OR WAIT null SECS
By Tina Brooks
Surgicalteam members go to great lengths to create and maintain a sterile field byfollowing aseptic techniques, thus helping to reduce the patient's risk ofsurgical site infections (SSIs). However, a stool cushion with a slight hole, apoorly placed light pod or even traffic flow can compromise what would haveotherwise 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 FallsChurch, Va., "so that you can set up your sterile field so your personnelhave freedom of movement, plenty of working room and that your sterile field isnot compromised."
The type of furniture used in the sterile field is an important factor thatcan affect the maintenance of the aseptic environment. "You want furniturethat is nonconductive because you have electrical things that you are using inthe operating room," says Graling. "You don't want static electricityto build up."
Graling emphasizes that wheels on furniture should be easy to clean, thuspreventing them from gumming up. Wheels are often exposed to fluids and stickysutures that inadvertently make their way to the floor. "If I'm trying tomove a table and I'm dressed in sterile attire, my hands can't go below the topof the table," she says. "Wheels must be free of gunk, easily movableand allow a single person to move a table by themselves."
With regard to tables, Graling recommends ones without sharp edges that willnot puncture the sterile drapes laid upon them. She also suggests using tableswith adjustable heights. "Not only do scrub nurses come in different sizes,but surgeons come in different sizes too. Some types of cases have a multitudeof instrumentation and they can be very lengthy surgeries. You want tables thatwill 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 thatfoam that can get wet can harbor microorganisms.
Other pieces of furniture that are not in the sterile field but should alsobe considered are cabinets and the circulating station. Cabinets with handlescan become places on which to hang items. Graling recommends using cabinets withsmooth surfaces instead.
"Many times the circulating station has storage," Graling says,"so it is best to have closed storage versus open storage. Open storagewould be like a modular bookshelf that you might have in your home. The tendencyis to go ahead and throw anything and everything there. But when you think ofaseptic technique and cleanliness in an OR, you think about the way that itemsare stored in a room. And, if you're looking at closed storage, storage that hasglass cabinets is preferable to cabinets that are opaque because you want to beable 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 educationof both nursing and cleaning personnel. You can imagine if the dust bunniesstart 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 trafficallows work flow," says Graling. "If I'm trying to bring in sterilesupplies from a sterile corps, I don't have to walk between a table, a patientand a light pod."
Fortunately, computer software has taken much of the guesswork out ofdesigning ORs. "You can sit down and literally look at where your bed wouldbe 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 theability to be easily moved and focused. "If I, as a clinician, have to grabonto the light handle and use a lot of force to move it, I'm more apt tocontaminate myself -- my hand might slip off the light handle or in terms ofhaving 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 arefurbishment and you're apt to leave something out," Graling adds."Sometimes, what I recommend to people is that 'you learn to live in yourspace first.'"