Some Infection Prevention Guidelines Remain Stubbornly Unclear
The Spaulding Classification guides the disinfection of devices and equipment, but does not go far enough, in the eyes of the study authors. "It would be nice if there were a similar model for outside-the-OR procedures," says Masse.
"Most of these sources referred, at some point, to 'your local policy'," they write.
The 5-Tiered Proposed Model
So Masse and his team used the data they could find combined with their own clinical experience to produce a five-tiered classification of procedures, encompassing "clean, aseptic, sterile-superficial, sterile-invasive," and "surgical-like procedures."
Each tier lists examples of procedures and whether gloves, masks, surgical gowns, and hats are needed. A skin biopsy is listed as "aseptic," which does not call for a surgical drape. A bone marrow biopsy is listed as "sterile superficial" and does require a drape.
Aaron Glatt, MD, is the chair of medicine at South Nassau Community Hospitals in on Long Island, NY, and a spokesman for the Infectious Disease Society of America.
He says that while it is not data-driven, the paper presents a sound first attempt at offering guidance. "Sometimes, there is just no data available to tell you what is optimal."
Clinicians often make decisions based on what would be appropriate in similar, but not identical situations. And while it is good to allow individual physicians to make the call, some may not be providing optimal care, Glatt says.
Don't Overdo It
The tiered system needs more review, but appears to offers a logical alternative.
"It's always easy to be very stringent – to say do everything, treat every procedure like it's the OR," he said. "But, that's not cost-effective, it's burdensome, and sometimes difficult to do. "
Susan Bleasdale, MD, is the medical director of infection prevention and control at the University of Illinois Hospital & Health Sciences System in Chicago.
She thinks the paper overstates the lack of guidance for procedures outside of the operating room, and notes that the Spaulding Classification guide the practices and equipment needed to protect both the providers and the patient.