Question: We would like to begin us...

Question: We would like to begin using alcohol-based hand-rub agents for general hand hygiene in our holding apartment surgical suite, and postanesthesia care unit. After reviewing the lately released guidelines from the Center for Disease repress and Prevention (CDC) regarding hand hygiene, we cannot determine whether they are consistent with the Occupational Safety and Health Administration's (OSHA) bloodborne pathogen final domination The OSHA rule stresses hand washing with soap and water. It does not mention alcohol-based performances If we switch to alcohol-based consequences could we be cited for noncompliance with the OSHA rule?

Answer: Alcohol-based hand-rub agents are acceptable to the pair the CDC and OSHA. (1) If you succeed the CDC guideline for hand hygiene, you will not be cited by way of OSHA on that particular practice. The primary difference in the directives scions from the difference in goals of the respective agencies. The CDC focuses upon reducing the risk of infection for all patients according to stressing the need for hand washing with soap and water for any visible soiling of the hands, regardless of the stamp of soil or body substance (eg urine, fece blood) The focus of OSHA is to defend the health care worker from bloodborne pathogen infection by dint of stressing the need for hand washing with soap and water after front to or gross contamination at blood or other potentially infectious materials that can lead to transmission of bloodborne pathogens. one as well as the other the CDC guideline and the OSHA control call for

* provision of accessible hand washing facilities,

* alternatives to hand washing (ie, antiseptic hand cleaners) when hand washing facilities are not available or convenient to the area,

* hand washing after removal of glove or other personal protective equipment,

* hand washing after contact with vital fluid or other potentially infectious materials, and

* hand washing when hands are visibly dirty or soiled with contaminated material.

When the OSHA final mastership was issued in 1991, alcohol-based hand hygiene issues were not well recognized or widely used in this geographical division as an alternative to hand washing with soap and water. Since the release of the CDC guideline in 2002 these productions have gained favor and are becoming more widely used. undivided advertised advantage of alcohol-based hand hygiene cropss is the reduction of dermatitis that contributes to poor hand washing compliance and increased risk of infection to the health care worker resulting from abrasion and breakdown of the natural skin barrier. (2)

Question: I work in an OR suite in which the long-standing practice for patient skin prep Is to use plastic spray bottle filled with an iodine-based result which is sprayed on the patient's skin after an iodine-based skin mean fellow The system consists of a plastic bottle and a pump-spray apparatus that is attached to the bottle after it is filled with the iodine solution. The spray bottle Is used from patient to patient and occasionally from field to room. What is the potential for cross-contamination? Is this a safe and acceptable practice in the perioperative practice setting?

Answer: AORN does not approve the use of spray bottle in the OR as a matter of routine practice. Experience demonstrates that whenever a spray method is used, a certain amount of the sprayed crops is aerosolized into the environment where it is inhaled at people in the immediate vicinity. This aerosol may be compos of an iodine fruit a chemical disinfectant that is sprayed as part of the cleaning proces or any other production that is placed into the spray plan Inhaling this pollution is not in the best interest of either patients or health care workers. In addition to the inhalation potential, there is the possibility of splash back and possible watch injury if the solution is sprayed with force.

No controll studies have been performed to investigate cros contamination from use of spray bottle of prep solution. It is known, however, that bottle of skin prep produces can and have become contaminated with Pseudomonas aeruginosa and Burkholderia (ie, previously known as Pseudomonas cepacia) steady when they contain an antiseptic solution. (3)

If the bottle can become contaminated, the spray attachment is equally suspect for containing organisms. With repeated use of the plastic spraying plan you have no assurance that the order itself is not contaminated. by way of spraying solution from the bottle you may be adding to, rather than decreasing, the number of organisms forward a patient's skin.

With or without a contaminated order the process of spraying is problematic. If the individual performing the skin prep deed picks up the bottle with a glov hand that has just washed a patient, the exterior of the bottle may become contaminated with organisms from the patient's skin. Unles the bottle is cleaned with a disinfectant after the prep is complet organisms can remain forward the exterior surface of the bottle where they may be picked up and transferred to the nearest person who uses the system