Access Now: AORN COVID-19 Clinical Support

Archive March 2020 XXI, No. 3

Infection Prevention: Playing Zone Defense Against Superbugs

Contain contamination to stop the spread of multi-drug resistant bacteria.

Brittany Frary

Brittany Frary, BSN, RN, CNOR


Brittany Frary
IN OR OUT? The staff member on the left remains outside of the zone, ready to grab supplies, while the anesthesia provider and circulating nurse wear yellow PPE inside the zone.

There's always the possibility that a patient with an active infection will arrive at your facility for surgery. To prevent SSIs and stop the spread of multi-drug resistant organisms, those of us in the OR tend to focus exclusively on the patient and not as much on what's happening around the patient. That's why our ORs have embraced the concept of the Risk Zone, which we define as the isolation of the patient's immediate environment. Any equipment, instruments or people within arm's reach of, or in actual contact with, a patient are inside the zone. The idea is to contain all contamination risk within that immediate area by establishing clear-cut guidelines such as these:

  • In pre-op. Make sure a note identifying the patient as a carrier is easily visible on the chart or in the EMR. Place the patient in a designated isolation room or bay with door signage. Keep the chart in an attached ante room. In the isolation area, have the patient perform hand hygiene and sign consent forms. Wipe down or throw away the pen they use. Place the forms in the patient's chart.
  • During transport to surgery. Slide the chart in a clean yellow bag or pillowcase. The nurse transporting the patient should wear a yellow gown and gloves to signify the patient is in contact isolation. To open the OR door, the nurse should not use her hands, but rather her elbows or back. If the door requires a badge scan, the nurse should lean over the sensor with her badge.
  • Inside the OR. The anesthesia provider should don a yellow gown and gloves before the patient enters. The circulator should also wear yellow PPE and stay with the patient inside the Risk Zone for transfer to the bed, positioning and anesthesia induction. Anyone assisting with positioning must be gowned and gloved.
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