to appropriate policies.

          6.   All flash sterilizers undergo an attest reading daily.  Refer

               to policy and procedure manual.

          7.   Chemical disinfection    

               a.   used to provide an alternative method of sterilization

                    and/or disinfection when time does not allow for steam or

                    ETO sterilization.

               b.   chemical should be prepared according to manufacturer's

                    instructions with mixing date and expiration date plainly

                    in view.

               c.   items should be thoroughly cleaned and dried

               d.   chemically disinfected items should be rinsed with water

                    and dried prior to use

               e.   PPE should be provided for personnel using any chemical

                    disinfectant and container should remain covered in a well

                    ventilated area.

                              

     C.   Surgical Scrub - See policy and procedure manual.

 

     D.   Gowning and Gloving - See policy and procedure manual.

 

     E.   Draping the Patient - See policy and procedure manual.

 

V.   DISPOSAL OF USED SUPPLIES

     

     1.   Personnel should exercise universal precautions using gloves, gowns

          and eye protection whenever dealing with potential infectious

          wastes.

     2.   Sharps enclosed in sharps book and discarded into sharps container.

     3.   Disposable linen which has come in contact with body fluids are

          discarded into red infectious waste bags;  sponges, lap sponges,

          neuropathy, etc. are discarded into the same type bag.

     4.   Reusable linen is discarded into biohazard yellow linen bag.

     5.   All instruments are immediately rinsed, box locks opened and

          replaced into mesh trays for terminal cleaning and sterilization.

     6.   Operating table and immediate furniture in room are wiped with

          germicidal solution and floors are cleaned with clean mop and

          germicidal solution moving and mopping under furniture.

 

VI.  TERMINAL HOUSECLEANING

 

     1.   OR suites and scrub utility areas are terminally cleaned when

          surgical schedule is completed.  See policy re: cleaning: surgical

          suites.