Technological Advances in Lighting and Booms for the OR: Impact on Infection Controland OR Efficiency

July 1, 2000

Technological Advances in Lighting and Booms for the OR: Impact on Infection Control
and OR Efficiency

By Annette C. Johnson, RN, BSN, CNOR

Photo courtesty of Berchtold

Recent technological advancements applied to the design and application of power booms
and overhead surgical lighting are creating new standards for the design of operating
rooms (ORs). These new advancements provide great opportunities for improvements in
infection control, enhance efficiency, and extend the skills and capabilities of the
surgeons and surgical staff. Today's OR typically consists of a myriad of equipment,
cables, and electrical cords that create multiple surfaces where dust and organisms can
accumulate. They also result in a maze in which the surgical team must maneuver and
manipulate. The "ORs of the Future" that use the new lighting and power booms
will be able to achieve higher standards for environmental sanitation as well as enhance
the capabilities and efficiency for the surgical teams.

Current clinical practices and procedures for surgical asepsis and the prevention of
infection are based on the basic principles that the transmission of infection occurs by
multiple methods. These can include airborne transmission, contact transmission, vehicle
transmissions, and vectors.1 Therefore, the safe delivery of care is a function
of how well these various methods of transmissions are controlled and eliminated. Proper
selection and application of lighting and power booms will allow better and more complete
control of how bacteria are transmitted in the OR. By remodeling or building new ORs using
the latest in new equipment and systems, clinical practices can immeasurably improve the
levels of safe care and lead to significantly higher standards for environmental

The impact of lighting and power booms on infection control and OR efficiency will be
noticeable in a range of measurable areas that contribute to overall OR efficiency and
performance. The following discusses these areas.

Reduction of the number
of pieces required to be transported in and out of the OR for each case.
Power booms
allow for the support and positioning of equipment from the ceiling. With equipment off
the floor and within easy reach, carts, hose drops, cables, and clutter are eliminated.

Cleaning, disinfecting, and sterilization of the OR's equipment: a basic requirement
for all effective infection control programs.
A key feature of the new lights and
booms is the ease with which the equipment can be cleaned, disinfected, and sterilized.
The physical design of the power booms and surgical lights allow for fast, easy, and
effective washing with microbial cleaning solutions. A well-designed surgical light does
not have vents or other areas that can collect contaminants and dust. Also, many of the
cords and cables in a standard OR can be internal to the power boom. This translates to
less surfaces to clean.

Reduction of personnel and room traffic in the OR. Care of the patient in the
surgical environment requires the movement of patients, personnel, and materials within
the surgical suite. According to the Association of Operating Room Nurses (AORN), Recommended
Practices for Traffic Patterns in the Surgical Suite
, adherence to specific guidelines
should be followed at all times. The development and implementation of appropriate traffic
patterns may minimize contamination and subsequent infections. AORN's recommended practice
suggests that movement of personnel and equipment should be kept to a minimum.2
Air is a potential carrier of microorganisms that can contaminate wounds. Because
microbial shedding increases with activity, greater amounts of airborne contamination can
be expected with increased movement of surgical team members. The number of people present
should be minimized during procedures because the number of airborne microorganisms is
directly related to the number of people present. Increased movement and talking also can
contribute to this airborne contamination. The use of power booms with consolidation of
equipment can assist in maintaining a safer environment. By providing specialized
equipment on the power booms, the need to move equipment and supplies in and out of the OR
is diminished. With the addition of a control center for equipment, the personnel in the
OR also can decrease the OR traffic. The control station allows the staff to operate
multiple pieces of equipment without moving about the room. The control station has the
ability to link both sterile and non-sterile equipment, including the OR table, lights,
video monitor, camera, light source, videocassette recorder, printer, arthroscopic shaver,
and insufflator. These devices can be managed by creating a single computer network that
is controlled either by the surgeon's voice commands or via a hand-held, sterile remote
control. With the use of these devices, the nurses and other staff members are freed from
the responsibility of managing these devices.3 Furthermore, a well-designed
surgical light does not require frequent re-positioning. The surgical team can set the
lights at the beginning of the case and be satisfied with the focus, illumination, and
shadow control throughout the duration of the case.

Reduction of OR duration by streamlining procedures. According to a 1992 study
by a Surgical Wound Infection Task Force (comprised of members from SHEA, APIC, CDC, and
SIS), the duration of a surgical procedure is a definite risk for procedure related
infection(s).5 A retrospective medical record review of five surgical
specialties was used to determine the influence of selected variables on the incidence of
surgical site infections (SSIs).

The Task Force concluded that to help reduce the infection rate, procedure times should
be as expeditious as is considered safe. A prolonged surgical procedure may be an
indicator of the complexity of the procedure, the expertise and skill of the surgeons, the
extent of tissue trauma, or procedures that are not planned and coordinated among team
members. A collaborative seasoned surgical team conducting a well-planned, long procedure
can assist in keeping the surgical time low. The use of power booms along with their
accompanying components can decrease surgical times by an average of 10 minutes per
procedure. These reductions are attributed to less equipment down time, more appropriate
positioning of monitors and equipment, and centralized control of devices. This decrease
in surgical time can significantly reduce the incidence of surgically acquired infections.

Ability to provide technology to decrease hazardous materials in the OR environment.
In recent years, much concern has been placed on the effect of "surgical smoke"
in the OR. Procedures performed using electrocautery pencils produce smoke plume that
contains toxic gases and vapors, such as benzene, hydrogen cyanide, formaldehyde,
bioaersols, dead and live cellular material (including blood fragments), and viruses.6
Complaints of personnel exposed to smoke include nausea, headaches, and eye and upper
respiratory irritation. The National Institute of Safety and Health (NIOSH) issued a
hazard alert in September 1996 on surgical smoke. One of the NIOSH conclusions was that
the smoke might contain bacteria and viruses that may transmit infection. The document
recommended that surgical smoke should be removed and properly filtered by a smoke
evacuation system as close to the surgical site as possible. The Occupational Safety and
Health Administration (OSHA) are close to releasing their long-awaited report on the
hazards of surgical smoke.7 This report will provide guidelines that will
require protection for the surgical care providers who are repeatedly exposed to smoke
plume. In the traditional OR, the smoke produced by electrocautery units and lasers are
not evacuated routinely. Documentation of the dangers of surgical smoke is long and
detailed. Proactive protection for patients and healthcare workers is imperative. The use
of a smoke evacuation product that is able to contain smoke at the point of origin will
lessen the volume of potentially harmful smoke released in the OR environment. Current
technology can provide smoke evacuation systems that are built into the power booms.
Stand-alone smoke evacuators are not widely used because they are noisy and require
valuable floor space. Boom-mounted systems require no floor space and eliminate noise as
motors are located in the ceiling. With low capital outlay and operating costs, these
evacuation systems can provide a convenient solution to smoke evacuation that does not
compromise current practices.

The rapidly changing technological world has produced many changes in healthcare
options. The "ORs of the Future" will have access to many of these advancements.
Careful planning and utilization of these options can provide a means to impact
significantly the reduction of surgically acquired infections. Surgical facilities that
take advantage of these opportunities can enhance the care provided to their patients,
improve the overall surgical environment, and have a positive impact on infection control

Annette C. Johnson RN, BSN, CNOR is an independent Health Care Consultant. She has
20 years of clinical, educational, and management experience in the surgical setting. She
recently managed an expansion and renovation project for an OR in a suburban North Texas
hospital, and she currently serves as President of the North Texas Chapter of AORN.

For references, access the ICT Web site.

Table 1: Infection Rates and Mean Duration of Surgery before Service

Service # of SSI's # of cases Duration Infection Rate (%)
Neuro 2 150 2:25 133%
Pacemaker 0 333 1:02 0.00%
Cardiac 45 1134 3:04 3.96%
Ortho 10 734 1:21 1.36%
Vascular 11 513 1:48 2.14%

For a complete list of references click here