The Guideline for Transmission-Based Precautions was approved by the AORN Guidelines Advisory Board and became effective as of January 16, 2025. 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 https://www.aorn.org/evidencetables/.
The rapidly changing health care environment presents perioperative personnel with continual challenges in the form of newly recognized pathogens and well-known microorganisms that have become more resistant to today’s therapeutic modalities. Protecting patients and personnel from transmission of potentially infectious agents continues to be a primary focus for perioperative team members. The prevention and control of multidrug-resistant organisms (MDROs) requires that all health care organizations implement, evaluate, and adjust efforts to decrease the risk of transmission.
Five principal elements are required for an infection to occur:
a reservoir
a pathway,
a body to infect,
a way to circumvent the body’s defenses, and
the ability of the infectious agent to survive.1,2
This document provides guidance to perioperative team members for implementing standard precautions and transmission-based precautions (ie, contact, droplet, airborne) to prevent pathogen transmission in the perioperative practice setting, by using conventional capacity strategies as well as a plan for emerging infectious disease preparedness. Additional guidance is provided about personal protective equipment (PPE); bloodborne pathogens; immunization of health care personnel (HCP); and activities of HCP with infections, exudative lesions, and nonintact skin.
Guidance on treatment of occupational exposure to patients with infectious agents is beyond the scope of this document. The reader should refer to the Centers for Disease Control and Prevention (CDC) when seeking the most current information for pathogen-specific guidance, especially during an outbreak or pandemic when guidance for PPE use and transmission-based precautions may change rapidly, such as in the context of a declared public health emergency (eg, the COVID-19 pandemic). The CDC optimization strategies for PPE (ie, contingency capacity and crisis capacity) are beyond the scope of this document. Guidance for prevention of surgical site infections, catheter-associated urinary tract infections, intravascular catheter-related infections, and ventilator-associated events is outside the scope of this document.
Preventing pathogen transmission is a priority in the perioperative environment and includes considerations for hand hygiene, environmental cleaning and disinfection, sharps safety, safe injection practices, surgical attire, sterile technique, and surgical smoke safety. These topics are addressed in other AORN guidelines, and although they are mentioned briefly where applicable (eg, standard precautions), the broader discussions are outside the scope of this document.
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