Bioterrorism; scrubbing between patients; gowning and gloving in a separate room; passing sharps - Clinical Issues

AORN Journal, Jan, 2002 by Ramona Conner

Question: In response to the Sept 11, 2001, attacks, administrators at my hospital have requested that all departments review their disaster response plans. I found that, although the surgical department was prepared for most events, we do not have a plan to respond to a bioterrorism attack. Many of our staff members believe that because bioterrorism is a nonsurgical emergency we do not need to include it in our plan. What does AORN recommend?

Answer: The surgical department disaster plan should include a response to a bioterrorist attack as part of the facility-wide disaster plan. The unfortunate reality is that a bioterrorist attack could affect every area of the health care system. It cannot be assumed that such an event would not involve surgical services. For example, victims infected with transmissible organisms (eg, smallpox) may require surgical intervention for a nonrelated injury. Infection control measures then must be taken to prevent transmission to care providers, other patients, and hospital visitors.

Addressing workers' fears. Acts of terrorism produce fear and panic. Health care workers are not immune to the effects of this fear. Surgical departments should have a plan in place to deal with the impact of a bioterrorist attack on staff members. Staff members may be reluctant to report to work when their family members and loved ones are threatened and in danger. Staff members who have children may be unwilling to provide care to infected patients and risk bringing infectious organisms home. Only through education, planning, and training can these human responses be understood and controlled.

Many government and private agencies have been actively assisting health care facilities in developing comprehensive response plans. AORN published a special edition of SSM titled "Preparing for a Disaster--What You Need to Know." This publication highlights previously published articles on biological warfare, recommended web sites for current information, and education sessions regarding bioterrorism that will be presented at the 2002 AORN Congress in Anaheim, Calif. This special edition was mailed to SSM subscribers in November 2001 and was included in the December 2001 issue of the AORN Journal.

Health care workers should become familiar with the Centers for Disease Control and Prevention "Bioterrorism readiness plan: A template for healthcare facilities." (1) This plan provides specific information on caring for victims of bioterrorism. In addition, the plan recommends that the following steps be taken to address workers' fears.

* Provide bioterrorism readiness education, including frank discussions of potential risks and plans for protecting health care providers.

* Invite active, voluntary involvement in the bioterrorism readiness planning process.

* Encourage participation in disaster drills.

Biological agents. There are four generally recognized organisms with bioterrorism potential--anthrax, botulism, plague, and smallpox. The web site for the Center for the Study of Bioterrorism and Emerging Infections at the St Louis University School of Public Health, available at http://www .bioterrorism.slu.edu, includes precautions and guidelines for dealing with an additional eight bacterial agents, four viral agents, and four biological toxins. Surgical staff members should become familiar with these biological agents and their modes of transmission, infection control practices, and decontamination methods.

Standard precautions. All patients having either suspected or confirmed exposure to a bacterial agent should be managed using standard precautions outlined in AORN's "Recommended practices for standard and transmission-based precautions." (2) Standard precautions include the following guidelines.

* Wash hands after touching blood, body fluids, or items contaminated by blood or body fluids, regardless of whether gloves are worn. Wash hands immediately after removing gloves and between patient contact.

* Wear clean, nonsterile gloves when touching blood or body fluids and any contaminated surfaces. Gloves should be changed between tasks and procedures performed on the same patient. Wash hands immediately after removing gloves and before leaving the patient care area.

* Wear a mask and eye protection or face shield to protect mucous membranes of the face while performing procedures and patient activities that may cause splashing of blood or body fluids.

* Wear a gown to protect skin and prevent soiling of personal attire. Remove soiled gowns promptly and wash hands.

Patients exposed to anthrax and botulism should be cared for using standard precautions. Patients exposed to plague or smallpox should be cared for using standard precautions, as well as droplet precautions. Droplet precautions include

* placing the patient in a private room or cohorting patients when private rooms are not available;

* separating patients by at least 3 ft if cohorting is not possible;

* limiting transport of infected patients to essential medical purposes (eg, transport to the OR); and