Back to Basics: Guideline Review and Commenting.

Professional guidelines are based on evidence. AORN develops the Guidelines for Perioperative Practice based on a review of pertinent evidence; however, perioperative nurses should participate in the review and public commenting process for these practice guidelines. This article explains how nurses can participate to strengthen the guidelines and help make them accurate and applicable to perioperative practice.

Implementing AORN recommended practices for selection and use of packaging systems for sterilization.

The delivery of sterile products to the sterile field is essential to perioperative practice. The use of protective packaging for sterilized items is crucial to helping ensure that patients receive sterile items for surgical procedures. AORN's "Recommended practices for selection and use of packaging systems for sterilization" offers guidance to perioperative team members in evaluating, selecting, and using packaging systems that permit sterilization of the contents, prevent contamination of sterilized items until the package is opened for use, protect the items from damage during transport and storage, and permit aseptic delivery of the items to the sterile field.

Introducing AORN's new model for evidence rating.

Nurses today are expected to implement evidence-based practices in the perioperative setting to assess and implement practice changes. All evidence-based practice begins with a question, a practice problem to address, or a needed change that is identified. To assess the question, a literature search is performed and relevant literature is identified and appraised. The types of evidence used to inform practice can be scientific research (eg, randomized controlled trials, systematic reviews) or nonresearch evidence (eg, regulatory and accrediting agency requirements, professional association practice standards and guidelines, quality improvement project reports). The AORN recommended practices are a synthesis of related knowledge on a given topic, and the authorship process begins with a systematic review of the literature conducted in collaboration with a medical librarian. At least two appraisers independently evaluate the applicable literature for quality and strength by using the AORN Research Appraisal Tool and AORN Non-Research Appraisal Tool. To collectively appraise the evidence supporting particular practice recommendations, the AORN recommended practices authors have implemented a new evidence rating model that is appropriate for research and nonresearch literature and that is relevant to the perioperative setting.

Steam sterilization and internal count sheets: assessing the potential for cytotoxicity.

Count sheets, when placed in contact with surgical instruments during steam sterilization, can transfer ink to the instruments. To explore whether this poses a safety concern, stainless steel instruments were placed on top of completely inked paper and subjected to steam sterilization, extracted, and tested for cytotoxicity. Preprinted labels were examined in a similar fashion. Extracts from stainless steel devices exposed to ink, toner, or labels showed no significant cytotoxic response, although the ink residue on the devices after steam sterilization is difficult to remove and detrimental to the instrument. Placing a barrier between the count sheet and the devices facilitates reuse of the instruments.