New Waves of Evidence Changing the Tides of ACORN Standards: A Case Exemplar Dr Sonya Osborne ACORN Standards Editor
Natural History of Asepsis 1847 1850 Ignaz SemMelweiss HANDWASHING 1800 1830 1850 1900 Despite various publications of results where hand washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time.
Natural History of Asepsis [the nurse s] hands and arms were to be thoroughly scrubbed in soap and 1861 Half of all surgeries end in death (REF) 1800 1830 1850 1900 water, and carbolized, giving special attention to the fingernails. Undated handbook Training School for Nurses from Hartford Hospital 1867 Joseph Lister ASEPTIC TECHNIQUE use of Carbolic Acid as an antiseptic to sterilise instruments and wounds;
Natural History of Asepsis 1861 Half of all surgeries end in death (REF) 1800 1830 1850 1900 1867 Joseph Lister ASEPTIC TECHNIQUE use of Carbolic Acid as wear clean gloves wash their hands;
Natural History of Asepsis 1893 Dr Gustav Neuber STERILE GOWNS AND CAPS 1800 1830 1850 1900 1900s Scrubs began appearing surgical cap and gown preceded use of scrubs 1894 Dr Robert Hunter SCRUB ATTIRE
Natural History of Asepsis It is safer and better that all should put on a complete change of costume rather than 1900s Scrubs began appearing surgical cap and gown preceded use of scrubs 1800 1830 1850 1900 simply don a sterilised coat and pair of trousers over the ordinary clothing as has been recommended by the German School. 1894 Dr Robert Hunter SCRUB ATTIRE
1878 Use of gloves to protect hands from caustic effect of cabolized recorded in US in 1878 Gloves 1890s Glove use popularised by William S Halstead protect the hands of an unusually efficient operating room nurse In the winter of 1889 and 1890...the nurse in charge of my operating room complained that the solutions of mercuric chloride produced a dermatitis of her arms and hands. As she was an unusually efficient woman, I gave the matter my consideration and one day in New York requested 1800 the Goodyear 1830 Rubber 1850 Company to make 1900 as an experiment two pair of thin rubber gloves with 1889 gauntlets. After a time the assistants Carolyn became Hampton so accustomed to working in gloves that they Halstead also wore them as operators and would remark that First they to use seemed rubber to be less expert with the bare hands than gloves with in the the gloved hands. operating room
Perioperative Attire 1945 Nurses, when they come on duty in the operating room, remove their uniform and put on an operating gown has a round neck tied at the shoulders pocket and loose belt 1920 1940 1960 1980 1924 circulating nurse should be easily picked out, wearing an operating room cap, but no mask, and a gown with special pockets for pencil and pad 1965 skirts sometimes send out a cloud of bacteria, especially when they are voluminous
History of ACORN Conference Committee 1977 At a meeting held at St Vincent s Hospital, Melbourne on the weekend of 6 7 December 1975 a group of ten operating room nurses from across Australia met to discuss the possibility of organising a national operating room nurses conference. Conference Committee 1977 Seated are L R Brenda Miles (NZ), Judith Cornell (NSW and Chair), Mary Barry (Vic and Treas) Source: https://www.acorn.org.au/acorn/acorn history/
History of ACORN Resolutions to national guidelines OR design New ORs air conditioning fumigated followed by microbiological testing efficient planning a national method of evaluating the effectiveness of operating design National standard for pack and gauze count. Pre operative visits; patient information booklet Operating suite staff initiate interaction with other nursing departments/other disciplines to reduce isolation OR experience included in basic nursing training program Preventive measures to eliminate gas pollution National guidelines to audit of nursing care in operating rooms. Source: https://www.acorn.org.au/acorn/acorn history/
Evidence Based Practice Movement 1990 2000 2010 2020 1972 Archie Cochrane Treatment decisions not based on systematic review of evidence
Evidence Based Practice Movement 1990 2000 2010 2020
Changes to A Standard over Time 1998 No supporting evidence linked to this criteria 1990 2000 2010 2020
Changes to A Standard over Time 2002 No supporting evidence linked to this criteria 1990 2000 2010 2020
Changes to Scrubbing, Gowning and Gloving Standard over Time 2008 Jewellery, including rings, can harbour microorganisms that could contaminate the surgical wound 5,619,20. However, a recent systematic review found no evidence linking surgical site infections with the wearing of rings 6,7. Supporting evidence AORN standard Text book Systematic review Literature review 1990 2000 2010 2020
Changes to Scrubbing, Gowning and Gloving Standard over Time 2014 Supporting evidence AORN standard Text book Systematic review Literature review 1990 2000 2010 2020
Changes to Scrubbing, Gowning and Gloving Standard over Time 2014 Supporting evidence AORN standard Text book Systematic review Literature review 1990 2000 2010 2020
Changes to Scrubbing, Gowning and Gloving Standard over Time 2016 More studies More systematic reviews Newer products Newer technology 1990 2000 2010 2020
Anatomy of a Standard Purpose Background Principles
Anatomy of a Standard Purpose Background Principles
Anatomy of a Standard Standard Statements Criteria
It s imperative - YOUR mission It is imperative that all perioperative nurses implement the throughout their workplace and promote integration of as second nature in perioperative practice.
Which standard next? Previous review date (20/100) Level of evidence (33/100) Government Policy/National Standards (5/100) Sentinel events (10/100) Membership feedback (9/100) Industry trends (5/100) Clinical developments (5/100) Environmental macro dynamics (3) Risk management (patients & staff) (5/100) Partnerships with other prof bodies (5/100)
Cause Matrix and of influencers Effect Matrix
Coming soon!* Major revisions Aseptic technique Scrubbing, gowning and gloving Anaesthetic nurse role Loan equipment New Organ procurement (new) *3 monthly release
ACORN Standards Review Process 3 monthly release cycle Team Formed Literature Reviewed Standard Revised Standard Approved Editor Published Review team Standards Team leaders Unpublished Stakeholders Committee Experts Legislation Members ACORN Board Stakeholders AS/NZS Editor NSQHS
ACORN Standards Review Process Board Structure Evidence Committee Editor Authors Faculty Process Recommendations Stakeholders Members Outcome
The imperative - YOUR Mission that all perioperative nurses implement the throughout their workplace and promote integration of as second nature in perioperative practice.
The standard you walk past is the standard you accept.