The Association of periOperative Registered Nurses (AORN) has published the 2020 Guidelines for Perioperative Practice with six updated guidelines along with a completely new format and evidence rating system. Guidelines for Perioperative Practice, published each January, is a collection of 33 guidelines that provide evidence-based recommendations to deliver safe perioperative patient care and achieve workplace safety.
The guidelines’ format this year has changed to make it easier for interdisciplinary teams to assess and implement guidelines in their specific care setting -- including a new evidence-rating model that changes the language used for the evidence quality rating and for the recommended strength rating into four levels: regulatory requirement, recommendation, conditional recommendation, and no recommendation.
“As new evidence is discovered and studies are published, AORN will update guidelines to reflect conclusions as they relate to practice,” said Amber Wood, MSN, RN, CNOR, CIC, editor-in-chief of AORN Guidelines for Perioperative Practice. “The revised Guideline for Surgical Attire provides an example of changed recommendations based on the release of several new published studies on surgical attire.”
AORN now recommends that some policy decisions for actions such as donning cloth caps are now determined at the facility level. The new evidence does not demonstrate any association between the type of surgical head covering material or extent of hair coverage and the outcome of SSI rates. AORN’s recommendation is to cover the scalp and hair when entering the restricted or semi-restricted areas and an interdisciplinary team, including members of the surgical team and infection preventionists, may determine the type of head covers that will be worn at the health care organization.
Other attire-related practice changes include a shift from arm covering in the restricted and semi-restricted areas to arms that may be covered during performance of preoperative patient skin antisepsis. Another new recommendation states that beards be covered when entering the restricted areas and while preparing and packaging items in the clean assembly section of the sterile processing area.
Revised recommendations in the Sterilization Packaging Systems guideline include a new recommendation based on evidence that colored plastic tip protectors be used to reduce the risk for a retained surgical item (RSI). “We are one of the first professional organizations to recommend this change, which reflects the unique perspective of the nurse’s focus to reduce the risk of RSI,” Wood notes.
In the revised Guideline for Sharps Safety, the recommendation for double-gloving is strengthened by citing a new systematic review of randomized controlled trials on double-gloving. The review includes evidence that glove perforations were reduced by 71% when wearing two pairs of gloves compared to wearing only one.
Storage temperature parameters for autologous skin and vessels are outlined in the revised Guideline for Autologous Tissue Management. New evidence is described to explain temperature ranges and storage times used in the literature for cranial bone flaps and parathyroid tissue.
The revised Guideline on Environmental Cleaning recommends that cleaning equipment, tools, and materials used in the surgical suite should not be used outside of the surgical suite because cleaning cart and equipment wheels could transfer soil and microorganisms to the surgical suite. A separate recommendation in the guideline states that a spray bottle should not be used when applying disinfectants to surfaces.
The revised Guideline for Preventing Unplanned Perioperative Hypothermia recommends that a risk assessment be conducted for every patient during preoperative care because all surgical patients are at risk of developing hypothermia because anesthesia blocks the normal bodily reactions that prevent hypothermia and certain patient and procedural factors may increase the risk for hypothermia.
With these guideline updates come new and revised implementation resources designed for interdisciplinary perioperative teams. For example, an updated gap analysis tool that accompanies the revised surgical attire guideline revisions will be “a great resource for nurses to facilitate a team-wide understanding of current attire practices,” Wood suggests.
AORN Guidelines for Perioperative Practice is available in print or electronically as part of eGuidelines Plus. eGuidelines Plus allows perioperative teams to easily search the most current evidence-based guidelines by topic, and access integrated recommendations, FAQs, and clinical tools to put the highest standards of care into practice.