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 actu-
al 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 desig-
nated 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 isola-
tion. 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.
It's extremely helpful to find another RN or tech who always stays
outside of the Risk Zone to assist as a staff resource. This person
enters the patient's in-room time on the computer, and is subsequently
available to open supplies, grab blankets out of the warmer, make
phone calls and so on.
After the patient has been moved to the surgical table, wipe
down the transport bed or stretcher in the OR before moving it to
Infection Prevention
IP
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