Special Edition on Operating Room Imperatives Special Edition- Operating Room Imperatives | Page 24

AORN Releases
2020 Guidelines for
Perioperative Practice
As new
evidence is
discovered
and studies
are published,
AORN will
update guide-
lines to reflect
conclusions as
they relate to
practice.”
— Amber
Wood, MSN,
RN, CNOR,
CIC
24
T
he Association of periOperative Registered
Nurses (AORN) has published the 2020 Guide-
lines 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,” says 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 perfora-
tions were reduced by 71 percent when wearing
two pairs of gloves compared to wearing only one.
Storage temperature parameters for autolo-
gous 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. 
Operating Room Imperatives 2020 • www.healthcarehygienemagazine.com