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Fast turnover: 10 unsafe practices

Publish Date: 11/21/2012

Efforts that produce quicker OR turnover times benefit everyone: patients get into surgery sooner, physicians spend less time waiting for rooms to be ready, perioperative team members can spend more time on other tasks and the organization can schedule more cases. But these benefits are lost when efforts to reduce turnover time result in bad practices that create infection control and safety issues.

Phenelle Segal RN, CIC, president of Infection Control Consulting Services, and Sharon Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN, PLNC, perioperative nursing specialist for AORN, identify 10 unsafe practices that may occur when perioperative team members are focused more on the clock than proper practices when turning over an operating room.

1. Equipment not wiped down effectively. This may involve items such as blood pressure cuffs, electrosurgical units, gel positioning pads, leads from monitoring devices and IV poles. "The team is rushed and the disinfectant may not be used correctly," Segal says. "There has to be complete contact between the cleaning agent and the item or piece of equipment."

"Not only does there have to be contact, the disinfectant has to have time to dry," Van Wicklin adds. "Don't be in such a hurry that all surfaces are not sufficiently cleaned, including equipment and positioning devices. Also, don't forget to clean the surgical spotlights between each procedure."

2. Not wearing PPE. When you're in a hurry, it's easy to overlook your own safety protection. "Picking up contaminated items without wearing gloves or forgetting your eye protection can have serious consequences," says Van Wicklin. "Hand hygiene is another safe practice that is equally important for the patient and the health care worker."

3. Disinfectant products not left on surfaces long enough. For disinfectant products to work properly, they must dwell on a surface for a period of time as identified by the manufacturer's instructions for use. If the dwell time is shortened, the surfaces may be inadequately disinfected and harmful organisms can be transmitted to patients.

"Perioperative personnel need to follow the manufacturer's recommended contact time before the surface is either dried off or the next setup is taking place," Segal advises. "If the rules for contact time are not followed, you are potentially rendering the cleaning suboptimal."

Not allowing sufficient time for the disinfectant to contact the surfaces being disinfected and to dry also leads to practices such as walking on wet floors, putting fresh linen on an OR bed that is still wet and spreading supplies around on tables and other surfaces that are still wet, Van Wicklin says.

4. Using wrong type and wrong amount of disinfectant. It's important to use an EPA-registered disinfectant and a sufficient amount of disinfectant, Van Wicklin says.

"You also need to make sure you're damp dusting rather than dry dusting and are not using a disinfectant that is in a spray bottle," Van Wicklin adds.

5. Gowns and gloves are donned before hands are dry. If surgical gloves are put on prior to a waterless surgical hand-scrub product drying on the hands and arms, this may potentially render the residual antimicrobial property ineffective.

"Waterless surgical hand-scrub products provide many benefits to the user," Segal says. "However, a culture change requires educating the perioperative team and developing new habits."

When using a waterless surgical hand scrub, follow manufacturers' instructions, adds Van Wicklin. "Team members need to consider the quantity of the product they're using; too much product can make it difficult to dry and too little renders it ineffective."

6. Moving on to the next case before cleaning is complete. Don't bring in supplies for the case to follow and spread them around the room while the room is still being cleaned, Van Wicklin advises.

7. Computer keyboards not cleaned. "It is easy to forget to wipe down computer keyboards and other non-sterile covered keypad or touchpad surfaces as they are often forgotten due to their not being used directly on the patient," Segal says.

Another reason personnel may not clean keyboards is fear that the disinfectant will harm the technology. "You have to follow the manufacturer's instructions when cleaning these items," Van Wicklin says.

8. Missing important high-touch areas. These include door handles, telephones and light switches, Van Wicklin says.

9. Neglecting the floor and not moving the OR table between cases. While cleaning the entire floor after each procedure is not necessary,  if there is any possibility that body fluids may have dripped or splattered on other areas of the floor, the entire floor should be cleaned, Van Wicklin says. Although the OR table may not need to be moved for floor-cleaning purposes, it should be moved to check for loose items (e.g., sponges, sutures) that may be concealed beneath it.

"Make sure you're using fresh cleaning supplies and mop solution for each patient," Van Wicklin adds.

10. Emptying trash and carrying out other room cleaning activities while the current patient is being aroused from anesthesia. "This is a safety issue because it is a distraction and brings increased numbers of people into the room during a critical time in the patient's care," Van Wicklin says.

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