perspectives
By Amber Wood , MSN , RN , CNOR , CIC , FAPIC
3 Ps for Post-Pandemic Infection Prevention for Perioperative Patients
COVID-19 cases are going down and elective surgeries are picking up for many hospitals across the country . As we adapt to post-pandemic perioperative care , it ’ s important to remember that many aspects of our practice are different now . For example , some surgical supplies are in high demand as manufacturing and elective surgeries begin to ramp up again . We are also done with emergency practices such as reprocessing N-95 respirators now that there are enough NIOSH-approved respirators in the marketplace dedicated for healthcare .
Although perioperative care looks a little different after COVID-19 , it ’ s important for all perioperative team members to remember that the basics of perioperative infection prevention remain the same . It ’ s also important to stop and think about infection prevention practices that may have slipped off our radar in recent months .
Here are three post-pandemic practices to help refocus on infection prevention essentials .
Personal Protective Equipment ( PPE ): Use it Correctly
Complacency is a very real concern in our practice settings as more people become vaccinated for COVID-19 . Remember that being vaccinated doesn ’ t replace the need for PPE . Think about measles — despite widespread vaccination for it , we still wear PPE to protect ourselves and our patients from this disease . The same holds true for COVID-19 . PPE remains our final barrier to prevent infection spread and we need to use it diligently and correctly .
PPE shortages during the pandemic put many of us in conservation mode to make sure we had enough PPE to protect ourselves when caring for COVID-19 positive or suspected patients . One big pandemic change with PPE was reprocessing N-95 respirators . However , the FDA has since revoked this recommendation , 1 now that enough NIOSH-approved N-95 respirators are available . Supply managers should make sure that any pandemic reliance on non- NIOSH approved N-95 respirators , including KN-95 masks , now stops . Using a NIOSH-approved , brand new respirator will provide a higher margin of safety for providers and patients .
Eye protection should also be a part of our PPE repertoire . During the height of COVID-19 , we donned eye protection to prevent COVID-19 exposure through the mucous membranes of our eyes . This will likely be something OR professionals add to their standard PPE , along with careful adherence to donning gowns and gloves correctly . If we use PPE correctly , there should not be any reason to change scrubs or shower between procedures .
Precautions : Follow Standard Precautions for Every Patient
Standard precautions are still required for every patient , every time , no matter what stage of pandemic response your facility is in . Jog your memory on all elements of standard precautions by reviewing the CDC overview 2 of these practices that include correct hand hygiene , specific PPE , and masking to reduce respiratory excretions from spreading in the perioperative environment .
Contact precautions are also important to follow ( or reinstitute post-pandemic in some facilities ), especially for multi-drug resistant organisms ( MDROs ) such as methicillin-resistant Staphylococcus aureus ( MRSA ). Long before and long after the pandemic , healthcare professionals should be vigilant about reducing antibiotic resistance , especially for surgical patients at risk for developing surgical site infections ( SSIs ) caused by MDROs .
Prevention : Protect Patients from Common Infections
Surgical site infections and MDROs should still be high on our list of infection concerns for surgical patients . Our vigilance with MDROs may have waned during the pandemic . Make sure this isn ’ t the case with your surgical patients by maintaining sterile technique , adhering to traffic flow standards , and remembering pre-COVID-19 practices , such as positive pressure ventilation that is ideal for preventing SSIs because it provides the cleanest air possible in the OR .
Don ’ t underestimate the power of hand hygiene — the most basic and most essential infection prevention strategy . Whether it ’ s preventing the spread of COVID-19 , which we know is still lingering on healthcare surfaces , or preventing our hands from transmitting MRSA to the surgical site , hand hygiene is a sound practice to keep infections from harming our patients .
Remember : Cutting Corners Risks Infection Spread
Supply shortages are still an issue as manufacturing ramps back up and this is hitting perioperative care in several ways , for example , sterilization wrap is still in short supply . This poses a major infection control risk as facilities come up with resourceful solutions such as cutting the wrap down to size . However , this fix is not recommended . Instead , AORN and IAHCSMM remind sterile processing professionals to continue following manufacturer instructions for using sterilization wrap and adopt use of alternative packaging to ensure surgical instruments are prepared for sterilization correctly during the sterilization wrap shortage . 3 , 4
Any time we have deviations from our normal practices , it affects our adherence to safety practices , and this has certainly been the case with COVID-19 . We need to make sure we are not cutting corners so we can continue to provide high-level care . If a facility is no longer able to provide that standard of care , leadership should consider if they can continue to safely perform elective surgeries .
Amber Wood , MSN , RN , CNOR , CIC , FAPIC , is senior perioperative practice specialist with the Association of periOperative Registered Nurses ( AORN ).
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