Juggling Patients, Physicians, Pathogens
The View Within a Bustling Phoenix OR
By Kelli M. Donley
A handwashing station lines the hallway within the circular OR at Good Samaritan Regional Medical Center in Phoenix.
Good Samaritan Regional Medical Center looms over central Phoenix like a misplaced piece of Swiss cheese of Herculean proportion. The large off-white building with rounded edges and porthole-sized black windows stands out in the city as an architectural point of interest.
However, the walls of this strange creation contain the true point of infection control interest. The OR's level 1 trauma center handles an average of 50-60 cases per day--many highlighting the dangers of inner-city life. Due to the central location of the hospital, OR patients are often gang-related and shooting victims. Car and construction accidents also keep healthcare workers juggling patient, staff, and facility needs.
It is a uniquely designed OR, with 15 procedure rooms and one additional trauma room. The large round "clock" of an operating facility works fluidly. Patients and physicians enter at "6 pm," while contaminated equipment exits the area at "12 pm." The OR rooms encircle the clock--the center of the circle filled with operating room assistants shuffling equipment onto trays and nurses calculating patient and staffing schedules.
Within the area, there is an aura of tension--similar to what one would feel at a racetrack. Each of the 100-plus staff members working at any given time are not only doing their jobs with precision and speed, but also calculating how to accomplish their tasks more effectively. A passerby can see healthcare workers pushing one patient to the recovery area, while a team of operating room assistants wait impatiently to prepare the room for the next patient in line.
Like a tag team, once the patient leaves the OR, the next group of employees scurries to their posts to get the room ready. Adding to the stress, to maintain the hospital's level 1 status, their trauma room must also always be open and ready. No scheduled procedures can take place in this allotted space.
According to Patricia Menges, RN, CNOR, service line director of general surgery at the facility, the goal is to have a room cleaned and ready for the next patient within a few minutes.
"It all depends on the case. We'd like to have the room clean within 30 minutes, but a big case like a heart procedure takes more time. However, a simple case should be ready in 25 minutes," she said.
To get staff members motivated about keeping up the pace, Nancy McCullough, assistant director of the OR, created an incentives program to get employees to work as a team. A monetary reward has been set as an incentive to get OR staff members working together efficiently to improve turnover times. A large white grease board charts team members and their expected workload.
A compulsory aspect of this turnover is instrument processing. Rather than sending all instruments to CS, management created a small operating sterilization unit within the OR. With interlocking hallways connecting the operating theaters and the localized CS, instruments are kept from reentering a sterile environment.
Healthcare workers in this sterilization area use Orthozyme and Enzol to clean the instruments before they are sent into the sterilizer. Staff in an adjoining room, on the other side of the instrument conveyor belt and sterilizer, categorize and organize the instruments, placing them methodically in the necessary instrument sets for the day's procedures.
After the bulk of the scheduled operations are complete, the bulk of the cleaning work begins. Environmental services employees work the 10:30 pm to 7 am shift, cleaning furniture, walls, floors, and other communal surfaces.
A variety of OR employees is responsible for keeping different elements of equipment clean and prepared for the next procedure. Using quaternary compound based-TBQ, staff members wipe down operating rooms, equipment in the halls, and other surfaces that may be contaminated.
Lining the circular OR walkways are grandiose pieces of medical equipment that seemingly reach out toward each other in prehistoric brachiosaurus-fashion. Large arms of neurological-operating devices curve toward a rack of X-ray vests, placed next to huddle of monitors and a gaggle of sharps containers. Millions of dollars worth of equipment, as necessary as the human talent in surgery, sit waiting for the next procedure. However, during this hallways resting time, the equipment surfaces can become contaminated with dangerous pathogens.
"Anesthesia technicians keep their equipment ready to go, and X-ray technicians are responsible for wiping down their machines between cases," Menges said. "We keep monitors and defibrillators clean on our own. Any equipment that has been out for repair or has been sitting out in the hall needs to be wiped down before being placed in the OR."
After the operating is complete and the room needs to be prepared for the next patient, staff members use detailed directions on how to make sure the room is cleaned to the highest caliber. This includes following regimented steps in eliminating sources of potential nosocomial infections.
"The mop only gets wet once," Menges said. "When our employees are cleaning the floors, they make sure the mop does not go back into the water bucket. After they are done mopping, the head is sent down to laundry to be processed. The trash and linens are also taken from the room and the bags are replaced."
Simple rules, such as the mop example, help minimize the hospital-borne infection rate at Good Samaritan. Teamwork, motivation, and compliance also help make this hospital's OR run effectively and successfully.