The Australian College of Operating Room Nurses (ACORN) has unveiled five revised standards for perioperative nursing.

The standards in infection prevention, perioperative attire, fatigue, environmentally-sustainable perioperative practice and asepsis have been updated in line with the latest evidence-based research.

ACORN education officer Dr Paula Foran, a perioperative nurse with 30 years’ experience, says the revised standards keep perioperative nurses at the forefront of best practice.

“New evidence is being developed all of the time,” she says.

“Three of the five reviewed standards are specifically related to the prevention of infections for patients undergoing surgery.

“Preventing infection is a huge issue. Once you cut into someone’s skin they have the potential to develop an infection and that is why perioperative nurses have very specific rules about preventing infections in our patients.

“And unfortunately when bacteria mutate, they don’t send us a text message to warn us,” she adds.

“We have to be ahead of pathogenic changes all of the time to prevent infections in our patients, so when there’s new evidence we will update our policies.”

Dr Foran, who holds an honorary position at Deakin University’s School of Nursing and Midwifery and a position at Deakin’s School of Medicine, says reviewing the standards for perioperative attire is another chance to remind nurses about the importance of infection control standards.

“Times change and you have to update policies all of the time with regard to attire,” she says.

“Years ago we used to wear boiler suits, they were one piece outfits and now we’ve gone for the pyjama style because we know that they provide less bacteria.

“We know that different types of pathogens can be harboured by hair which is why we have hair covered in the operating theatre.

“Staff like to wear their own coloured hats which is lovely and the patients love that too but we have to remind our staff then they should perhaps look at laundering those hats in their own health care facility, not to take them home.

“A lot of our policies are not just about preventing infections for the patients, but they’re about preventing infections for ourselves too.”

ACORN is the largest specialty nursing college with more than 3500 members.

The standards review is a rigorous process where teams of experts in the specialty field, including academics, clinicians, educators and industry representatives, oversee the development or review of several standards each year.

Dr Foran says ACORN then holds live webinars and recordings of education sessions to bring perioperative nurses up to speed on the changes, in a bid to assist compliance in the workplace.

She says other standards earmarked for upcoming review include the role of the anaesthetic nurse, handling of loan equipment, and surgical scrubbing, gowning and gloving.

“There’s new information in scrubbing, gowning and gloving - that ritualistic operating theatre behaviour to prevent infection,” she says.

“There is now lots of evidence-based practice information on the scrub process. For example, we would normally scrub for five minutes for the first of the day and subsequently for three minutes thereafter.

“Now, we’re actually looking at waterless scrub solutions that have been used overseas, so all of these sorts of things will be incorporated into the new standard.

“We’re also writing a policy on loan equipment - how to deal with it, how soon should it arrive prior to surgery so it’s ready for the patient’s procedure, and how to make sure that it’s processed appropriately.

“It’s a big business organising the loan equipment.”

In another major development this year, ACORN has partnered with the University of Tasmania to offer postgraduate nursing specialisation courses in perioperative nursing, anaesthetics or recovering nursing.

The University of Tasmania is providing full scholarship for the online courses for ACORN members, covering all HECS fees.

Dr Foran says perioperative nursing is a “fantastic” career path.

“I really love it,” she says.

“It’s an area where the technical nature of perioperative nursing sometimes leads people to believe that there isn’t as much nursing care by the nurses that work there, that it’s a more technical role than a nursing role.

“But in fact, I would argue really strongly that the more technical the operating theatre has become, the more perioperative nurses have risen to the occasion and provided more nursing care, and that perioperative nurses are caring for patients and nursing them all the way through their perioperative stay.

“Unfortunately because of the drugs we use in anaethesia, patients often don’t remember the care that they’ve had with us - we’re a little bit invisible.

“People will say - I was asleep the whole time, but when they’re there, we might be chatting to them at lots of different points.

“Certainly there’s nurses there holding patients’ hands, explaining what’s going on as all of their lines and etcetera are going in prior to surgery, relaxing them prior to surgery.”

Throughout the operation, perioperative nurses are very heavily involved in preventing conditions such as deep vein thrombosis, hypothermia and pressure areas.

That monitoring continues in the post anaesthetic care unit, where perioperative nurses are overseeing the condition of patients, before they move into the ward.

“The more technical that theatres become, in my opinion, the more nurses’ nurse,” Dr Foran says.

“We work as the patient advocates. We speak up for the patient at all sorts of levels.

“Patients really need to know that when they’re having an operation, and feel at their most vulnerable, perioperative nurses will be there caring for them.”