FAQs clinical standards

 

Is ACORN able to provide guidance re: surgical sount documentation (eg; what it should include as a minimum), or an example template? We are looking to review our count policy and documentation as staff feel it is inadequate and doesn't reflect the Accountable items standard.

This response refers to the Accountable items standard contained in the current edition of the ACORN Standards for Perioperative Nursing in Australia. As you would appreciate the ACORN Standards are designed to provide an overarching framework as a series of recommendations and rationales regarding various aspects of perioperative nursing. ACORN is aware that some jurisdictions have their own recommendations regarding mandatory fields within a Count Sheet. Where specific national or state legislation and guideline exist they will take precedence. For that reason and also due to the introduction of electronic medical record systems, ACORN no longer promotes its template on the ACORN website.


I need some clarification on accountable items. In the process of updating the policy. Also clarification of disposal of swabs on completion of count and end of surgery.

See above.


When conducting a first count (i.e. uterine count LUSCS) and a pack has been deliberately been retained in the patient, how is this legally documented on the count sheet? Currently, when a pack is put in-situ it is written on our whiteboard x1 pack in-situ @ time, but if there is a pack in-situ and a count is required it is still documented as the amount of packs in the sterile field even though the pack in-situ is not able to be visualised. 1) Should we be writing the packs only which can be visualised with an asterix and explanation on the count sheet where the remaining pack is? or, 2) Should we document all the packs in the sterile field even though the scrub/scout cannot see all the packs?

Please review the ACORN standard, Accountable items.

In the principle of that standard it is noted in reference to prevention of inadvertently retained items that:

“This is achieved by performing a manual and visual search of the operative/procedural field, as thoroughly as possible and in a way that is compatible with the safety and welfare of the patient".

Further, please note Standard statement 2 and specifically Criteria 2.9 which states:

"2.9 the instrument nurse has a duty to ensure that when accountable items are deliberately retained in the patient, the number of retained accountable items and their location is documented on the APD. The totals in the final count are minus the number left in the patient."

As you would appreciate the ACORN Standards are designed to provide an overarching framework as a series of recommendations and rationales regarding various aspects of perioperative nursing. ACORN is aware that some jurisdictions have their own recommendations regarding mandatory fields within a Count Sheet. Where specific national or state legislation and guideline exist, they will take precedence. For that reason and also due to the introduction of electronic medical record systems, ACORN no longer promotes a specifc template or form.

Also please note that Standard statement 1 specifically states:

“The health service organisation has a duty to develop a policy/guideline which clearly defines the management of items used during surgery and procedures within their organisation and is used in conjunction with the standard”.

This statement indicates that your organisation should develop a policy and recommendations specific for the organisation. In view of that ACORN is unable to provide you with a definitive answer.


When performing bilateral cataract removal and intraoccular lens implantation, is it advisable to have a seperate instrument set-up for each eye? During this most recent case, we utilised the same instruments, however changed the sterile drapes. We are unsure of best practice guidelines during bilateral implant procedures.

In responding to your question ACORN found it necessary to review recommendations from AORN which are reproduced below:


"Can the same sterile field setup be used for two different areas on the same patient?

Two procedures on the same patient that involve two different wound classifications (ie, clean, clean-contaminated, contaminated, dirty) should have separate sterile fields and instrumentation. Instruments should not be used interchangeably. Having separate sterile fields and instruments for sites of different wound classes on the same patient reduces the risk of infection of the cleaner wound.

Resource:

•           Guideline for sterile technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2018:e133-e172. Updated October 24, 2018

https://www.aorn.org/guidelines/clinical-resources/clinical-faqs/sterile-technique Accessed 5/8/2020

It would seem that it is common practice in Australia to use one set-up for sequential procedures where the wound classifications are consistent across both operative sites.

Please also be aware of the recommendations contained in the Accountable items standard as reproduced below from the current edition of the ACORN Standards for Perioperative Nursing n Australia:

"2.6 where sequential procedures are undertaken on the same patient, or when a two-stage procedure is performed, which requires two ‘set-ups’, e.g. laparoscopic assisted vaginal hysterectomy

2.6.1 when the operating room is being cleared between the surgery/procedures and different ‘set-ups’ are being used, then a separate APD is used for each procedure

2.6.2 when the operating room is not being cleared between the surgery/procedures and the same ‘set-up’ is being used, then the instruments and other accountable items from the first surgery/ procedure are isolated and a separate APD is used. The final count of the first procedure is carried over to be the first count of the second procedure and so on. Accountable items should not be removed from the operating room until all procedures have been completed." 


Where in the standards I can find Standard regarding change over count eg: scrub replacing scrub / scout replacing scout ?

The information is found in the Standard Management of accountable items used during surgery and procedures.


I am just wondering if anyone can tell me which version/year the standards changed to recommending instruments be counted by tray lists please. Building a case to change our practice to align with the standards!

2010-2011 ACORN Standards - S3 Counting of Accountable Items Used During Surgery
Standard Statement 5
The nurse shall utilise a tray list as a risk management and inventory management tool.

Standard Statement 6
2012-2011 ACORN Standards - S3 Counting of Accountable Items Used During Surgery
HCFs shall have standardised instrument trays and corresponding tray lists to assist
with the counting and documentation of instruments.

2014-2015 ACORN Standards - Management of Accountable Items Used During Surgery/ Procedures in the Perioperative Environment
Standard Statement 6
HCFs shall have standardised instrument trays and corresponding tray lists to assist with the counting and documentation of instruments.

14th edition ACORN Standards - Management of Accountable Items Used During Surgery/ Procedures in the Perioperative Environment
Standard statement 6
Health service organisations have a duty to have standardised instrument trays and corresponding tray lists to assist with the counting and documentation of instruments.

15th edition ACORN Standards - Management of Accountable Items Used During Surgery and Procedures
Standard Statement 6
Unchanged


I am a Scrub/scout educator and there is a practice at my hospital recently that I believe is against the standards and would like some advice please. Staff are placing used Raytec and packs into their bowl of the table, on the bowl stand together. I thought I remembered reading in the standards that Raytec should never leave your table and should never be stored in the same container as packs. However I can't find this in the current policy. Can you please advise what should be best practice?

The current ACORN Standards are the 16th edition, published in May 2020. All previous editions are rescinded. The current Accountable items standard includes the following standard statement:

Nurses performing surgical/procedural counts have a duty to comply with the recommended practice for safe counting technique in accordance with the health service organisation policy/guideline.

There are 8 criteria listed under the above standard statement. There were no other references or instructions similar to your recollection. 


Accountable items Standard 2.6.2 It is not possible to isolate the instruments from the first procedure as these instruments are still being used for the second procedure and only one setup is being used for both procedures. The second procedure may begin before finishing the first procedure and therefore it is not possible to finalise the count from the first procedure to commence the count on the second procedure. Often in a laparoscopically assisted vaginal hysterectomy the surgeon will go back into the abdomen after finishing at the bottom end to ensure that the vault is closed properly. I think this needs some clarification.

 

Your question did not specifiy exactly which ACORN Standard you are referring to however I assumed it was the current version of the Accountable Items standard published in May 2020.

With regard to the points you make I thank you for raising them. The recommendation contained in criteria 2.6 and sub-criteria 2.61 and 2.6.2 is:

2.6 where sequential procedures are undertaken on the same patient, or when a two-stage procedure is performed, which requires two ‘set-ups’, e.g. laparoscopic assisted vaginal hysterectomy 
2.6.1 when the operating room is being cleared between the surgery/procedures and different ‘set-ups’ are being used, then a separate APD is used for each procedure 
2.6.2 when the operating room is not being cleared between the surgery/procedures and the same ‘set-up’ is being used, then the instruments and other accountable items from the first surgery/ procedure are isolated and a separate APD is used. The final count of the first procedure is carried over to be the first count of the second procedure and so on. Accountable items should not be removed from the operating room until all procedures have been completed.

This criteria has not changed over the past 6 editions of the ACORN Standards which means it has been reviewed by 6 different review teams and approved by 6 ACORN Board of Directors over a 10-year period. Given its longevity and the absence of any other enquiries regarding it in this case I will acknowledge your concerns, include them as part of the next review but not escalate them as a mater of urgency, safety or potential risk.

My own reading of 2.6 is that the key point is that Accountable items should not be removed from the operating room until all procedures have been completed. This approach ensures that there is no inadvertant opportunity for any accountable item(s) used in Stage 1 or subsequent stages, to be removed thereby confusing the account.

ACORN is aware that some jurisdictions have their own requirements for prevention of Retained surgical items and as always ACORN remins standards users that the following caveats always apply:
ACORN strongly recommends that in each health service organisation where surgery/procedures are performed, there shall be a perioperative multidisciplinary committee which reviews operating procedures, formulates local policy/guidelines and ensures that they are followed. Health service organisation management should ensure that this standard and any accompanying local policy or guideline are read and acknowledged by all staff working in the perioperative environment. 
National and jurisdictional statutory requirements must be followed and take precedence over all recommendations contained within this standard. In NSW, it is mandatory that perioperative nurses adhere to the current version of the relevant New South Wales health policy. 
This standard should be used in conjunction with other current, relevant ACORN standards, and national and jurisdictional statutory requirements, standards and guidelines. In particular, the Australian Commission on Safety and Quality in Health Care (ACSQHC) National Safety and Quality Health Service Standards (NSQHS Standards). 

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

Our theatre complex of 9 theatres has only one corridor shared to transport sterile set-ups, used instruments from the cases, patients and staff. I would like advice on how to contain used instruments being transported from individual theatres to CSSD using this shared corridor. Currently we fold the back table cover over the instruments and trays to contain them but we have been advised that this is insufficient to meet accreditation.

Please review the following ACORN Standards:

•           Asepsis

•           Infection Prevention and

•           Planning and design of the perioperative environment

The Planning and design of the perioperative environment standard does in fact refer to a single corridor model and ACORN encourages you to re-read that standard.

In the Asepsis standard statement 4 and its associated rationale and criteria, specifically 4.6-4.8 indicate that covered containers or vehicles must be used to move soiled instruments to the reprocessing area. Please liaise with your infection control team to establish a system for this in your operating suite. Please also refer to Standards Australia. AS/NZS 4187:2014 Reprocessing of reusable medical devices in health service organisations. Canberra: Standards Australia; 2014 which is the cited reference to that requirement at Criteria 4.7.


How long can I leave a sterile surgical tray open before surgery? We open our trays up in a small area with walk through, so this isn't a big theatre, it is day surgery. Just wondering if there is an ACORN standard for this?

With regard to asepsis this issue is well described in detail in the ACORN Standards; specifically the standards on Asepsis, Infection Prevention, Instrument nurse and Reprocessing re-usable medical devices. Please access and read each of those specific standards. Please note that ACORN’s clinical responses are not a substitute for the ACORN Standards and ACORN does not provide in depth responses for questions relating to content covered in the ACORN Standards.


The organisation I work for currently does not allow staff to count in the set up room, however staff are allowed to set up for cases there. As they are not allowed to count there, staff take instruments out of the trays, remove the inner packaging of consumables and have everything ready before the trolleys are pushed into theatre after the patient has been positioned on operating table where the initial count is performed. The staff do this as they find that by the time they get into the operating room, they have very little time to count.I am not comfortable with this practice, as I believe no instrument should be taken out the trays or inner packaging removed until one is ready to count. I have worked in other facilities where staff set up and count in set up room before trolleys are pushed in operating room. What will be an acceptable practice in this instance? I have been taught that one should count where one is setting up regardless of where, whether it is in set up or operating room. Can the initial count be done in set up room before case commences?

Under criteria 2.5 within ACORN's Asepsis standard it states: “

Perioperative personnel have a duty to:

2.5           prepare an aseptic field for one patient at a time and within the confines of the operating/procedure room where the procedure is intended to occur

By its nature the implication of this standard is that the first and all subsequent counts must be undertaken in the the confines of the operating/procedure room where the procedure is intended to occur or has occurred.

So whilst this rationale is infection control based it has ramifications for management of accountable items. Again, please understand that the ACORN Standards are not mandatory however they are considered best practice and have been used previously as representation of the reasonable standard of care expected by perioperative patients and staff.

ACORN encourages you to change your local practice so that it complies with this recommendation unless you have a state-specific directive or mandate that tolerates a different approach.


There used to be a statement in the ACORN standards about maintaining an appropriate distance from the sterile field at all times.  However, I am not longer able to see that stated in the new standards and need to reference it! It used to be a long time ago in the Asepsis and Clinical Care section but now I can only see in the PATS – 'maintains a "safe" distance'? 

 

Please also note that the current edition of the ACORN Standards is the 16th edition. Each new edition supersedes those previous. As such if a statement is no longer included it may indicate one or more of the following
the evidence underpinning that standard may have changed
the issue is no longer considered critical by the perioperative experts who contribute to the updating of ACORN’s standards
there is new and contrary  advice addressing this issue and published by a jurisdictional or national boy or organisation 
other as considered reasonable by ACORN’s editorial team
 
ACORN apologises for the disconnect now evident in some of the ACORN PATs published prior to the 16th edition of the ACORN Standards. ACORN is currently prioritising updating of the ACORN PATs and other companion tools to assist with implementation of the ACORN Standards. Current PATs subscribers will be advised when any approved updates are available. Please also appreciate that the ACORN Clinical team of staff is small with limited capacity. As always we appreciate your enquiry and patience as we improve. 

When doing a DIEP flap should the microscope be fully draped? I strongly feel it should be, but am in disagreement with someone. Also, what should happen to the instruments, etc from the first part of the op (done by different team) given that at least one pack is left in the breast when teams change from general surgeon to plastic surgeon? I again am not in agreement with same person.

 

The current Asepsis standard contained within the ACORN Standards for Perioperative Nursing in Australia does not specifically address your question. However that standard does include a number of general principles which detail requirements for instruments and items entering a sterile field. I would also recommend you considering your personal and organisational obligations outlined in Standard 3 of the current National Safety and Quality in Healthcare Standards, and also in the 2019 NHMRC national infection control guidelines.

It is also important that you appreciate that ACORN can direct you to the relevant Standard for reference, however we cannot provide interpretation of the Standard. The application and interpretation of the Standards involve many factors that will be individual to the situation and facility in which you work.


I have a question regarding the setting up of sterile instrumentation in a negative pressure theatre. I cannot find in the standards that it’s not ok to set up instrumentation in a negative pressure theatre. We have 2 negative pressure theatres due to COVID and we want to minimise the opening and closing of the theatre doors and to decrease that we could set up before the patient gets into theatre. 

The current ACORN Standards regarding setting up, irrespective of the type of airconditioning, are found under criteria 2.5 within the Asepsis standard released recently as part of the 16th edition of the ACORN Standards. It states: “
Perioperative personnel have a duty to:
 
2.5 prepare an aseptic field for one patient at a time and within the confines of the operating/procedure room where the procedure is intended to occur
 
By its nature the implication of this standard is that the first and all subsequent counts must be undertaken in the the confines of the operating/procedure room where the procedure is intended to occur or has occurred.
 
Within that same Standard Criteria under Standard statement 4 recommend:
 
Personnel have a duty to:
4.1 minimise the movement of personnel and equipment within the room as per relevant ACORN standards
4.2 ensure doors to the operating/procedure room are closed except for the movement of the patient, staff and equipment
4.3 limit the number of personnel in the room to only those required to be present to carry out the procedure
 
Again, these principles apply regardless of the type of air conditioning or control.

We are looking at changing our skin-to-skin policy during caesarean section. Proposed procedure change where appropriate by midwifery & surgical team: - once baby is out & cord is cut the drape at the proximal end of the abdomen would be lifted the baby would be pushed onto the mothers chest by surgeon - the drape would be placed back down & the case would continue. The perioperative nursing team feel this represents significant risk to the aseptic field. Does ACORN have a view on this? 

ACORN’s standard on Asepsis includes the broad principles which if followed should ensure asepsis is maintained. ACORN’s role is not to recommend or provide advice on specific clinical practices which are as you recognise often matters for local determination.

Please note that Standard statement 4 in the current 16th edition of the ACORN Standard on Asepsis states: “The physical environment shall be controlled in a manner which sustains asepsis”. If any proposed practice change challenges the maintenance of asepsis then it should be reconsidered.


What are the standards for having sterile stock stored in theatres. ie sponges swabs sutures etc on scout trollies? is it seen as infection risk?

 

With regard to asepsis, storage and handling of sterile stock please refer to the following ACORN clinical standards as published in the 16th edition of the ACORN Standards in full:

Asepsis - page 36
Infection prevention - page134
Reprocessing re-usable medical devices - page 276
Single use items - page 302

Further ACORN would also encourage you to read the current edition of the Australian guidelines prevention and control of infection healthcare which is accessible via  https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019

ACORN did not receive any questions or comments regarding this standard during 2020.

I was after information on the excessive use of personal perfume in the perioperative environment. My facility is struggling to find some common ground with this. I cannot find any information in the standards. Any information would be appreciated to help develop a policy that can be implemented.

ACORN's standards are silent on this issue probably because the decision should be organisation-wide rather than perioperative-specific. There are multiple confined areas within health service organisations where staff and patient are in close proximity. Any policy should address aftershave as well as perfume. ACORN keeps a watching brief on emerging evidence or research but in this case for now ACORN advises you take it up with your organisation’s OH&S management as it is a governance issue. If you or any others in your workforce are truly sensitive then I suspect there could be good grounds from an occupational health perspective to discourage and/or ban staff from wearing perfume while at work.


I am trying get a clear direction on best practice at this time. While extubating patients in the operating theatre. Is it necessary to mop the floor between each patient when there is no visible signs of blood or body fluids evident? All equipment that has been touching the patient is wiped down in between patients and the staff are practising standard precautions. We are a private day surgery facility so therefore our patients are screened and high risk procedures are not being undertaken

ACORN’s recommendations regarding routine cleaning of the operating room are well described in the current edition of the ACORN Standards for Perioperative Nursing in Australia. I would strongly suggest that you review that document in particular the standards on Cleaning and maintaining the perioperative environment and Infection prevention

The national Infection Control Guidelines are freely available at https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019 Please note the recommendations included in Appendix 2 on Recommended routine cleaning frequencies.

If your question relates to specific COVID-19 precautions ACORN continues to refer all members to the ACORN recommends members follow the Australian government's advice and regular updates available at www.health.gov.au

As you would appreciate members’ needs vary greatly and it is therefore difficult for ACORN to provide specific advice. I would also recommend in this case that you seek advice from your infection control staff or Chair of the infection control committee.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

My inquiry is regarding documentation of the APD in conjunction with EMR. We do not have an APD in EMR so we are keeping the paper version and currently trying to update it. There is a discussion about whether or not we should have a section on the paper APD with nurses names and signatures for identification purposes as well as a separate section for changeover counts and initial, 1st, 2nd, ++ final counts. we are a bit divided on the topic and would like an unbias point of view from those who create our guidelines. I can send you a copy of our draft if that makes things clearer. 

 

Whilst ACORN appreciates your request please be advised that we cannot provide interpretation of the ACORN Standards. The application and interpretation of the Standards involve many factors that will be individual to the situation and facility in which you work. There may well also be national and/or jurisdiction-specific obligations regarding documentation with which your organisation must comply. These would include the NSQHS standards for Clinical governance and Communicating for safety.

The principles underpinning ACORN’s recommendations are as detailed in the current Documentation and patient information management standard included in Vol 1 Clinical Standards pages 80-94.


I am looking for literature relating to recording of blood loss in the operating theatre for circulating nurses (i.e weighing sponges/raytec, reading suction canister, etc). I can't seem to find any information in the ACORN standards or in medical databases.

ACORN Standards are silent on this matter. It is outside the scope of ACORN’s Standards and I am not aware of any current consideration to ACORN taking a different position. Please note that this may well be an issue for local management to determine. To assist you I have made an anonymised posting on ACORN’s Facebook page and some of ACORN’s followers have begun posting replies. You can access the ACORN FB page at https://www.facebook.com/ACORNCompany


My workplace and i have been trying to find the ACORN standards in relation to other patients paperwork being brought into the operating theatre whilst another patient is already inside. Ie Mr Smith is in surgery, and Mr Jones periop paperwork is brought into theatres to be completed before he enters, since the list has quick turnovers. This then continues on, 2 documents inside at one time.

ACORN Standards are generally silent on this matter. Specific detailed guidance is outside the scope of ACORN’s Standards and I am not aware of any current consideration to ACORN taking a different position. Please note that this may well be an issue for local management to determine. 

To assist you please refer to the current ACORN Documentation and patient information management standard which includes the following explanatory statements:

4.4 matching electronic records to the clinical workflow pattern to reduce the risk of patient care interruptions and adverse outcomes

5.6 make electronic records available at the point of care or service delivery according to workflow

Also to assist you I have made an anonymised posting on ACORN’s Facebook page and some of ACORN’s followers have begun posting replies. You can access the ACORN FB page at https://www.facebook.com/ACORNCompany


ACORN did not receive any questions or comments regarding this standard during 2020.

Do you have a committee or an individual who can inform me about any ACORN policies on the reduction or recycling of plastic and packaging waste used in the supply of single use medical devices?

 

Since 2014 ACORN has regularly updated its Environmentally sustainable perioperative practices guideline which is included in the Standards for Perioperative Nursing in Australia. That standard provides specific advice and recommendations regarding sustainable perioperative practices. As you would also appreciate there may different approaches and practices to this issue locally and between jurisdictions. Overall, ACORN supports perioperative practices that are sustainable and compliant with relevant local mandates.

Access to the ACORN Standards for Perioperative Nursing in Australia is available by subscription. Please note that a new, updated 16th edition of the Standards is scheduled for late May 2020. Existing subscribers will automatically have their access changed to the new edition. For your information the Environmentally sustainable perioperative practices guideline in the new 16th edition has undergone only very minor review. It will most likely undergo comprehensive review in a future edition of the ACORN Standards. Purchase options are detailed at Standards shop 

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

 In regards to Laser Safety standard, I would like to clarify the definition of "laser nurse" and "laser users and operators". My understanding is that the "laser nurse" is any nurse who is involved in the laser case i.e. the nurse who pushes the buttons on the laser generator machine, the circulating, scrub and anaesthetic nurses. The Australian/New Zealand Standard AS/NZS 4173:2018 does not refer to the "laser nurse". My understanding of "laser user" is the surgeon using the laser to effect the target tissue, and the "laser operator" is the nurse/surgeon/technician who pushes the buttons on the laser generator machine. AS/NZS 4173:2018 1.4.47 refers to the laser operator as "any person who operates laser controls (eg. parameter settings, actuation switch). The operator may also be the user." AS/NZS 4173:2018 1.4.49 defines the laser user as "Any person who controls the delivery of the laser radiation to the working area." If this is correct that would mean the standard requires the "laser operator" to have documented authorisation to operate the laser with annual validation of skills. There is contention in the workplace that the "laser nurse" does not require skills validation because nurses are not "laser operators"- the claim is that the surgeon effecting the tissue with laser is the "laser operator", not the person pushing the buttons on the laser generator machine. Thank you for you assistance in this matter.

Please refer to the Glossary on page 160 of the current 16th edition of the ACORN Standards. Specifically note the defintions of Laser nurse and Laser safety officer. ACORN’s definition of the Laser nurse is diametrically opposed to the workplace contention (the "laser nurse" does not require skills validation because nurses are not "laser operators") 

Please also note that 2.1.1 of the current ACORN Laser safety standard stipulates that ‘criteria and documentation for facility authorisation of laser users and operators. This is dependent on state licensing requirements). Also please note that the ACORN standard does not include any use of the term laser operator. I would suggest that is intended given variation between jurisdictional recommendations and requirements. Also please note the general recommendation included in the standard which reads ‘perioperative nurses apply new state/territory and national guidelines and rules to the control of medical
laser practices, as they become effective.


 

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

ACORN did not receive any questions or comments regarding this standard during 2020.

Can you provide advice on scenarios for when a level 2 surgical fluid resistant mask is suitable for use in an operating environment as a contingency or business as usual requirement when managing limited stock levels of surgical masks.

According to the current ACORN Perioperative Attire standard

Personnel have a duty to:

6.1 wear disposable, high filtration masks

6.1.1 whenever a sterile/aseptic field is being prepared or maintained

6.1.2 in the restricted areas during surgical procedures

6.1.3 whenever there is risk of blood or body fluid splash

Obviously, the current global demands on PPE require all health service organisations to re-consider how they manage their PPE stock and how they undertake the required risk assessment that informs their choice of PPE. ACORN is currently referring all members to the national COVID-19 advice for health care workers and to their jurisdiction-specific advice. In this case, ACORN would also recommend you seek advice from your local infection control team as they would most likely have a better understanding of the current guidelines specific to your hospital.


I am reviewing our district's procedure on perioperative attire. Would you please advise governance surrounding disposable attire (i.e. Australian Standard)?

ACORN strongly encourages you to read the current Perioperative attire standard as it details ACORN’s recommendations including a health service organisation’s obligations to supply disposable head-covers and masks.

A comprehensive table from pages 11-13 of Volume 1 - Clinical standards  lists the seven relevant Australian Standards cited in the Perioperative attire standard. It would help you get a clearer understanding of ACORN’s recommendations and from where they arise.


I am a third year nursing student and have been lucky enough to receive a placement in theatre I have facial hair and was wondering if I need to shave it off or if there are ways to protect the operating room from errant facial hairs?

With regards to strategies and processes to limit the shedding of microorganisms or hair from face of perioperative staff there are a number of recommendations. ACORN would also draw your attention to the possible limitations in protection for the wearer of a face mask and particularly an N95 ask or respirator when facial hair impedes the seal of the mask.

Please refer to the current Australian Guidelines for the Prevention and Control of Infection in Healthcare https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019 see pages 114-116.305.

The Perioperative attire standard in the ACORN Standards for Perioperative Nursing in Australia also make the following recommendations:

"Standard statement 2

The scalp, sideburns, facial hair, ears and nape of the neck are completely covered by a surgical head cover to minimise microbial dispersal when staff are the restricted, and semi-restricted areas of the perioperative environment should be clearly defined within each health service organisation. This also applies to any perioperative staff member performing surgical hand antisepsis."


I have changed health services and recall previously reading an email regarding cloth hats within the preoperative environment. I recall this letter stating that there hadn't been specific trials or research conducted and that ACCORN was happy to support research. And that it welcomed evidence based practices. Can you point me in the right direction, as there are currently policies being reviewed and I would like to have good evidence based referencing, where possible?

ACORN’s Perioperative Attire standard which is at pages 223-234 of the current Volume 1 of the 16th edition of the ACORN Standards for Perioperative Nursing in Australia makes several statements regarding perioperative headwear.

In 2018 ACORN published a Statement regarding cloth headwear in the perioperative environment. ACORN has not changed its position since this statement was published.

From time-to-time ACORN receives requests from individuals to review its position however we are not aware of any significant valid and reliable new pieces of peer-reviewed research that invalidate ACORN’s position. We continue to scan the public policy and research fields in the event that new credible, peer-review, high-quality research from well-designed studies is published.


Cytotoxic precautions in the OR Are nurses in the OR wearing N95 masks during surgery for patients who are under cytotoxic precautions eg had cytotoxic medication in the last 7 days I could not find anything in the standards Or a procedure specific to theatre

ACORN Standards are silent on this matter. It is outside ACORN’s scope and I am not aware of any current consideration to ACORN taking a different position. Please note that this may well be an issue for local management to determine. To assist you I have attached a copy of the current Queensland  Guide for handling cytotoxic drugs and related waste. I would also recommend that you investigate this matter locally with pharmacy, OH&S and oncology services. I suspect that if needed, precautions would be universal across the care setting. You will need to determine the local and jurisdictional guidance on this matter.


Just enquiring how the public hospitals can wear cloth hats (that do not get laundered or reviewed for thread count etc) and private hospitals do. Have a lot of nurses that work across public and private and the inconsistencies with the standards is surprising. 

 

As you would appreciate the ACORN Standards are not enforceable. For further explanation please read the paragraphs below. Regardless, ACORN’s current recommedations regarding perioperative attire, including headwear, constitute what ACORN, Australia’s peak body for perioperative nurses, considers to be best practice. How an organisation or individual complies with non-mandatory standards such as the ACORN standards for perioperative attire is a matter for that organisation.

ACORN is not aware of any research demonstrating a direct association or variation in surgical outcomes associated with the laundering and reuse of cloth hats in public hospitals compared to private hospitals. 

 

Hi is there any standards or requirements pertaining to taps within the scrub area. It has been suggested that the hospital I work at change their current taps to sensor taps. I would like to know what ACORN thinks of this please.

The ACORN standards mention tap type in the following standard:

Planning and design of the perioperative environment 5.2.4 page 309 
5.2 The infection control risk assessment will be prepared by the multidisciplinary team to identify which could occur within the design and building documents and building contracts. This should include a detailed assessment and review of: 5.2.1 the proposed air conditioning system for all areas within the operating suite 
5.2.2 proximity of operating rooms to the sterilising services 
5.2.3 location of set-up rooms 
5.2.4 location and types of surgical scrub/hand washing sinks, taps and water flows 

You may also find additional information in  The Australasian Health Facility Guidelines (AusHFG) https://healthfacilityguidelines.com.au/australasian-health-facility-guidelines . There is some detail about scrub areas available at this link  https://healthfacilityguidelines.com.au/component/scrub-4m2

I have also skimmed and attached The Australian Guidelines for the Prevention and Control of Infection in Healthcare and the Australian Commission on National Hand Hygiene Initiative Manual however I could not find any specific recommendation regarding sensor taps. 

 I wanted to know why the "TIME" for a pneumatic tourniquet is less for the upper limb vs the lower limb? Is the "TIME" a cell is  "ischemic" the same regardless of being in the lower limb or upper limb?  

The ACORN Standards for Perioperative Nursing in Australia are developed through rigorous review of the best available research and other evidence in Australia and abroad. Individual standards, guidelines and position statements are best-practice at the time of revision. Please refer to the revision history at the end of each individual document for the last revision date. 
  
Our Standards query team can direct you to the relevant Standard for reference, however we cannot provide interpretation of the Standard. The application and interpretation of the Standards involve many factors that will be individual to the situation and facility in which you work.
ACORN has not currently prioritised a comprehensive review of the current Pneumatic tourniquet standard however it is likely that a review is needed before the standard is reissued. 
Accordingly ACORN will keep this email conversation on file so that when this standard is next undergoing review your arguments can be considered.


Please also understand that the ACORN Standards are currently undergoing major review including consideration of how they are structured, the quality of evidence used to underpin their recommendations and ways to appropriately respond to user feedback. That work is part of the ACORN Roadmap project and is our organisational priority from now until the next edition of the ACORN Standards. You can follow the RMP at https://www.acorn.org.au/rmp

ACORN did not receive any questions or comments regarding this standard during 2020.

I am after information and or guidance around compliant storage in a sterile stock room. We store sterile consumable stock which we supply to Medical teams that visit our Asia/Pacific partner countries. We are not located in a hospital but we do supply our program trip kits with the sterile stock from the equipment room. We are in the process of an up-grade and in order to meet infection control compliance with our storage solutions, I was hoping you could advise.

The ACORN Standards for Perioerpative Nursing in Australia contain guidelines for the safe storage of sterile stock. Organisations can access these standards by purchase via ACORN’s website. See https://www.acorn.org.au/standards--personal-use-license Please note that in late May 2020 ACORN will release the next updated edition of the ACORN Standards for Perioerpative Nursing in Australia which include a significant update of the standard relating to storage of sterile stock. Given that RACs is not a health care facility where surgical procedures are conducted the required practices for storage of sterile stock may be different to those of a clinical setting. In a sense they would be like the standards manufacturers and distributors of sterile stock must adhere to. One option would be to contact the manufacturer of each item that you store and seek their advice and instructions for use. In general sterile stock must be a certain height from flooring, it must be stored in a room that is free of pests or vermin, protected from sunlight, dampness and inadvertant loss of seal through accidental puncture, tear or rip. Please also consider this issue in the context of the National Infection Control Guidelines (attached) and also the Australian Health Facility Guidelines available at www.healthfacilityguidelines.com.au inparticular Part D: Infection Prevention and Control. You may also gain insight by reviewing the requirements of AS 4187: 2014  Reprocessing of reusable medical devices in health service organisations https://www.standards.org.au/standards-catalogue/sa-snz/health/he-023/as-slash-nzs--4187-colon-2014


I just have one query in the new Reprocessing standard in 15.1.1 a reference to the Federal Sterilising Research Advisory Councils of Australia Recommendations for Practice is included along with AHFG however the sterilising council is not detailed in the reference section and I have not been able to locate the documents you are referring to. 

 

With regard to the new Reprocessing re-usable medical devices standard and the criteria at 15.1.1 I have checked this and all the draft versions of this standard and can report to you that the reference to AHFG is correct as cited. The inclusion of FSCRACA Federal Sterilising Research Advisory Councils of Australia recommendations for practice is included in criteria 15.1.1 does not refer to any specific FSRACA document or webpage but as inferred by the lower case, non-italicised “recommendations for practice” refers to any general recommendations FSRACA may make. As such there is no missing or overlooked reference and I concede that placement of the superscript 27 at the end of that sentence rather than immediately following the italicised Australian Health Facility Guidelines may have confused you. This citation placement is a function of the modified Vancouver referencing style ACORN routinely uses. It is convention that the identification of references within text may vary according to the preferred style of the organisation/ publisher.


Does anyone have experience in transporting wrapped and sterilised Reusable Medical Devices between hospitals in Temperature and Humidity controlled Containers? We  would really like to meet the AS/NZS 4187 2014 in regards to Transport and Storage of RMD's ie between 18 to 25o C and 35 to 70% humidity. Any advice on purchasing a temperature and humidity controlled container will be gratefully received. 

Thank you for your question which is beyond the scope of the ACORN Standards. I have posted on ACORN’s Facebook account asking for advice from your perioperative peers. You have not been identified in that post.
 
As a suggestion perhaps you could begin discussions with colleagues from Far North Queensland and also with SRACA.
 
Please know that ACORN completely agrees that you must comply with the requirements of AS4187 and any relevant jurisdictional and national infection control guidelines, standards and legislation that relate to reprocessing, transportation  and storage of sterile devices.

 


In the previous edition of the ACORN Standards for Perioperative Nursing in Australia I read that sharps must only be discarded by the original user and its not advised they are counted away, I cant find this in the current  edition, can you assist?

ACORN recommends that you review the general intent and over-arching principles of each Standard in the current 16th edition as they discuss ACORN’s recommendations and the need  to  always consider specific local policies and risk management. Specifically I draw your attention to Standard statement 7 of the current 16th edition Accounatble items standard and Criteria 3.4 of the current 16th edition of the Sharps and preventing sharps-related injury standard. Both standards indicate that a health care worker is indeed responsible for the management and safe disposal of any sharp they use. 

The literature suggests that screw caddies should be replaced by sterile implants packaged singularly. We have about 50 trays with caddies containing implants (screws and plates) being continually reprocessed. I would be grateful for any advice on how Operating Theatres transitioned to sterile single use. 

Unfortunately ACORN has no unique insights into this issue and has not seen “the literature” to which you refer. Perhaps you could seek the views of the authors of those pieces of literature. You may also wish to connect with the state local associations to seek advice from their orthopaedic experts.

ACORN did not receive any questions or comments regarding this standard during 2020.

We are updating our policy on jewellery in the perioperative area and the ACORN standards state no rings are allowed. Is it permissible for any staff in the area to wear wedding rings as some staff (mainly recovery) are physically unable to remove their rings?
 

Please refer to the Perioperative attire standard. Within this standard Standards statement 8 recommends “Jewellery worn within the perioperative environment is limited to items that can be contained within the perioperative attire.”ACORN’s  rationale for this includes evidence proving that microorganisms are harboured under and within rings and it also refers to the risk of accidental traction on the ring causing avulsion of the soft tissues. This can result in injury ranging from a simple contusion injury to traumatic amputation”

In 2019 the National Health and Medical Research Council published revised Australian Guidelines for the Prevention and Control of Infection in Healthcare. The NHMRC’s recommendation see below  are built into the National Safety and Quality Health Service (NSQHS) Standards compliance with which is mandatory for Australian health service organisations. Please note that page 40 of the NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare states “if jewellery must be worn in clinical areas it should be limited to a plain band (e.g. wedding ring) and this should be moved about on the finger during hand hygiene practices. In high-risk settings such as operating suites/rooms, any jewellery, even a plain band, should not be worn.”  In relation to your question ACORN’s recommendation is that no jewellery, including wedding rings, should be worn.

Although there is less evidence concerning the impact of jewellery on the effectiveness of hand hygiene, rings can interfere with the technique used to perform hand hygiene resulting in higher total bacterial counts. Hand contamination with infectious agents is increased with ring wearing], although no studies have related this practice to healthcare worker-to-patient transmission. The consensus recommendation is to strongly discourage the wearing of watches, rings or other jewellery during health care; however if jewellery must be worn in clinical areas it should be limited to a plain band (e.g. wedding ring) and this should be moved about on the finger during hand hygiene practices. In high-risk settings such as operating suites/rooms, any jewellery, even a plain band, should not be worn.


Do you have any information on the moments of hand hygiene in theatres?

Since November 2019 the Australian Commission on Safety and Quality in Health Care has had responsibility for the National Hand Hygiene imitative  in Australian health service organisations. There are specific obligations that health service organisations have including assessment of local hand hygiene compliance. These obligations may differ between jurisdictions and so I would also recommend you review materials specific for NSW on the Clinical Excellence Commission’s website specifically at http://cec.health.nsw.gov.au/keep-patients-safe/infection-prevention-and-control/healthcare-associated-infections/hand-hygiene  

ACSQHC’s resources for hand hygiene can be accessed free of charge at https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control/national-hand-hygiene-initiative-nhhi/what-hand-hygiene

ACORN has produced a series of 12 Practice audit tools (PATs) specific to the perioperative environment. PAT 3 is for Surgical hand antisepsis, gowning and gloving. The ACORN PATs are available for purchase as a set of 12. More information is available at https://www.acorn.org.au/practiceaudittools.


I am just wondering whether ACORN has any recommendations regarding the use of surgical scrubs? I am currently looking at comparing Isopropyl Alcohol 90%  to others such as chlorhexidine and iodine to provide evidence to management in our theatres to perhaps introduce it as an alternative scrub throughout the day.

ACORN does not make recommendations regarding specific products as we appreciate that different jurisdictions and organisations have various procurement procedures in place including tenders with specific manufacturers and distributors. There are also important issues such as staff tolerance to the active ingredients in a solution used for surgical hand antisepsis. Care should be taken in selecting that solution as sensitivities may develop. Both iodine and chlorhexidine (CHG) are excellent antiseptics, the main benefit for chlorhexidine is persistence. It should be in combination with alcohol so that immediate kill is achieved (by the alcohol) and persistence (by the CHG) are attained.

As you suggest ACORN’s general recommendations are described in the Surgical hand antisepsis, gowning and gloving standard. The only stipulation is that the scrub used for surgical hand antisepsis has antimicrobial properties and is used only as per manufacturer’s instructions.

For more information you may find the National Hand Hygiene Initiative Manual useful. More information about the national hand hygience initiative is available at https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-hand-hygiene-initiative-manual

I also refer you to the 2019 Australian Guidelines for the Prevention and Control of Infection in Healthcare. The guidelines are accessible at www.nhmrc.gov.au and the following definitions are taken from it.

Surgical ABHR: Antiseptic hand rub performed preoperatively by the surgical team following the surgical pre-wash to eliminate transient flora and reduce resident skin flora. Such antiseptics often have persistent antimicrobial activity. Use should be in accordance with manufacturers’ instructions. Surgical ABHRs are often a waterless and high percent alcohol solution.

Surgical hand preparation: The process of eliminating transient and reducing resident flora prior to surgery. This comprises removal of hand jewellery, performing hand hygiene with liquid soap if hands are visibly soiled, removing debris from underneath fingernails and scrubbing hands and forearms using a suitable antimicrobial formulation


I just wanted to clarify something from the standard for surgical hand antisepsis. It states in there that surgical hand scrub and surgical hand rub should not be used sequentially. What is the rationale behind this? I am unable to access the full text article that is referenced for this statement. Medical staff in particular in our facility are doing this regularly, doing a traditional scrub then applying the waterless hand rub. We are hoping to change their practice but know they will want some more information.

This is an interesting question and it has been asked of ACORN on at least one other occasion in the past 12 months which has prompted ACORN to revise the wording of the recommendation. In our new 16th edition of the ACORN Standards those sections of the standard have been re-worded to:

"3.11 Do not combine surgical hand scrub and alcohol-based surgical hand rub sequentially as using surgical hand scrub and washing may result in moist hands and moisture may dilute the antimicrobial properties of the surgical hand rub. Surgical hand scrub may also enhance skin irritation and dryness.

3.12 Generally, hand washing prior to applying an alcohol-based surgical hand rub is not necessary and it may dilute the effectiveness of the surgical hand rub and can predipose users' hands to irritation. However, if hands are visibly soiled or dirty, they should be washed with a non-antimicrobial soap before surgical hand preparation and must be completely dry before applying the alcohol-based surgical hand rub solution."

The other important information is that if two different types of antimicrobial agents are used sequentially the first may reduce the efficacy of the second. These rationales are well described in the Kampf article1. Also please check the World Health Organization. Guidelines on hand hygiene in health care. First global patient safety challenge: Clean care is safe care. Geneva: WHO; 2009. as it also helps explain this recommendation.

1. Kampf G, Löffler H. Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection. J Hosp Infect. 2003;55(1):1-7. doi:10.1016/s0195-6701(03)00223-8


In the "Surgical hand antisepsis, gowning and gloving" standard section 3.5 where it says that surgical antiseptic hand scrub agents and alcohol base surgical hand rub should not be used sequentially does this mean that if you do your 5 min scrub at the start of the day using antimicrobial hand-wash the following hand washes after that cannot be a 90 second Skinman alcohol hand rub? It must be a 3 min washes continuing using the chosen antimicrobial hand wash? If we chose to use the 90 second Skinman alcohol antiseptic hand rub we must use that at the start of the day in-replace of our 5 min scrub and continue to use that all day for the sequential washes?

ACORN’s recommendation is:

3.5 Antimicrobial surgical hand scrub agents and alcohol-based surgical hand rub agents should not be combined sequentially2,p.153. If you choose to use a surgical hand scrub you must continue using that same antiseptic for all subsequent scrubs.

ACORN’s recommendation makes no mention of a specific duration as we are aware that in all cases manufacturer’s IFUs should be followed and they may differ depending on which agent is used. The statement states that if you start your first scrub of the day using a scrub agent (solution A) then you cannot change to a different agent for your subsequent scrubs. Simply put you must continue to use Solution A for the remaining scrubs for the day. This is because of incompatibilities between surgical scrub and alcohol-based rubs solutions that render the agents to be less effective. This recommendation is based on WHO’s recommendation World Health Organization. Guidelines on hand hygiene in health care. First global patient safety challenge: Clean care is safe care. Geneva: WHO; 2009 See page 153. Page 153 reads:

" H. When using an alcohol-based surgical handrub product with sustained activity, follow the manufacturer’s instructions for application times. Apply the product to

dry hands only (IB). Do not combine surgical hand scrub and surgical handrub with alcohol-based products sequentially (II)."

You may also wish to undertake further discussions with your local perioperative leaders and your infection control team. ACORN will never provide manufacturer-specific advice. Instead you should seek a recommendation and gaurantee from the manufacturer that your proposed use of hand hygiene solutions is optimal, safe and does not reduce patient or staff safety. Please appreciate that ACORN’s recommendations are necessarily broad and over-arching whereas you may have specific local or jurisdictional obligations that override ACORN’s recommendations.


I am wanting clarification on the new standards of scrubbing, my understanding of the standard is that we no longer have to do a first 5 minute scrub of the day. I read it as you can simply arrive and use the alcohol scrub rub and then gown and glove, without any real hand washing.

ACORN is not sure what you mean by the term “real hand washing”. The current NHMRC national infection control guidelines use the term “surgical hand preparation”. Please review their recommendations on page 176 which I have reproduced below.

"Hand hygiene for surgery

Surgical hand preparation should reduce the release of skin bacteria from the hands of the surgical team for the duration of the procedure; in case of an unnoticed puncture of the surgical glove that releases bacteria to the open wound. Surgical hand preparation must eliminate the transient and reduce the resident flora. There are special surgical scrub formulations available for use, although any product used within Australia should preferably be listed on the Australian Register of Therapeutic Goods (ARTG). Current WHO guidelines recommend the use of an alcohol-based formulation for preoperative surgical hand preparation, given its superior antimicrobial efficacy compared to other methods. Specific policies and procedures on products and methods of surgical hand preparation should be developed locally."

Manufacturers’ instructions for use are critical and for waterless surgical hand preparation they should be followed. Further the American AORN recommend that:

“A standardized surgical hand scrub with a soap (antimicrobial agent), nonabrasive sponge, and water does not have to be the first surgical hand scrub of the day before an alcohol-based surgical hand rub product is used, unless it is recommended in the manufacturer's instructions for use. The surgical hand scrub reduces the transient and resident flora of the hands, which also may reduce health care-associated infections. A standardized surgical hand scrub using an alcohol-based hand rub product will decrease transient and resident flora on the hands. Hand washing does however need to be performed before the first surgical hand scrub of the day”.

AORN recommends hand washing before the first surgical hand scrub. Hand washing is defined by the ACSQHC National Hand Hygiene Initiative User Manual as the application of soap and water to the surface of the hands. The soap could be plain or antimicrobial. A critically important step is that before any surgical hand preparation is applied the healthcare worker’s hands must be dry. When the hands are dry and only then the surgical hand scrub using the skin antiseptic can be performed for the first surgical scrub. As per the ACORN Standards “The skin antiseptic used for the first surgical hand scrub of the day should continue to be used for subsequent scrubs because the beneficial, cumulative or sustained effects of skin antiseptics differ.”


Can you please define sequential in relation to the use of hand scrub and hand rub. We are undertaking our yearly assessments and want to ensure that if they do a 5 minute scrub, gown and glove they can then demonstrate practically use of the a specific product and go on to use their scrub/rub of choice for the rest of the day.

ACORN’s use of the word “sequential” is no different from its everyday usage ie. following in a logical order or sequence.

ACORN’s recommendation regarding hand hygiene and the sequence of hand hygiene solutions is as per the current standard:

"3.5 Antimicrobial surgical hand scrub agents and alcohol-based surgical hand rub agents should not be combined sequentially 2,p.153. If you choose to use a surgical hand scrub you must continue using that same antiseptic for all subsequent scrubs."

ACORN’s recommendation makes no mention of a specific duration as we are aware that in all cases manufacturer’s IFUs should be followed and they may differ depending on which agent is used. The statement states that if you start your first scrub of the day using a scrub agent (solution A) then you cannot change to a different agent for your subsequent scrubs. Simply put you must continue to use Solution A for the remaining scrubs for the day. This is because of incompatibilities between surgical scrub and alcohol-based rubs solutions that render the agents to be less effective. This recommendation is based on WHO’s recommendation World Health Organization. Guidelines on hand hygiene in health care. First global patient safety challenge: Clean care is safe care. Geneva: WHO; 2009 See page 153

Page 153 reads: "H. When using an alcohol-based surgical handrub product with sustained activity, follow the manufacturer’s instructions for application times. Apply the product to dry hands only (IB). Do not combine surgical hand scrub and surgical handrub with alcohol-based products sequentially (II)."


Gowning and gloving

As we can not source our usual 6.5 gloves from our current supplier our hospital is sourcing other companies. I have been asked what reference ACORN use for gloves I am presuming its reference the AS/NZS standard. I can not find any other reference in the Standards

Unfortunately, your question is vague and non-specific regarding the type of glove ie. non-sterile, sterile or reusable utility gloves you are enquiring about. Regardless please note that all ACORN recommendations for infection control are consistent with the requirements and recommendations included in the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019). Please refer to section 3.3 Personal protective equipment for glove-specific recommendations.

The document is available at https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019


Hi, just want to check with you as have always used the open gloving technique as this is what evidence says is the superior technique in unassisted gloving. The evidence is a randomised trial that was published in 2003, the gold standard of clinical research, and until now there is still no randomised trial conducted to challenge this evidence. May I know what is your take on this?

 

I have checked the current edition of the ACORN Standards and note that on page 317 in the Surgical hand antisepsis, gowning and gloving ACORN’s advice is as follows:

Surgical scrub team members have a duty to: 
4.7 use the closed gloving method as the preferred method for donning surgical gloves. This method assists in maintaining an aseptic field by allowing members of the surgical scrub team to don gloves in a manner consistent with the principles of aseptic technique58. 

The reference underpinning this recommendation is

Jones C, Brooker B, Genon M. Comparison of open and closed staff-assisted glove donning on the nature of surgical glove cuff contamination. Aust N Z J Surg 2010;80(3):174–177.


Is there a standard regarding the pre scrub prior to using 90 second hand alcoholic rubs for Perioperative surgical scrubs? 

ACORN has addressed questions similar to this several times recently and in multiple public forums. There was a recent FB post about it. It was discussed in the first edition of our newsletter “The Oak”. It is also contained in the Clinical FAQs page on ACORN’s website. Here are the links that will help you:
 
https://www.acorn.org.au/clinicalfaqs
 
https://www.acorn.org.au/asap

 

 

 

ACORN did not receive any questions or comments regarding this standard during 2020.

Does ACORN have a standard surrounding midwifery/nursing attendance for a Cesarean Section?

With regard to the attendance of a midwife at a Caesarian section ACORN Standards are silent on this matter and I am not aware of any current consideration to ACORN taking a different position. Please note that this may well be an issue for local managemnt to determine.

In terms of scope of practice and professional obligations you should also consult the relevant Nursing and Midwifery Board of Australia Midwife standards for practice availabel at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/Midwife-standards-for-practice.aspx


I was wanting to know the ACORN standpoint on bone cement vapour for nurses. Is there a guideline or recommendation from ACORN for best practice relating to exposure to MMA (Methyl Methacrylate)? 

I was wanting to know the ACORN standpoint on bone cement vapour for nurses. Is there a guideline or recommendation from ACORN for best practice relating to exposure to MMA (Methyl Methacrylate)? 


Surgical site marking, who should be responsible? Patients receiving cataract surgery, surgeon refusing to mark correct site before pre op eye drops given. Should the surgical marking be the responsibility of the nurse giving the eye drops? Can 2 RN's check consent and mark correct site? Should the marking remain the surgeons responsibility? 

 

Please read the current Surgical safety standard included in the 16th edition of the ACORN Standards published in May 2020. In that standard marking of the surgical site is included as pre-induction task. With regard to the responsibility for undertaking the actual marking the standard is not explicit. I would encourage you to work locally within your organisation to have the organisation set a local requirement which clearly confirms which member(s) of the surgical team must ensure this task has been done and done correctly. As you may expect ACORN supports personal and team accountability applicable to all members of the perioperative team. The work of teams and shared accountability underpins many safety measures.

For interest you may also wish to access the RACS documents related to this issue which are available at https://www.surgeons.org/Resources/reports-guidelines-publications/useful-guides-standards#Surgical%20Safety%20Checklist

It is also important that you understand the mandates governing your clinical practice which include compliance with the national safety and quality health service standards. Please note in particular the Communicating for Safety Standard available at https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard  Actions 6.5 and 6.6 are explicit around Correct identification and procedure matching. 


ACORN did not receive any questions or comments regarding this standard during 2020.

The Australasian Transplant Coordinators Association are updating our guidelines for facilitating Organ and Tissue Donation. I have been allocated to review the theatre component of the guidelines and would like to include the ACORN standards or guidelines on organ retrieval. This could include the standard instruments you suggest or any other information you provide your members. Thank you for your time to assist me with the ATCA guideline changes

 

Thank you for submitting a question to ACORN regarding the Standards for Perioperative Nursing in Australia. Your question as ACORN received it is reproduced below.
 
Thank you for notifying ACORN of ATCA’s work in updating its guidelines for Organ and Tissue Donation. ACORN does have a specific clinical standard which is currently in the form of a guideline; Posthumous organ procurement. It was part of ACORN’s recent release of the 16th edition of the ACORN Standards. The purpose of that specific guideline is to provide direction for additional support for managing posthumous organ procurement at the donor hospital, in order to ensure a consistent approach that is high in quality and safety. ATCA can purchase the ACORN Standards via our website www.acorn.org.au/standards ACORN is also grateful if instead ATCA refers ATCA Guideline users to that specific ACORN Standard which if used should be attributed. ACORN’s preferred citation is:
Recommended citation: 
Australian College of Perioperative Nurses Ltd (ACORN). Standards for Perioperative Nursing in Australia 16th ed: Volume 1 – Clinical Standards. Adelaide, South Australia: ACORN; 2020.
 
Please note that the usual copyright obligations apply to the ACORN Standards which are:
 
© Australian College of Perioperative Nurses Ltd claims copyright ownership of all information found in both volumes of Standards for Perioperative Nursing in Australia, unless stated otherwise. No information found in Standards for Perioperative Nursing in Australia may be used for commercial or other purposes (except as legally allowed for personal and educational use) unless the College gives its prior written consent to the intended use. 
Copyright information 
Copyright owners are entitled to take legal action against persons who infringe their copyright. A reproduction of material that is protected by copyright may be a copyright infringement. Certain dealings with copyright will not constitute an infringement, including: 
a reproduction that is a fair dealing under the Copyright Act 1968, including a fair dealing for the purposes of research or study 
a reproduction that is authorised by the copyright owner. 
 
It is a fair dealing to make a reproduction for the purposes of research or study or of a reasonable portion of a work which, in the case of both the hardcopy and electronic forms of this work, is ten per cent of the number of pages or one chapter.
 
An alternative way in which ACORN may be able to assist ATCA is if ATCA requests ACORN review of the final draft or section of your upcoming revised Guidelines. If that is of interest to ATCA please let ACORN know.

I would like to know the requirements around consent in paediatric patients. When a child comes to theatre does the parent that signs the consent form have to be present? or can it be the other parent who may not have consented for the surgery? 

Please note that consent is beyond the scope of ACORN recommendations as it a legislative matter determined by the relevant jursidictions. It should be addressed in the relevant state/ territory legislation for whichever state you are practising. To help you access materials relevant to your state I include and attachment from the ACSQHC. I would also strongly encourage you to visit the Commission’s website https://www.safetyandquality.gov.au/publications-and-resources/resource-library/informed-consent-fact-sheet-clinicians where additional material is likely available.