Environmental Factor Control

Guidelines:

• Sterility is event related
  • Quality of packaging
  • Storage conditions
  • Methods/conditions of transport
  • Amount/conditions of handling
  • Environmental Conditions
    • Humidity, exposure to contaminants, etc.
    • 68-75 degrees fahrenheit
    • 20-60% humidity for ORs
    • Max 60% humidity for sterile storage rooms
    • 15-22 air changes per hour

Considerations:

• Multidisciplinary team collaboration is vital to sterility maintenance.
  • Infection Preventionist
  • Facility Plant Engineer
  • Nursing
  • Sterile Processing Personnel
  • Biomedical Personnel

Nurse’s role:

• Cover the sterile field if it will not be used immediately or during periods of increased activity
• Position heater-cooler devices away from sterile field
• Direct airflow exhaust of equipment away from sterile field
• Implement interventions to minimize personnel exposure to potentially infectious materials and reduce contamination of sterile field
  • PPE
  • Surgical helmet systems
  • Training personnel on correct use
  • Manufacturer’s recommendations
  • Cover active handpiece with clear sterile drape
• Keep doors to the OR closed, only open when necessary
• Implement measures to minimize risk of contamination to sterile field
  • Posted sign
  • Limited traffic
  • Direct observation

Pitfalls:

• Remember, sterility is event-related!
• Even when temperature and/or humidity are out of range, there is no predetermined guideline on when to close an OR and generally it is unnecessary.
• Make an informed decision based on:
  • Assessment
  • Collaboration
  • Event details
  • Visible evidence of contamination

Examples:

• Perform an environmental assessment by multidisciplinary team for event-related sterility concerns:
  • Extend of damage
  • Environmental cleanliness
  • Integrity of sterile supplies
  • Functionality of power supply
    • Emergency generator = delay elective procedures
    • Essential equipment operated from emergency (red) power outlets
  • HVAC
    • Do not resume elective procedures until minimum air exchanges met
    • Do not resume elective procedures until temperature within range
    • Do not resume elective procedures until humidity in range, assess for condensation
  • Assess water supply
    • Do not perform procedures until water is functioning or if contaminated
    • Do not perform procedures until steam is functioning

Linchpins (Key Points):

• Perioperative patient care is based on surgical aseptic principles
• Sterility is event-related
• Multidisciplinary team collaboration is vital
• Follow CDC, AORN, Manufacturer guidelines