Skip to Content

The Guideline for a Safe Environment of Care was approved by the AORN Guidelines Advisory Board and became effective as of December 21, 2023. Information about the systematic review supporting this guideline, including the PROSPERO registration number, systematic review questions, description of the search strategy and evidence review, PRISMA 2020 flow diagram, evidence rating model, and evidence summary table is available at


This document provides guidance for maintaining a safe environment of care for patients and perioperative personnel. The recommendations include information on

  • clinical alarms and alert alarms,

  • occupational injuries (ie, slips, trips, and falls),

  • fire safety,

  • electrical equipment,

  • blanket and fluid warming cabinets,

  • medical gas cylinders,

  • waste anesthetic gases,

  • a latex-safe environment,

  • hazardous chemicals, and

  • waste management.

The following topics are outside the scope of this document:

  • chemotherapeutic agents and disposal of medications (See the AORN Guideline for Medication Safety1 );

  • environmental stewardship (See the AORN Guideline for Design and Maintenance of the Surgical Suite2  and the AORN Position Statement on Environmental Responsibility3 )

  • heating, ventilation, and air conditioning (See the AORN Guideline for Design and Maintenance of the Surgical Suite2 );

  • use of lifting equipment and moving patients (See the AORN Guideline for Safe Patient Handling and Mobility4 );

  • noise and distractions (See the AORN Guideline for Team Communication5  and the AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care6 );

  • patient injuries related to incorrect tubing connections (See the AORN Guideline for Medication Safety1 );

  • personnel injuries related to exposure to bloodborne pathogens (See the AORN Guideline for Transmission-Based Precautions7  and Guideline for Sharps Safety8 );

  • product evaluation (See the AORN Guideline for Medical Device and Product Evaluation9 );

  • radiation safety (See the AORN Guideline for Radiation Safety10 );

  • handling and disposal of radionuclides and radiopharmaceuticals (See the AORN Guideline for Radiation Safety10 );

  • sterilization methods using hydrogen peroxide, peracetic acid, ozone, and ethylene oxide (See the AORN Guideline for Sterilization11 );

  • high-level disinfectants and liquid chemical sterilants used for processing flexible endoscopes (See the AORN Guideline for Processing Flexible Endoscopes12  and Guideline for Manual High-Level Disinfection13 )

  • surgical smoke (See the AORN Guideline for Surgical Smoke Safety14 ); and

  • workplace violence (eg, active shooter, lateral violence).

Read MoreShow Less

Interested in facility access to eGuidelines+?