OR WAIT 15 SECS
By Annette C. Johnson, RN, BSN, CNOR
Recent technological advancements applied to the design and application of power boomsand overhead surgical lighting are creating new standards for the design of operatingrooms (ORs). These new advancements provide great opportunities for improvements ininfection control, enhance efficiency, and extend the skills and capabilities of thesurgeons 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 canaccumulate. They also result in a maze in which the surgical team must maneuver andmanipulate. The "ORs of the Future" that use the new lighting and power boomswill be able to achieve higher standards for environmental sanitation as well as enhancethe capabilities and efficiency for the surgical teams.
Current clinical practices and procedures for surgical asepsis and the prevention ofinfection are based on the basic principles that the transmission of infection occurs bymultiple methods. These can include airborne transmission, contact transmission, vehicletransmissions, and vectors.1 Therefore, the safe delivery of care is a functionof how well these various methods of transmissions are controlled and eliminated. Properselection and application of lighting and power booms will allow better and more completecontrol of how bacteria are transmitted in the OR. By remodeling or building new ORs usingthe latest in new equipment and systems, clinical practices can immeasurably improve thelevels of safe care and lead to significantly higher standards for environmentalsanitation.
The impact of lighting and power booms on infection control and OR efficiency will benoticeable in a range of measurable areas that contribute to overall OR efficiency andperformance. The following discusses these areas.
Reduction of the numberof pieces required to be transported in and out of the OR for each case. Power boomsallow for the support and positioning of equipment from the ceiling. With equipment offthe floor and within easy reach, carts, hose drops, cables, and clutter are eliminated.
Cleaning, disinfecting, and sterilization of the OR's equipment: a basic requirementfor all effective infection control programs. A key feature of the new lights andbooms 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, andeffective washing with microbial cleaning solutions. A well-designed surgical light doesnot have vents or other areas that can collect contaminants and dust. Also, many of thecords and cables in a standard OR can be internal to the power boom. This translates toless surfaces to clean.
Reduction of personnel and room traffic in the OR. Care of the patient in thesurgical environment requires the movement of patients, personnel, and materials withinthe surgical suite. According to the Association of Operating Room Nurses (AORN), RecommendedPractices for Traffic Patterns in the Surgical Suite, adherence to specific guidelinesshould be followed at all times. The development and implementation of appropriate trafficpatterns may minimize contamination and subsequent infections. AORN's recommended practicesuggests that movement of personnel and equipment should be kept to a minimum.2Air is a potential carrier of microorganisms that can contaminate wounds. Becausemicrobial shedding increases with activity, greater amounts of airborne contamination canbe expected with increased movement of surgical team members. The number of people presentshould be minimized during procedures because the number of airborne microorganisms isdirectly related to the number of people present. Increased movement and talking also cancontribute to this airborne contamination. The use of power booms with consolidation ofequipment can assist in maintaining a safer environment. By providing specializedequipment on the power booms, the need to move equipment and supplies in and out of the ORis diminished. With the addition of a control center for equipment, the personnel in theOR also can decrease the OR traffic. The control station allows the staff to operatemultiple pieces of equipment without moving about the room. The control station has theability 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 thatis controlled either by the surgeon's voice commands or via a hand-held, sterile remotecontrol. With the use of these devices, the nurses and other staff members are freed fromthe responsibility of managing these devices.3 Furthermore, a well-designedsurgical light does not require frequent re-positioning. The surgical team can set thelights at the beginning of the case and be satisfied with the focus, illumination, andshadow control throughout the duration of the case.
Reduction of OR duration by streamlining procedures. According to a 1992 studyby a Surgical Wound Infection Task Force (comprised of members from SHEA, APIC, CDC, andSIS), the duration of a surgical procedure is a definite risk for procedure relatedinfection(s).5 A retrospective medical record review of five surgicalspecialties was used to determine the influence of selected variables on the incidence ofsurgical site infections (SSIs).
The Task Force concluded that to help reduce the infection rate, procedure times shouldbe as expeditious as is considered safe. A prolonged surgical procedure may be anindicator of the complexity of the procedure, the expertise and skill of the surgeons, theextent of tissue trauma, or procedures that are not planned and coordinated among teammembers. A collaborative seasoned surgical team conducting a well-planned, long procedurecan assist in keeping the surgical time low. The use of power booms along with theiraccompanying components can decrease surgical times by an average of 10 minutes perprocedure. These reductions are attributed to less equipment down time, more appropriatepositioning of monitors and equipment, and centralized control of devices. This decreasein 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 thatcontains toxic gases and vapors, such as benzene, hydrogen cyanide, formaldehyde,bioaersols, dead and live cellular material (including blood fragments), and viruses.6Complaints of personnel exposed to smoke include nausea, headaches, and eye and upperrespiratory irritation. The National Institute of Safety and Health (NIOSH) issued ahazard alert in September 1996 on surgical smoke. One of the NIOSH conclusions was thatthe smoke might contain bacteria and viruses that may transmit infection. The documentrecommended that surgical smoke should be removed and properly filtered by a smokeevacuation system as close to the surgical site as possible. The Occupational Safety andHealth Administration (OSHA) are close to releasing their long-awaited report on thehazards of surgical smoke.7 This report will provide guidelines that willrequire protection for the surgical care providers who are repeatedly exposed to smokeplume. In the traditional OR, the smoke produced by electrocautery units and lasers arenot evacuated routinely. Documentation of the dangers of surgical smoke is long anddetailed. Proactive protection for patients and healthcare workers is imperative. The useof a smoke evacuation product that is able to contain smoke at the point of origin willlessen the volume of potentially harmful smoke released in the OR environment. Currenttechnology 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 requirevaluable floor space. Boom-mounted systems require no floor space and eliminate noise asmotors are located in the ceiling. With low capital outlay and operating costs, theseevacuation systems can provide a convenient solution to smoke evacuation that does notcompromise current practices.
The rapidly changing technological world has produced many changes in healthcareoptions. 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 impactsignificantly the reduction of surgically acquired infections. Surgical facilities thattake advantage of these opportunities can enhance the care provided to their patients,improve the overall surgical environment, and have a positive impact on infection controlstandards.
Annette C. Johnson RN, BSN, CNOR is an independent Health Care Consultant. She has20 years of clinical, educational, and management experience in the surgical setting. Sherecently managed an expansion and renovation project for an OR in a suburban North Texashospital, 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 (%)|
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