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Breaks in Aseptic Technique Require Review of OR Basics

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Continued from page 3

Traffic in the OR

Besides the issue of scrubs and non-sterile items being brought into the OR, many survey respondents noticed the chaos that seems to rule surgical arenas these days. As one survey respondent noted, “Traffic control is almost nonexistent, with people leaving doors open and staff constantly going in and out of rooms.” Another survey respondent observed that silence is golden, remarking, “There is excessive talking during cases and definitely way too much chatter among team members during sterile procedures.”

“I agree that there are numerous distractions in the ORs today.” McNamara says. “WakeMed is a teaching facility, so we have many types of students coming through. It’s important to control the traffic and we may turn students or observers away. You must find ways to limit traffic when it poses a potential hazard for infection control or patient confidentiality. We made one day a week off limits to students, because our staff needs a day without all of that extra attention to teaching. We also have a policy with restrictions for vendor representatives. There are many distracters evidenced in the literature such as pagers going off, the music blaring, vendors or observers present -- those are the things that are going on in ORs and if not controlled they can become distractions that could potentially contribute to errors.”

Some respondents also noted that the increased traffic in ORs cause greater build-ups of grime and said cleaning needed to be more thorough. “Cleaning protocol should be more standardized at our hospital,” noted one respondent, while another remarked, “There needs to be better communication between the OR and environmental services about the need for extensive cleaning after heavy-soil cases.”

Instrumentation Issues

A number of ICT survey respondents indicated problems with surgical instruments not being properly cleaned and disinfected before they reached the OR. Many said they observed obvious bioburden that had not been removed from surgical instrument, as well as saw their own colleagues dump instruments into piles after use without any kind of pre-cleaning efforts (For a related article on reprocessing, see page 18). Other survey respondents said they were concerned about too many dropped instruments and too much use of flash sterilization. Said one survey respondent, “If you even have the slightest doubt about an item and its sterility don’t use it. Flash it, or get another one. Think of each patient as your loved one.”

Hand Hygiene

Numerous ICT survey respondents complained about the blatant lack of hand hygiene in their surgical suites as well as elsewhere in their healthcare institutions. The grievances related to everything from missing critical hand hygiene opportunities, to a lack of hand hygiene when changing gloves, to improper use of alcohol-based handrubs.

A number of ICT survey respondents said they were worried about people not speaking up about this pervasive lack of hand hygiene. McNamara says her facility has had great success with their hand hygiene education program known as the FROG program, whose acronym stood for “friction rubs out germs.” As McNamara explains, “This was a hospital-wide project in which we had frogs everywhere to remind people to engage in appropriate and correct hand hygiene. The really ingenious part of the program is that we used the word ‘ribbit’ as a subtle way to remind people that they were observed not washing their hands when they should. Many times people don’t want to confront others, especially physicians. So with the FROG program they could simply say ‘ribbit’ to someone and that would make them stop and think about a missed handwashing opportunity. The staff found it to be very non-threatening and enabled them to approach someone when they saw someone not performing good technique. It doesn’t embarrass anyone, and it seemed to work for us. We were also conducting audits, and the good news is that when the Joint Commission was here, they only found two instances where people were not performing proper hand hygiene.”

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