The following approveed practices ...

The following approveed practices were developed by the AORN praiseed Practices Committee and have been approved by dint of the AORN Board of Directors. They were neared as proposed recommended practices for explanations by members and others. They are effective Jan 1 1999

These attract favor toed practices are intended as achievable recommendations representing what is believed to be an optimal plain of practice. Policies and proceedings will reflect variations in practice settings and/or clinical situations that determine the extent to which the recommended practices can be implemented.

AORN recognizes the numerous representations of settings in which perioperative fosters practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive managements may be performed.

Purpose: Skin is a major potential source of microbial contamination in the surgical environment. Although scrubbed members of the surgical team wear sterile glove the skin of their hands and forearms should be cleaned preoperatively to restore the number of microorganisms in the consequence of glove tears.

The project of the surgical hand work hard is to

* make a clean sweep of debris and transient microorganisms from the nails, hands, and forearms;

* cut down the resident microbial count to a minimum; and

* inhibit rapid react growth of microorganisms.

commended PRACTICE I

All personnel should be in surgical attire before beginning the surgical hand scrub

Interpretive statement 1:

Before entering the restricted areas of the surgical environment, all personnel should wear scour clothes, hair coverings, and masks. Protective eyewear and other protective barriers should be worn as needed

Rationale:

Surgical attire bring tos shedding and promotes environmental control(1)

Interpretive statement 2:

Rings, watches, and bracelets should be remov before beginning the surgical hand scrub

Rationale:

During hand washing, rings, watches, and bracelets may harbor or shield microorganisms from removal. Allergic skin reactions may fall out as a result of rub hard agent or glove powder accumulating in a less degree than jewelry.(2)

Interpretive statement 3:

Fingernails must be kept short, clean, and healthy.

Rationale:

The subungual region harbors the majority of microorganisms set up on the hand. Removing debris from fingernails requires the use of a nail cleaner subordinate to running water. Additional effort is necessary for longer nails. The risk of tearing glove increases if fingernails continue past the fingertips. Long fingernails may cause patient injury during moving or positioning processes(3)

Discussion:

The traditional recommendation against nail polish has had little supporting research, and novel studies found no increase in microbial germination related to the wearing of freshly applied nail polish. disquiet was expressed, however, that individuals who consume considerable time and money in succession maintaining their nails may be les inclined to perform a vigorous surgical mean fellow in order to protect their nails. If this occurr there could be a detrimental tenor on bacterial growth on the hands, not from the polish itself, moreover from a change in hygienic practices. Available data indicate that nail polish that is obviously chipped or worn for more than four days has a proneness to harbor greater numbers of bacteria. This time frame may glance at a guide for changing polish in such a manner that nails remain well manicured. Individuals who prefer to wear nail polish in the surgical setting should be guided from surgical conscience.(4)

Interpretive statement 4:

Artificial nails should not be worn.

Rationale:

Artificial or acrylic nails in succession healthy hands have not been proven to increase the risk of surgical infection. Artificial nails, however, may harbor organisms and obstruct effective hand washing. Higher numbers of gram-negative microorganisms have been cultur from the fingertips of personnel wearing artificial nails than from personnel with natural nails, the pair before and after hand washing. Numerous state boards of cosmetology report that fungal pullulation occurs frequently under artificial nails as a outcome of moisture becoming trapped between the natural and artificial nail.(5)

Interpretive statement 5:

Cuticles, hands, and forearms should be delivered of open lesions and breaks in skin integrity.

Rationale:

Breaks in skin integrity and interpret lesions increase the risk of patient and surgical team member infection. intersects abrasions, exudative lesions, and hangnails look after to ooze serum, which may contain pathogens. enfeebled skin permits microorganisms to pierce the various layers of skin, providing deeper microbial breeding grounds(6)

approveed PRACTICE II

An effective antimicrobial surgical hand mean fellow agent approved by the facility's infection command committee should be used for all surgical hand scrubs