Keep Your OR Team Comfortable

Staff Safety

By: Joe Paone

Published: 5/16/2019

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The physical demands of surgery can wear down your doctors and staff.


You make every effort to ensure your patients’ comfort for the few hours that they pass through your facility, but what about your surgeons and staff? Like gladiators, they emerge from the locker room gloved, gowned and ready to do battle. Day after day, week after week, month after month, they stand and bend and twist and turn under the harsh glare of the OR lights for hours on end. Here are 6 simple things you can do to make the OR a more comfortable working environment for them.

1. Temperature. Cooling vests and gowns lower the body temperature and tension levels of overheated surgeons and staff.

Jill Byrne, MSN, RN, CNOR, an OR nurse at Cleveland Clinic and a doctoral student at Case Western Reserve University, took it upon herself to invent a surgical cooling vest.

“I’ve stood side-by-side with overheated surgeons struggling every day to provide the best patient care possible,” says Ms. Byrne, who’s partnered with Cardinal Health to market her CoolSource Cooling System. “This sparked my pursuit to create an intuitive solution — a cooling vest — to help them stay focused. Beyond performance alone, it has been inspiring to witness the positive impact on OR civility due to improved comfort with the vest.”

On the other side of the climate spectrum, staffers who are shivering from the mid-60s OR temps can wear heated garments that use batteries or electric hookups.

2. Fatigue. Surgical floor mats are an economical way to make standing a bit more comfortable. Some also provide suction for high-fluid procedures, addressing a couple issues at once.

David A. Abrutyn, MD, an orthopedic surgeon at Summit Medical Group Orthopedics in Berkeley Heights, N.J., focuses on sports medicine, so he does a lot of “wet case” procedures such as ACLs and rotator cuffs. He’s been standing on single-use suction mats for 7 years, and he says they’ve proven very beneficial, both in terms of his personal comfort and in keeping the floor dry and clear of cloths.

“If you do 6, 7 cases a day, and you can stand on something that’s more ergonomic, padded and comfortable, that’s better than standing on a hard floor,” he says. “And the suction really facilitates with turnover time, because it reduces cleanup after cases and reduces risk of cross contamination.”

3. OR attire. Footwear is another important aspect of physical OR comfort. Obviously, that begins with shoes. They should protect the feet from fluids and needles, and be slip-resistant, sterilizable, and easy to remove if need be due to cramps or just to give the feet some air. Compression socks are a compelling option; proponents say they increase blood flow and reduce muscle soreness.

Another issue: well-fitting gowns. If the gown is too tight, it can restrict the clinician’s range of motion, which could lead to discomfort and pain over time. Too long, they might trip over it. Soft material with a good fit should be the goal.

BEAT THE HEAT Cooling vests like the CoolSource Cooling System, which an OR nurse invented, let your surgeons and staff stay more comfortable and focused.   |  Cardinal Health

4. Ergonomics. Set up the room to minimize physical exertion. Do you have to crane your neck to see the monitor? Do your instruments have comfortable hand grips? Is the table set to its proper height?

5. Above the din. Many surgeons feel more comfortable operating with music playing in the background, but that can create as many problems as it solves. The surgeon may like the familiar sounds of classic rock, but the anesthetist might feel most calm with classical, and the nurse might respond better to the energy of hip hop. In addition, music can interfere with communication among the surgical team, especially when taking into account the normal beeps and clamor of the OR.

Noise can hinder auditory processing function, especially when intraoperative conversations relay unpredictable information, according to “Effect of Noise on Auditory Processing in the Operating Room” (osmag.net/ExVEw9), a study in the May 2013 Journal of the American College of Surgeons.

Average noise levels in ORs “commonly are greater than federal limits for occupational noise exposure and frequently exceed those considered a hazard to health,” according to “Noise in the Operating Room”

(osmag.net/Dg7BhH), a study in the October 2014 issue of Anesthesiology. Those researchers suggested keeping irrelevant conversation to a minimum, using plastic bowls and trays instead of metal ones, installing sound insulation, and using materials in floors, walls and ceilings that don’t reflect sound.

6. Mental stress. Usually when we think of “comfort in the OR,” we think of the physical aspects. But mental comfort is also important. The pressure of performing a perfect procedure, the interpersonal relationships among the surgical team, personal matters that are weighing on staffers’ minds, job satisfaction … all of these and more can make surgical staffers cranky at the very least. Burnout and depression among surgeons is a widely documented phenomenon as well.

To manage minds and emotions in these charged environments, encourage brief breaks during a shift. Yes, time is money, as we all know, and many facilities and surgeons are trying to handle as many procedures as they can during the day. But you also need to think of the long game, particularly the health and well-being of your most valuable assets — your surgeons — as well as other valuable surgical staff, and ultimately the many patients who lay on your operating tables. Even if it’s just a minute or 90 seconds, a break — call it a “recovery opportunity” for those who believe “break” sounds wasteful or frivolous — helps staff not just physically, by enabling them to sit or stretch, but also can relieve the crushing mental tension and exhaustion that can build up over so many hours with so much at stake.

The role of caretaker

There’s a certain bravado or stoicism involved with many surgeons and nurses — they’re trained to say, “I got this,” and many of them don’t complain about the aches, pains and exhaustion that come along the way, as a matter of pride. That can come at the expense of their long-term well-being. Injuries could even shorten their careers. You need to take care of them if you can — especially if they won’t take care of themselves. OSM

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