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Special precautions necessary for patients with AIDS
AUGUST 1985, VOL 42, NO 2
AORN JOURNAL
Clinical Issues Special precautions necessary for patients with AIDS
B
We recently scheduled a patient with acquired immune deficiency syndrome (A1 S) for a bronchoscopy and lung biopsy. We followed the Centers for Disease Control (CDC) guidelines printed in the May 1983AORiVJournul for care of the specimens and for cleaning of the equipment and room, and we used as many disposables as we had available. The patient required intubation following the procedure and was placed on a ventilator in the postanesthesia recovery room (PAR). What precautions need to be taken in the PAR?
A
Patients with AIDS or suspected AIDS pose special problems when they require mechanical ventilation. There is the potential for environmental contamination from oral and nasal respiratory secretions and blood. The cause of AIDS appears to be a transmissable infectious agent that can be contained in saliva. The use of disposable mouthpieces and oral airways is mandatory in these circumstances. Because airborne pathogens can be disseminated in the expired air from the ventilator, anyone in contact with this patient should wear gloves, gown, and mask, and protective eyewear to prevent conjunctival contamination. The patient should be cared for in a separate room.’ The ventilator exhaust should either be vented to the outside or a filter should be placed in the expired gas line. After the patient is transferred out of the PAR, any surfaces contaminated with blood, saliva, or body fluids should be cleaned with a 1:lO dilution of 5.25% sodium hypochlorite solution (household bleach), and the same procedure is used in the
OR. Other nondisposable equipment used should be gas sterilized.2
Q
The remodeled outpatient surgery unit in our hospital is located adjacent to the OR suite but not connected to it. Because the remodeled rooms were formerly patient rooms, some are carpeted. One of these is used for eye cases and contains the laser. Some surgeons have requested this room for minor procedures such as lipoma removals, using either local or general anesthesia. They also want a scrub sink installed in the bathroom to replace a small sink. The maintenance engineer cannot guarantee that the air exchange system can be upgraded to provide the same type of filtering and number of air exchanges as in the main OR suite. The carpeted floor cannot be mopped but can be scrubbed weekly. Should we allow these small procedures to be scheduled in this room?
A
Many underused areas within hospitals are logical areas to be remodeled into outpatient facilities. The 1985 Joint Commission on the Accreditation of Hospitals (JCAH) Manual has an excellent section on hospital-sponsored ambulatory care services. It states: “When surgical services are provided in an ambulatory care setting, the policies and procedures shall be consistent with those applicable to inpatient surgery, anesthesia, and postoperative recovery . . . . ”3 The cleaning practices outlined in the AORN recommended practices for OR sanitation should be followed.4 In reference to the carpeting, recommended practice IV states that between cases and at the 261
AUGUST 1985, VOL 42, NO 2
completion of each day’s schedule, “floors should be totally flooded and the solution picked up via the wet vacuum system” or “a clean mophead and solution should be used in each room.”5 Carpeting would preclude this practice. Recommended practice V, guideline 5, states: “An effective air-handling system for the surgical suite is essential in OR sanitatioa”6 The care of the outpatient requires the same precautionary measures as the care of the inpatient-especially in the areas of microbiology, housekeeping and maintenance, and safety. The facilities should be appropriately equipped and manned with controls against infection, waste anesthetic gases, electrical and mechanical failure, and fire and explosion. And the facility should be equipped for emergency cardiopulmonary resuscitation.
Q
Have you any informationon venereal warts? Are they as innocuousas other condylomata? Per aps the condition is not serious enough to warrant our attention, but I would be grateful for any help regarding etiology and the handling of the patient in the OR.
A
Warts are benign papillomas of the skin and adjacent mucous membranes caused by an epidermotropic deoxyribonucleic acid (DNA) virus and human papilloma virus (HPV). Genital warts grow on the genitals and rectum at the junction of the squamous epithelium and mucous membranes. Approximately 10% of American males and 20% of American females are affected. Warts are transmissable; contact with the virus may be indirect (eg, through walking barefoot near or in a swimming pool or shower) or direct (eg, through sexual intercourse). There is no morphologic difference between the ordinary skin wart virus and the genital wart virus. Warts can occur at any skin location, but certain sites are favored. Warts assume Merent appearances in different locations. Some warts and their locations are: plantar warts on the bottom of the foot, common warts on the hands (these may also occur in the genital area), flat warts on the face, juvenile laryngeal papillomas, and anogenital warts (condylomata acuminata). Anogenital warts must be differentiated from the moist, flat papules of
AORN J O U R N A L
secondary syphilis, condyloma lata. Warts can be removed by surgery, cauterization, or laser. The handling of the patient in the OR is the same as for any case, ie, AORN recommended practices for OR sanitation, recommended practice I11 “All items that have come in contact with the patient and/or sterile field should be considered contaminated, and their disposition should reflect appropriate contamination control measures.”7 DORRIS L. DAVIS, RN, MS CONSULTATION SPECIALIST
Notes 1. J Murray et al, “Pulmonary complications of the acquired immunodeficiency syndrome: Report of a national heart, lung, and blood institute workshop,” New Engrclnd Journal of Medicine 310 (June 21,1984) 1682-1688. 2. J Conte, W Hadley, M Sande, “Infection-control guidelines for patients with the acquired immunodeficiency syndrome (AIDS),” New England Journal of Medicine 309 (Sept 22, 1983) 740-744. 3. Joint Commission on Accreditation of Hospitals, AMH/85: AccreditationManual for Hospitak (Chicago: JCAH, 1984) 46. 4. Association of Operating Room Nurses, Inc, AORN Stanahrh and Recommended Practkes for Perioperative Nursing (Denver: AORN, 1985) I11 8-1-111 85. 5. Z b d 111: 8-2. 6. lbd I11 8-3. 7. Z b d I11 8-1-111 8-2.
Suggested readjng Fitzpatrick, T et al. Dermatology in General Medicine (New York: McGraw Hill, 1979) 1631-1672.
The AORN Journal welcomes readers’ questions about clinical ksues. Address questions to ‘%linical Issues,” AORN Consultation Division, I0170 E Mississippi Ave, Denver, CO 80231. All questions will be reviewed for inclusion in this column.
269
AORN JOURNAL
Clinical Issues Special precautions necessary for patients with AIDS
B
We recently scheduled a patient with acquired immune deficiency syndrome (A1 S) for a bronchoscopy and lung biopsy. We followed the Centers for Disease Control (CDC) guidelines printed in the May 1983AORiVJournul for care of the specimens and for cleaning of the equipment and room, and we used as many disposables as we had available. The patient required intubation following the procedure and was placed on a ventilator in the postanesthesia recovery room (PAR). What precautions need to be taken in the PAR?
A
Patients with AIDS or suspected AIDS pose special problems when they require mechanical ventilation. There is the potential for environmental contamination from oral and nasal respiratory secretions and blood. The cause of AIDS appears to be a transmissable infectious agent that can be contained in saliva. The use of disposable mouthpieces and oral airways is mandatory in these circumstances. Because airborne pathogens can be disseminated in the expired air from the ventilator, anyone in contact with this patient should wear gloves, gown, and mask, and protective eyewear to prevent conjunctival contamination. The patient should be cared for in a separate room.’ The ventilator exhaust should either be vented to the outside or a filter should be placed in the expired gas line. After the patient is transferred out of the PAR, any surfaces contaminated with blood, saliva, or body fluids should be cleaned with a 1:lO dilution of 5.25% sodium hypochlorite solution (household bleach), and the same procedure is used in the
OR. Other nondisposable equipment used should be gas sterilized.2
Q
The remodeled outpatient surgery unit in our hospital is located adjacent to the OR suite but not connected to it. Because the remodeled rooms were formerly patient rooms, some are carpeted. One of these is used for eye cases and contains the laser. Some surgeons have requested this room for minor procedures such as lipoma removals, using either local or general anesthesia. They also want a scrub sink installed in the bathroom to replace a small sink. The maintenance engineer cannot guarantee that the air exchange system can be upgraded to provide the same type of filtering and number of air exchanges as in the main OR suite. The carpeted floor cannot be mopped but can be scrubbed weekly. Should we allow these small procedures to be scheduled in this room?
A
Many underused areas within hospitals are logical areas to be remodeled into outpatient facilities. The 1985 Joint Commission on the Accreditation of Hospitals (JCAH) Manual has an excellent section on hospital-sponsored ambulatory care services. It states: “When surgical services are provided in an ambulatory care setting, the policies and procedures shall be consistent with those applicable to inpatient surgery, anesthesia, and postoperative recovery . . . . ”3 The cleaning practices outlined in the AORN recommended practices for OR sanitation should be followed.4 In reference to the carpeting, recommended practice IV states that between cases and at the 261
AUGUST 1985, VOL 42, NO 2
completion of each day’s schedule, “floors should be totally flooded and the solution picked up via the wet vacuum system” or “a clean mophead and solution should be used in each room.”5 Carpeting would preclude this practice. Recommended practice V, guideline 5, states: “An effective air-handling system for the surgical suite is essential in OR sanitatioa”6 The care of the outpatient requires the same precautionary measures as the care of the inpatient-especially in the areas of microbiology, housekeeping and maintenance, and safety. The facilities should be appropriately equipped and manned with controls against infection, waste anesthetic gases, electrical and mechanical failure, and fire and explosion. And the facility should be equipped for emergency cardiopulmonary resuscitation.
Q
Have you any informationon venereal warts? Are they as innocuousas other condylomata? Per aps the condition is not serious enough to warrant our attention, but I would be grateful for any help regarding etiology and the handling of the patient in the OR.
A
Warts are benign papillomas of the skin and adjacent mucous membranes caused by an epidermotropic deoxyribonucleic acid (DNA) virus and human papilloma virus (HPV). Genital warts grow on the genitals and rectum at the junction of the squamous epithelium and mucous membranes. Approximately 10% of American males and 20% of American females are affected. Warts are transmissable; contact with the virus may be indirect (eg, through walking barefoot near or in a swimming pool or shower) or direct (eg, through sexual intercourse). There is no morphologic difference between the ordinary skin wart virus and the genital wart virus. Warts can occur at any skin location, but certain sites are favored. Warts assume Merent appearances in different locations. Some warts and their locations are: plantar warts on the bottom of the foot, common warts on the hands (these may also occur in the genital area), flat warts on the face, juvenile laryngeal papillomas, and anogenital warts (condylomata acuminata). Anogenital warts must be differentiated from the moist, flat papules of
AORN J O U R N A L
secondary syphilis, condyloma lata. Warts can be removed by surgery, cauterization, or laser. The handling of the patient in the OR is the same as for any case, ie, AORN recommended practices for OR sanitation, recommended practice I11 “All items that have come in contact with the patient and/or sterile field should be considered contaminated, and their disposition should reflect appropriate contamination control measures.”7 DORRIS L. DAVIS, RN, MS CONSULTATION SPECIALIST
Notes 1. J Murray et al, “Pulmonary complications of the acquired immunodeficiency syndrome: Report of a national heart, lung, and blood institute workshop,” New Engrclnd Journal of Medicine 310 (June 21,1984) 1682-1688. 2. J Conte, W Hadley, M Sande, “Infection-control guidelines for patients with the acquired immunodeficiency syndrome (AIDS),” New England Journal of Medicine 309 (Sept 22, 1983) 740-744. 3. Joint Commission on Accreditation of Hospitals, AMH/85: AccreditationManual for Hospitak (Chicago: JCAH, 1984) 46. 4. Association of Operating Room Nurses, Inc, AORN Stanahrh and Recommended Practkes for Perioperative Nursing (Denver: AORN, 1985) I11 8-1-111 85. 5. Z b d 111: 8-2. 6. lbd I11 8-3. 7. Z b d I11 8-1-111 8-2.
Suggested readjng Fitzpatrick, T et al. Dermatology in General Medicine (New York: McGraw Hill, 1979) 1631-1672.
The AORN Journal welcomes readers’ questions about clinical ksues. Address questions to ‘%linical Issues,” AORN Consultation Division, I0170 E Mississippi Ave, Denver, CO 80231. All questions will be reviewed for inclusion in this column.
269