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By Scott Eric Barrett
Preventinginfection in Pre and Post Op settings is a major goal in every hospital. Theirony of surviving an extensive surgical procedure only to catch an infectionfrom a tainted instrument or surface is difficult to accept. Like most problemsin hospitals, infection control is dealt with by adhering to specific proceduresand guidelines. A well-integrated infection control team is the first step indecreasing contamination risks.
"Teamwork in the OR is very important," says Sandy Freeman, thehead nurse at Phoenix Baptist Hospital/Medical Center. "Everybody isvigilant about sterile procedure in the OR. If any member of the operating roomquestions the sterility of anything, if they think that there has been a breakin technique, there are no questions asked. If a person has contaminated yourglove, 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 immediatelycorrected. That's how we work together."
The cleaning task begins in the morning as the OR staff wipes down all theflat surfaces with an antimicrobial solution before the supplies for the firstprocedure are unveiled. After the initial cleaning, the OR staff does a visualinspection when they come in to make certain the environment is acceptable totheir eyes.
Once the patient is transferred to recovery, the staff wet vacs or mops thefloor, 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 anddisinfect the OR between procedures varies depending on the complexity of theprocedure and the amount of instrumentation used. Outpatient surgeries, likecataract surgery, can take place more than 20 times a day while cases such asfusion back surgeries take up to 13 hours for one procedure. The mean turnaroundtime for an OR averages roughly 30 minutes.
The cleaning day concludes with terminal cleaning. Terminal cleaning is amore 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 theceiling-mounted equipment and the furniture, including cart wheels, are wipeddown as well.
Besides adhering to cleanliness protocols, certain products like the BetadineÂ®Prep StickÂ® Applicator help healthcare professionals in the battle to preventinfections. The BetadineÂ® Prep StickÂ® is a self-saturating site preppingsystem that contains betadine solution 10%. The product contains approximately2.4 grams of antiseptic solution that covers an approximately 12 by 12 incharea. It is a package dry tool. The healthcare professional simply removes thedevice from the package and squeezes the plastic handle to break the patentedseal to release the solution into a foam swab.
"The product is an effective way of preventing infection because itcontains betadine solution," says Mark Slotnick, Senior Product Manager atPurdue Frederick. "Betadine solution has been known as an effective broadspectrum antimicrobial for over 40 years in the healthcare market. It providesthe solution in a user-friendly device for healthcare professionals to adhere totheir prepping protocols."
Besides cleaning, another method for preventing infection is througheffective PPE practices. Standard Protective Personal Equipment (PPE) includeseyewear (usually supplied in eyeglasses format or a mask with a face shieldcombination), gowns, gloves, and shoe covers or booties. Double gloving is oftenpracticed but not recommended for procedures like sewing vessels into the heartor performing eye surgery since these procedures require a keen tactile sense.Most hospitals conform to OSHA standards regarding PPE. Standard patient PPEincludes gowns, drapes, booties, gloves, and hair cover.
"There are a lot of steps along the way in processing and accounting forsurgical instruments," says Laura Pappagallo, quality managementcoordinator at Mayo Clinic Hospital (Phoenix, Ariz.). "The process startsdown in central service. Instruments are assembled in sets and have aninstrument count sheet. The sets are counted and put together according to thecount sheet."
All of the instruments are inspected to make certain the integrity of thepackaging has not been compromised. The instruments should have indicators thatprove the instruments have met the standards for sterilization.
Once the instruments are brought into the OR, they are opened and countedagain while comparing them to the instrument count sheet according to AORNpolicy for counting during surgical procedures. The instruments are also countedwhile the body or wound is being closed. A final count is done during the skinclosure. Not every surgical case requires that instruments be counted during thecase, however. Minor finger or hand procedures wouldn't, while abdominal caseswould.
Once the instruments are confined, contained, and brought down to CS, theyare counted, cleaned, disinfected and processed and put back together again.
"Any instrument that has not been wiped off and that has blood or bodyfluid on it, we use a special product called Pro EZ that is veryeffective," says Paulette Marquardt, supervisor of central services at theMayo Clinic Hospital in Phoenix. "We spray the instruments when they firstarrive, then open them up and send them through water decontaminators. Thesystem prevents a lot of washing by hand."
"The circulator is primarily the patient advocate," says LynetteKing, manager of perioperative services at Mayo Clinic. "They are the eyesand ears of the patient. The patient can't tell you that they are hot or cold orthat they are falling off the bed because they are under generalanesthetic."
Circulators also monitor the room for breeches in technique. They areresponsible for keeping the room neat, orderly and free of contaminants. Duringthe operation, circulators are responsible for making certain that all thenecessary supplies are on hand and readily available to the OR staff. They arealso responsible for confining and containing all the blood and body fluid thatmay have fallen on the floor. After the operation, circulators are responsiblefor 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 isdesigned," Pappagallo concludes. "We have sterile cores that supportour operating room and our central services area is one floor below us directlysupporting our suite. We have unilateral direction of flow for all instruments,supplies, equipment--and of course, patients."