The following approveed practices ...

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

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

AORN recognizes the various settings in which perioperative promotes 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 steps may be performed.

Purpose: These approveed practices provide guidelines for achieving high-level disinfection of instrumentation and durable equipment.

attract favor toed PRACTICE I

Items to be disinfected should be categorized as single in kind of the following:

* critical,

* semicritical, and

* noncritical.

Discussion:

The Spaulding classification arrangement named for its developer, Earle Spaulding, was lay opened many years ago. It has withstood the passage of time and continues to be used today by the agency of infection control practitioners and others to determine the correct processing regularitys for preparing instruments and other items for patient use. According to the Spaulding a whole the level of disinfection required is based forward the nature of the item and the manner in which it is to be used.(1)

Interpretive statement 1:

Items that come into sterile tissue or the vascular plan are categorized as critical and should be sterile. Examples of critical items include

* surgical instruments,

* cutting endoscopic accessories that break the mucosal barrier and the intents through which they are used,

* cardiac and urinary catheters,

* implants, and

* needles

Rationale:

If critical items are contaminated with microorganisms, including bacterial spores, the risk of infection is substantial.(2)

Discussion:

common problem associated with the Spaulding order is that it does not consider question s with processing complicated equipment that may be heat labile (eg arthroscopes, laparoscopes). In about arenas there is controversy regarding whether as it was instruments should be sterilized or receive high-level disinfection. Sterilization would not be a puzzle if these items could be steam sterilized, nevertheless most are heat labile and require other sterilization classifications Whereas new technologies make it easier to sterilize these heat-labile items, there is no conclusive evidence that the preferr sterilization of these endoscopes decreases patient infection risk.(3) Practitioners who are affected by way of this controversy should consult and chase guidelines developed by the Association for Professionals in Infection superintendence and Epidemiology (APIC) and the Center for Disease rule and Prevention.(4) Critical items that are not sterilized should be courseed immediately before use.

Interpretive statement 2:

Items that reach [i]or[/i] attain any place [i]or[/i] point in contact with nonintact skin or mucous membranes are considered semicritical and should receive a minimum of high-level disinfection immediately before use. Examples of semicritical items include

* respiratory therapy equipment,

* anesthesia equipment,

* bronchoscopes

* gastrointestinal endoscopes, and

* cystoscopes.

These items also may be sterilized.

Rationale:

Intact mucous membranes generally resist infection according to common bacterial spores but are susceptible to other organisms.(5)

Interpretive statement 3:

Items that arise in contact only with intact skin are categorized as noncritical items and should receive intermediate-level or low-level disinfection or cleaning. Examples of noncritical items include

* bedpans,

* vital current pressure cuffs,

* crutches,

* linens,

* bedside tables, and

* furniture.

Rationale:

Intact skin acts as an effective barrier to chiefly microorganisms.(6)

Interpretive statement 4:

Semicritical devices contaminated with hepatitis B virus, HIV, or Mycobacterium tuberculosis should receive a minimum of high-level disinfection.(7)

Rationale:

Research has demonstrated the effectiveness of high-level disinfectants to inactivate these and other pathogens that may contaminate semicritical devices.(8) This practice is consistent with standard precautions, which suppose that all patients potentially are infected.(9)

Interpretive statement 5:

The APIC guidelines for inactivation of the Creutzfeldt-Jakob disease (CJD) agent should be followed.(10) Disposables are commited and, when practical, should be used if the patient is consideration to be infected with the CJD agent.(11)

Rationale:

Critical and semicritical items or surfaces contained with the CJD agent require unique decontamination transactions The need for special recommendations is fit to an extremely resistant subpopulation of prions. Although a certain discrepancies exist between different studies, all studies present to view that these prions resist normal inactivation meanss Noncritical patient care items or surfaces have not been involved in disease transmission.(12)