What to Ask When Evaluating Products
AORN (2010) suggests that healthcare professionals keep the following questions in mind when gathering information from manufacturers in the following product categories:
- In what instances should sterilization and high-level disinfection be used?
- What is the sterilization equipment’s status with the FDA, CDC, or any other regulatory group?
- Operating theory and principles?
- Ease of operation?
- What is the cost of the equipment and cost of operation?
- What is the maintenance schedule and maintenance history?
- What products/instruments/scopes does the chamber accommodate?
- How big or small a load?
- Are there any product restrictions (e.g., manufacturers not recommending)?
- What is the equipment’s footprint – how much space will it take?
- New construction or remodeling?
- What are the goals/objectives of the new construction or remodeling?
- How much space is needed for the desired equipment, and is there enough room without contaminating the sterile field?
- Is there a footprint of what the room will look like fully equipped (e.g. CAD-CAM, other 3D rendition)?
- What are special considerations – (e.g., shielding for MRI)?
- If the construction is a remodeling project, what special precautions should be taken to segregate rooms that are in use from the remodeling area? Have infection control procedures been established?
- Will any equipment be hung from booms? If so, will reinforcement of the ceiling be required?
- What considerations will be taken regarding traffic flow in the remodel or new construction space?
- If the construction project is a hybrid room, what is the size and configuration of the imaging equipment? Does the floor need to be reinforced?
- Who is responsible for coordination with clinical staff members, architects and equipment manufacturers?
3. Greening of the OR
- Have clear and measurable objectives been identified?
- Will there be a focus on energy consumption, waste or both?
- What will be the process to evaluate reusable versus disposable items?
- What will and will not be considered for reprocessing?
- How to balance against patient/staff safety – (e.g., double gloving for sharps safety)?
- When is it feasible to refurbish equipment rather than replace it?
- Are there surgical items that are disposed of but never used and are there ways to reduce that waste?
- What steps are taken to segregate noninfectious from infectious waste? Could this process be improved?
- Are inventory processes optimized to reduce obsolescence?
- With new construction or remodeling, has the facility taken steps to achieve energy efficiency?
4. Orthopedic/cardiac surgery
- Is the orthopedic service current on minimally invasive techniques?
- Does the facility set clear expectations with its orthopedic suppliers for delivery of instrument sets, allowing plenty of time for sterile processing?
- Are cardiac service staff members current on minimally invasive and other new cardiac techniques?
- Have clear expectations been set for cardiac suppliers, including valve inventories, pacemaker and implantable defi brillator assistance?
- Are perioperative staff members in sync with imaging teams for both orthopedic and cardiac imaging-assisted procedures?
- Is equipment current and staff members trained for tourniquet usage, bone cement, and blood transfusions?
- Are preference cards current for cardiac and orthopedic services?
- Are communications optimal between nursing and surgeon team members in these specialties?
- Do you ensure that a complaint is filed on a returned product which is immediately replaced during a procedure?
5. Infection prevention
- Does the facility have an infection surveillance process in place?
- Does the facility conduct risk assessments to identify infection-susceptible patients?
- Does the facility have clear policies and procedures for prep solutions?
- Does the facility perform terminal cleaning of the ORs on a regular and consistent basis?
- Per AORN’s recommended practices, does the facility prohibit homelaundering scrubs?
- What is the facility’s policy related to external OR personnel wearing scrubs from a different facility? And if it is prohibited, how is the policy enforced?
- Does the facility track and meet SCIP requirements for antimicrobial prophylaxis?
- Does the facility have clear policies related to steam sterilization for immediate use, and where is high-level disinfection appropriate or inappropriate?
- Are wrapped sterile trays inspected to ensure integrity?
- Are traffic patterns controlled within the OR areas to minimize air flow toward the operative site?
- Do perioperative staff members maintain good aseptic technique?
- Do perioperative staff members wear protective equipment to reduce the risk of staff members becoming contaminated by bloodborne pathogens?
- Do staff members at the surgical site double glove to reduce the likelihood of needlesticks and other sharps injuries?
- Has the facility evaluated blunt needles and established neutral zones to improve sharps safety?
6. Patient and staff safety
- Are staff members well-trained in performing “counts” and does the facility enlist the use of adjunct technologies to reduce the likelihood of retained surgical items?
- Are staff members vigilant about positioning, repositioning and padding for patients who are susceptible to pressure ulcers?
- Are policies and procedures in place to ensure blood compatibility for blood transfusions?
- Is the universal protocol implemented?
- Are checklists used to reduce the likelihood (and ultimately eliminate) wrong-site or wrong-patient errors?
- Are steps taken to reduce smoke in the surgical environment?
- What equipment and devices are used to protect staff members from bloodborne pathogens and ergonomic injuries?
- What steps have been taken to establish a culture of safety?
Source: AORN. Product Selection: Key Considerations; The Vital Relationship Between Industry and the Perioperative Nurse.