I would like to know how others are defining maximal barrier precautions for CVAD insertion in terms of the gown for the assistant. I know the assistant MUST wear a bonnet and mask and I believe a non-sterile gown if they are close to the sterile field. Others believe they do not need to wear a gown. This assistant is within 3 feet of the field,adding on sterile items,prepping the arm and reaching by the field to release the tourniquet and even holding the patient's arm under the sterile drape. Happy for any advice!
Here is the CDC website that discusses MSB
CDC - Hand Hygiene and Aseptic Technique - 2011 BSI Guidelines - HICPAC
This only addresses the inserter and patient and not any assistants. I don't think a circulating nurse in the OR wears a sterile gown. Using this analogy it might not be necessary for your assistant to wear a sterile gown either. RE a non-sterile gown for this assistant, are you thinking that a non-sterile gown is safer than their uniform that has been in contact with multiple patients? That might be a good thought but I am not aware of any evidence to support it yet. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you kindly for your response.Yes, Lynn that is exactly what I am thinking. I realize they function as a circulating nurse of sorts, however, the environment is much less controled than that of an OR and often overcrowded and difficult to manage. The use of a sterile gown would be obviously overkill.I have some concerns on certain insertions when the assistant is under the sterile drape and holding the patient's arm and lifting the edge of the drape to release the tourniquet. It seems that on some insertions they are more intimately involved and in those instances it would be wise to wear a clean gown.Those are the insertions that I have concerns about.
Definitely see your points on all of these issues. But there is a lack of evidence to support any type of gown for this assistant unfortunately. So your emphasis must be on all these risks while considering the fact that treatment for VAD infection acquired in the hospital will NOT be reimbursed to the hospital. Weigh the costs of these gowns vs these treatment costs to make your business case to support a clean gown. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
AORN
Should unscrubbed perioperative team members wear long-sleeved jackets when performing preoperative patient skin antisepsis?
Perioperative team members should wear scrub attire that covers the arms while performing preoperative patient skin antisepsis. Wearing long-sleeved attire helps contain skin squames shed from bare arms. Performing the preoperative skin antisepsis without wearing a long-sleeved jacket may allow skin squames from the perioperative team member’s bare arms to drop onto the area that is being prepped and may increase the patient’s risk for an SSI.
Resources
•Guideline for surgical attire. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
•Guideline for preoperative patient skin antisepsis. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
•Andersen BM, Solheim N. Occlusive scrub suits in operating theaters during cataract surgery: effect on airborne contamination. Infect Control Hosp Epidemiol. 2002;23(4):218-220.
•Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
Updated November 6, 2014.
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Should unscrubbed perioperative team members wear long-sleeved jackets when opening sterile supplies?
Perioperative team members should wear scrub attire that covers the arms when opening sterile supplies. Wearing long-sleeved attire helps contain skin squames shed from bare arms. Opening sterile supplies onto the sterile field without wearing a long-sleeved jacket may allow skin squames from the perioperative team member’s bare arms to drop onto the sterile field and may increase the patient’s risk for an SSI.
Resources
•Andersen BM, Solheim N. Occlusive scrub suits in operating theaters during cataract surgery: effect on airborne contamination. Infect Control Hosp Epidemiol. 2002;23(4):218-220.
•Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
Updated November 13, 2014.
from: https://www.aorn.org/guidelines/clinical-resources/clinical-faqs/attire
*************Note: Scrub Attire means, scrubs from the hospital, changed daily, laundry by the hospital. ********************
R. Terry Jones, RN, CRNI, VA-BC
Memorial Hermann Northeast Hospital
Humble, Texas