Access Now: AORN COVID-19 Clinical Support

Are You Removing PPE Properly?

Healthcare workers contaminate their skin and clothing while removing gowns and gloves more often than they might realize, according to research published in JAMA Internal Medicine.

Researchers studied a sampling of healthcare personnel from 5 Ohio hospitals who underwent simulations involving the removal of gloves or gowns "contaminated" with fluorescent lotion. The study's participants were asked to remove the PPE in their usual manner. A black light was then used to check for contamination of skin sites on their hands, forearms, neck and face, as well as their hair and the sleeves, chest and back of their shirts.

The study participants then received educational training about proper PPE removal, including a 10-minute video presentation, 20 minutes of demonstrations on proper donning and doffing protocols, a review of common breaches and practice sessions involving the fluorescent lotion and black light test.

According to the findings, 46% of 435 glove and gown removals resulted in contamination. Notably, contamination occurred during 53% of glove removals and 38% of gown removals. The educational interventions reduced skin and clothing contamination from 60% to 19%, an improvement that was sustained for the duration of a 3-month follow-up period.

"These findings highlight the urgent need for additional studies to determine effective strategies to minimize the risk of contamination during PPE removal, to improve PPE design and to identify optimal methods for training of personnel in PPE use," write the authors.

Daniel Cook

AAOS Issues New ACL Repair Guidelines

The American Academy of Orthopedic Surgeons' new guidelines for anterior cruciate ligament repair and rehabilitation consider patient-specific factors to help physicians determine treatment and post-op care for optimal recovery.

The appropriate use criteria look at a patient's age and activity level, as well as the presence of advanced arthritis and the status of the ACL tear to chart a course. The new guidelines also include 2 checklists designed to help patients return to normal activity levels sooner after surgery.

The "Return to Play" checklist covers topics like returning an athlete to their sport, engaging patients with ACL-injury prevention programs and ensuring the surgical site and graft are fully healed. The "Postoperative Rehabilitation" checklist outlines post-op protocol, including physical therapy.

According to the organization, the guidelines and checklists are designed to work together to help surgeons make better decisions in the treatment of ACL patients throughout the perioperative period and beyond.

"The good news for patients and practitioners is that ACL reconstruction with autograft or allograft tissue is very successful," says AAOS's Robert Quinn, MD in a statement. "What these guidelines do is delineate, in a very easy-to-maneuver way, what the most appropriate treatments are in each category. It actually gives you the specific circumstances to plug in, and highlights where the evidence matches the recommendations."

Kendal Gapinski

99% of ASCs Use CMS-Mandated Checklists

Virtually every Medicare-certified ASC nationwide uses a safe surgery checklist, says the Centers for Medicare & Medicaid Services, which last week released data on the Ambulatory Surgery Center Quality Reporting Program's Safe Surgery Checklist Use.

The data, collected in 2012, found that 99% of ASCs had adopted the checklist, which covers practices before anesthesia is administered, before the incision is made, during closing and before the patient leaves the operating room. ASCs are required to report whether they use the safe surgery checklist for all patients, not just those covered by Medicare.

CMS established its quality reporting system for ASCs in 2012 in response to the ASC community's desire to publicly demonstrate its performance on quality measures. The use of safe surgery checklists is one of 10 measures Medicare-certified facilities must report on to avoid Medicare payment reductions.

Jim Burger

InstaPoll: Rate the Impact of ICD-10

Closing in on the end of the second week of ICD-10, how would you rate the impact of the new diagnostic coding system? Tell us in this week's InstaPoll.

Most (59%) of the 103 respondents to last week's poll question think telehealth post-op visits make sense. The results:

Are telehealth visits post-op for "low-complexity" surgeries a good idea?

  • yes 59%
  • no 27%
  • unsure 14%

Dan O'Connor

News & Notes
  • ASCs keep SSIs low In a ringing endorsement of the quality of outpatient surgery, a team of healthcare researchers has found that fewer than 15% of ambulatory surgery patients who return to clinical settings for unplanned care within 30 days of their procedures do so on account of surgical site infections, they report in the October 6 issue of JAMA.
  • Carpal tunnel approaches compared Open and endoscopic carpal tunnel release surgeries deliver similar outcomes over the long term, say Swedish researchers in a letter to JAMA. While the 2 approaches have been shown to have similar effectiveness up to 5 years, outcomes at the 11- to 16-year mark have not until now been compared.
  • Keep closing communication relevant Surgical teams who coordinated their intraoperative efforts with case-relevant communications saw a lower risk of surgical site infections, while those who engaged in case-irrelevant discussions during closing saw that risk increase, according to a recent study in the British Journal of Surgery.