What are the key recommendations for the Operating Room Nurses Association of Canada (ORNAC) standards 2025 to ensure patient safety and infection control?

ORNAC Standards 2025: Key Recommendations for Patient Safety and Infection Control

The Operating Room Nurses Association of Canada (ORNAC) standards for 2025 focus primarily on creating dedicated COVID operating areas (COAs), implementing strict infection control protocols, and ensuring proper personal protective equipment (PPE) usage to minimize infection risks during surgical procedures.

Operating Room Preparation and Environment

• Dedicated COVID operating rooms (ORs) should be located as close as possible to the entrance of the theater block to minimize environmental contamination 1
• Negative pressure ORs are ideal for minimizing infection risk, but when not available, high air exchange cycle rates (≥25 cycles/hour) should be implemented to effectively reduce viral load 1
• Equipment in each OR must be minimized to what is strictly necessary for each procedure, with standard anesthetic trolleys replaced by dedicated pre-prepared ones with minimal but adequate stock 1
• All required surgical materials should be preemptively prepared in sterilizable steel wire baskets, with dedicated containers for infected and sharp disposable instruments 1
• Disposable materials should be preferred whenever possible, including linen, to minimize contamination risks 1

Personnel Protection and Protocols

• All healthcare personnel must wear appropriate PPE before contact with infected patients, including FFP2/FFP3 facial masks, disposable waterproof coats/gowns, double nitrile gloves, protective goggles/visors, disposable head caps, and long shoe covers 1
• FFP3 masks should be worn by operators working close to patients during aerosol-generating procedures such as intubation, non-invasive ventilation, tracheostomy, and manual ventilation 1
• All personnel in direct contact with patients must wear double gloves at all times, even while operating, with immediate glove changes after contact with infected materials 1
• Personnel with beards should pay special attention to mask fit to ensure adequate protection 1

Intraoperative Management

• OR doors must remain closed at all times with clear signage discouraging unnecessary entry 1
• The scout nurse and operating surgeon should anticipate all needed materials before the operation begins to minimize staff movement 1
• Personnel present in the OR during surgery must not leave the room until the procedure is completed 1
• All electromedical devices and surfaces must be used with protective covers and properly sanitized after each operation 1
• After patient departure, sufficient time should be allowed before the next procedure to reduce air contamination, depending on the room's air exchange rate 1

Patient Transport and Management

• Patient transit to and from the operating area must be as quick as possible via pre-defined direct paths kept short and away from other patients 1
• Non-intubated patients must wear surgical masks, disposable waterproof gloves, disposable caps, and shoe covers during transport 1
• Transport personnel should be specifically trained, equipped with PPE, and minimize contact with patients 1
• Recovery phase after surgery should be conducted in the OR before transferring the patient to the ward/ICU 1

PPE Removal and Sanitization

• Staff should remove PPE in dedicated doffing areas following a specific sequence to prevent contamination 1
• The first pair of gloves should be removed first as they are likely heavily contaminated, followed by protective suite, shoe covers, head cap, face mask, glasses, and finally the second pair of gloves 1
• Hand disinfection with hydro-alcoholic solution must be performed immediately after removing all PPE 1
• Scrubs should be replaced after each procedure, ideally following showering 1

Environmental Cleaning and Waste Management

• OR and surrounding exchange areas must be sanitized immediately after each procedure, with particular attention to objects used for infected patients 1
• Dedicated containers for hazardous medical waste should be placed immediately outside the OR for disposal of contaminated materials and PPE 1
• Containers should be closed and sealed before transfer to collection points, with PPE worn when handling and transporting them 1
• Disposable laundry should be preferred when possible, with all linen handled carefully to prevent infection spread 1

Special Considerations for COVID-19 Patients

• Patients should wear surgical masks when leaving isolation areas 2
• Family visits may be limited or prohibited; when allowed, visitors should wear appropriate protective equipment 2
• Telemedicine should be utilized for follow-up care whenever possible to maintain social distancing 2

Common Pitfalls and Caveats

• Failure to properly remove PPE can lead to self-contamination; strict adherence to doffing protocols is essential 1
• Underestimating the importance of air exchange rates can increase infection risk; ensure proper ventilation systems are in place 1
• Neglecting to anticipate all needed surgical materials before beginning procedures can lead to unnecessary staff movement and increased contamination risk 1
• Inadequate protection during aerosol-generating procedures poses significant risk; ensure FFP3 masks are worn during these high-risk activities 1