OR Furniture Can Make or Break a Sterile Field
By Tina Brooks
Surgical 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."
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.'"