OR Furniture Can Make or Break a Sterile Field

January 1, 2003

htopic.gif (1883 bytes)

OR Furniture Can Make or Break a Sterile Field

By Tina Brooks

team members go to great lengths to create and maintain a sterile field by
following aseptic techniques, thus helping to reduce the patient's risk of
surgical site infections (SSIs). However, a stool cushion with a slight hole, a
poorly placed light pod or even traffic flow can compromise what would have
otherwise been a successful surgical procedure.

"You need to be aware when you design your rooms about the heights,
movability and flexibility of the infrastructure," says Paula Graling, RN,
MSN, CNOR, a clinical nurse specialist at Inova Fairfax Hospital in Falls
Church, Va., "so that you can set up your sterile field so your personnel
have freedom of movement, plenty of working room and that your sterile field is
not compromised."

OR Furniture

The type of furniture used in the sterile field is an important factor that
can affect the maintenance of the aseptic environment. "You want furniture
that is nonconductive because you have electrical things that you are using in
the operating room," says Graling. "You don't want static electricity
to build up."

Graling emphasizes that wheels on furniture should be easy to clean, thus
preventing them from gumming up. Wheels are often exposed to fluids and sticky
sutures that inadvertently make their way to the floor. "If I'm trying to
move a table and I'm dressed in sterile attire, my hands can't go below the top
of the table," she says. "Wheels must be free of gunk, easily movable
and allow a single person to move a table by themselves."

With regard to tables, Graling recommends ones without sharp edges that will
not puncture the sterile drapes laid upon them. She also suggests using tables
with adjustable heights. "Not only do scrub nurses come in different sizes,
but surgeons come in different sizes too. Some types of cases have a multitude
of instrumentation and they can be very lengthy surgeries. You want tables that
will accommodate, allowing surgeons to work comfortably for long hours,"
she says.

Stools should be covered with a type of wipeable surface for easier cleaning,
either vinyl or plastic. Cushions shouldn't have any holes. Graling says that
foam that can get wet can harbor microorganisms.

Other pieces of furniture that are not in the sterile field but should also
be considered are cabinets and the circulating station. Cabinets with handles
can become places on which to hang items. Graling recommends using cabinets with
smooth surfaces instead.

"Many times the circulating station has storage," Graling says,
"so it is best to have closed storage versus open storage. Open storage
would be like a modular bookshelf that you might have in your home. The tendency
is to go ahead and throw anything and everything there. But when you think of
aseptic technique and cleanliness in an OR, you think about the way that items
are stored in a room. And, if you're looking at closed storage, storage that has
glass cabinets is preferable to cabinets that are opaque because you want to be
able to see your supplies," she says.

Graling points to another catch-all that has recently entered into the OR --
video equipment. Items can be placed on the shelves supporting the equipment,
which also tend to collect dust.

"We really need to take care of our cleaning practices and the education
of both nursing and cleaning personnel. You can imagine if the dust bunnies
start to get on those booms and shelves. It can be a problem," she says.

Traffic Flow and Furniture Placement

"Your rooms have to be designed in such a way that the flow of traffic
allows work flow," says Graling. "If I'm trying to bring in sterile
supplies from a sterile corps, I don't have to walk between a table, a patient
and a light pod."

Fortunately, computer software has taken much of the guesswork out of
designing ORs. "You can sit down and literally look at where your bed would
be placed and then draw in where your table and lights are," she says.

Graling adds that lights should be placed correctly in the ceiling, with the
ability to be easily moved and focused. "If I, as a clinician, have to grab
onto the light handle and use a lot of force to move it, I'm more apt to
contaminate myself -- my hand might slip off the light handle or in terms of
having to grab it with both hands I might contaminate my sleeve," she says.

"It takes a lot of planning to do a new construction or even to do a
refurbishment and you're apt to leave something out," Graling adds.
"Sometimes, what I recommend to people is that 'you learn to live in your
space first.'"