Pre and Post Op Infection Control Coordination
By Scott Eric Barrett
Preventing infection in Pre and Post Op settings is a major goal in every hospital. The irony of surviving an extensive surgical procedure only to catch an infection from a tainted instrument or surface is difficult to accept. Like most problems in hospitals, infection control is dealt with by adhering to specific procedures and guidelines. A well-integrated infection control team is the first step in decreasing contamination risks.
"Teamwork in the OR is very important," says Sandy Freeman, the head nurse at Phoenix Baptist Hospital/Medical Center. "Everybody is vigilant about sterile procedure in the OR. If any member of the operating room questions the sterility of anything, if they think that there has been a break in technique, there are no questions asked. If a person has contaminated your glove, the glove is simply changed; there is never a discussion or an argument. If somebody thinks there has been a break in technique, it is immediately corrected. That's how we work together."
Clean, Clean, Clean
The cleaning task begins in the morning as the OR staff wipes down all the flat surfaces with an antimicrobial solution before the supplies for the first procedure are unveiled. After the initial cleaning, the OR staff does a visual inspection when they come in to make certain the environment is acceptable to their eyes.
Once the patient is transferred to recovery, the staff wet vacs or mops the floor, wipes down all the flat surfaces with an antimicrobial solution again, and removes all the trash and linen from the suite. The time to clean and disinfect the OR between procedures varies depending on the complexity of the procedure and the amount of instrumentation used. Outpatient surgeries, like cataract surgery, can take place more than 20 times a day while cases such as fusion back surgeries take up to 13 hours for one procedure. The mean turnaround time for an OR averages roughly 30 minutes.
The cleaning day concludes with terminal cleaning. Terminal cleaning is a more thorough cleaning that takes place after the last operation of the night. All the surgical lights are wiped down and all of the fixed equipment like the ceiling-mounted equipment and the furniture, including cart wheels, are wiped down as well.
Besides adhering to cleanliness protocols, certain products like the Betadine® Prep Stick® Applicator help healthcare professionals in the battle to prevent infections. The Betadine® Prep Stick® is a self-saturating site prepping system that contains betadine solution 10%. The product contains approximately 2.4 grams of antiseptic solution that covers an approximately 12 by 12 inch area. It is a package dry tool. The healthcare professional simply removes the device from the package and squeezes the plastic handle to break the patented seal to release the solution into a foam swab.
"The product is an effective way of preventing infection because it contains betadine solution," says Mark Slotnick, Senior Product Manager at Purdue Frederick. "Betadine solution has been known as an effective broad spectrum antimicrobial for over 40 years in the healthcare market. It provides the solution in a user-friendly device for healthcare professionals to adhere to their prepping protocols."
Besides cleaning, another method for preventing infection is through effective PPE practices. Standard Protective Personal Equipment (PPE) includes eyewear (usually supplied in eyeglasses format or a mask with a face shield combination), gowns, gloves, and shoe covers or booties. Double gloving is often practiced but not recommended for procedures like sewing vessels into the heart or performing eye surgery since these procedures require a keen tactile sense. Most hospitals conform to OSHA standards regarding PPE. Standard patient PPE includes gowns, drapes, booties, gloves, and hair cover.
Staying on Top of Instruments
"There are a lot of steps along the way in processing and accounting for surgical instruments," says Laura Pappagallo, quality management coordinator at Mayo Clinic Hospital (Phoenix, Ariz.). "The process starts down in central service. Instruments are assembled in sets and have an instrument count sheet. The sets are counted and put together according to the count sheet."
All of the instruments are inspected to make certain the integrity of the packaging has not been compromised. The instruments should have indicators that prove the instruments have met the standards for sterilization.
Once the instruments are brought into the OR, they are opened and counted again while comparing them to the instrument count sheet according to AORN policy for counting during surgical procedures. The instruments are also counted while the body or wound is being closed. A final count is done during the skin closure. Not every surgical case requires that instruments be counted during the case, however. Minor finger or hand procedures wouldn't, while abdominal cases would.
Once the instruments are confined, contained, and brought down to CS, they are counted, cleaned, disinfected and processed and put back together again.
"Any instrument that has not been wiped off and that has blood or body fluid on it, we use a special product called Pro EZ that is very effective," says Paulette Marquardt, supervisor of central services at the Mayo Clinic Hospital in Phoenix. "We spray the instruments when they first arrive, then open them up and send them through water decontaminators. The system prevents a lot of washing by hand."
"The circulator is primarily the patient advocate," says Lynette King, manager of perioperative services at Mayo Clinic. "They are the eyes and ears of the patient. The patient can't tell you that they are hot or cold or that they are falling off the bed because they are under general anesthetic."
Circulators also monitor the room for breeches in technique. They are responsible for keeping the room neat, orderly and free of contaminants. During the operation, circulators are responsible for making certain that all the necessary supplies are on hand and readily available to the OR staff. They are also responsible for confining and containing all the blood and body fluid that may have fallen on the floor. After the operation, circulators are responsible for the transfer of care to the recovery room.
Keeping the OR sterile takes teamwork and rigid following of procedure.
"We are fortunate at the Mayo Clinic because of the way our suite is designed," Pappagallo concludes. "We have sterile cores that support our operating room and our central services area is one floor below us directly supporting our suite. We have unilateral direction of flow for all instruments, supplies, equipment--and of course, patients."