Environmental controls; multiuse syringes and needles; patient identification; Staphylococcus aureus - Clinical Issues - question and answer

AORN Journal,  June, 2003  by Joan Blanchard

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Question: What should the humidity and temperature be in the perioperative setting? We have discussed this with plant operations personnel, and they explained that they take care of it so we do not need to worry about it. Should we be concerned with this?

Answer: Environmental control should be a concern of perioperative nurses although plant operations personnel control the heating, ventilation, and air conditioning systems. Knowing the parameters helps alert perioperative nurses to potential problems and allows corrective action to be initiated when needed. AORN does not recommend temperatures for the OR, anesthesia gas storage area, or postanesthesia care unit independently; however, AORN does endorse the temperature and humidity information published for these areas by the American Institute of Architects Committee on Architecture for Health and the US Department of Health and Human Services (Table 1).

A relative humidity that is too high can result in damp or moist supplies with added opportunity for mold growth. A relative humidity that is too low can result in excessive bacteria-carrying dust in the surgical environment. (1) In some geographic locations throughout the United States, maintenance of the recommended relative humidity is difficult. Special centralized units may be needed to maintain the recommended humidity level. Such units should be self-regulating to maintain the humidity at a constant level within the recommended range. Room units of any kind are not recommended (eg, fans, floor coolers). Such units create unwanted dust and air turbulence and may dispense harbored mold and bacteria into the environment.

Question: An anesthesia care provider in our setting is reusing the same syringe and needle for multiple patients. This includes obtaining medications from a multiuse vial and injecting the medication into different patients' IVs. Is this an acceptable practice?

Answer: The practice of administering medications to multiple patients from the same syringe, even if the needle has been changed, is not advisable. (2) It is impossible to exclude all microorganisms from the environment, but for the safety of both patients and personnel, every effort is made to minimize and control these microorganisms. (3)

AORN has incorporated the guidelines provided by the Occupational Safety and Health Administration and US Public Health Service into its "Revised statement on patients and health care workers with bloodborne diseases." (4) These guidelines describe how to implement a bloodborne pathogens program, including preventing and treating needle sticks and other sharps injuries and exposure to hepatitis B, hepatitis C, and HIV.

The American Society of Anesthesiologist's "Recommendations for infection control for the practice of anesthesiology" support the practice of using aseptic technique, using multiuse vials appropriately, and not reusing syringes and needles. (5) Preventing contamination of medications requires safe handling of parenteral medications to prevent nosocomial infections in patients undergoing anesthesia or sedation. Many factors can influence contamination of medications that are likely to support the growth of organisms.

Preservative-free medication ampules, vials, and prefilled syringes for single patient, single-dose items should be checked for the presence of preservative agents. Single-use ampules and vials should be discarded after the contents have been drawn up, and prefilled syringes should be discarded after they are used because a single dose ampule, vial, or prefilled syringe contains medication intended for single use and generally does not contain the bacteriostatic or preservative agents found in multidose vials. Additionally, the Centers for Disease Control and Prevention suggests medications be drawn up as close to administration time as possible. These medications may become contaminated with bacteria or other microorganisms from non-sterile glass fragments, airborne contaminants, or failure to use aseptic technique. For example, postoperative fever, infection, sepsis, or other life-threatening illnesses have been reported after extrinsic contamination of propofol, as has death.

Syringes and needles are single-use sterile items. Medications from a syringe must not be administered to multiple patients, even if the needle is changed. Connecting or entering a patient's IV infusion contaminates these items. All used needles and syringes should be discarded immediately into a sharps container. Using single-use needles and syringes prevents a siphoning effect that aspirates the needle contents into the syringe when the needle is removed. A needle containing viruses or bacteria will contaminate the syringe even if the needle is flushed before removing it from the syringe.

Bloodborne pathogens may contaminate the syringe when used with IV, intramuscular, or subcutaneous administration of medication. If backflow occurs during blood sample aspiration or from a transfusion, there also could be contamination. Reuse of syringes and needles puts patients at risk for cross contamination and health care workers at risk if a needle-stick injury occurs.