Safety in the OR: Keeping Staff and Patients Safe From Harm

Standardizing your gloving policy requires leadership that solicits multidisciplinary feedback and gives everyone the ‘why’ behind the ‘what.’

Deb Spratt, MPA, BSN, RN, CNOR, NEA-BC, CHL, an independent perioperative consultant based in Rochester, N.Y., has more than 50 years of healthcare leadership under her belt and holds the rare distinction of never having suffered a needle stick during her career. She’s seen plenty of change in and around the OR during her tenure, but the key element of a successful safety policy has remained unchanged.

“Your policy needs to be embraced by all members of your team. If it’s not, you’re going to face constant pushback,” says Ms. Spratt. “You can’t have workplace safety if you don’t have team safety.”

Comfortable, capable and safe

The policy that dictates the donning and doffing of surgical gloves is a prime example of what Ms. Spratt is talking about. After all, gloving is a critical but often overlooked process that occurs constantly in the perioperative setting.

Obviously, your surgeons need to feel comfortable, capable and safe in the gloves they use for intricate procedures, and one of the chief complaints among physicians about the gloves their facility leaders purchase is related to tactile feel, or lack thereof. “Whether your team dons a straight- or a curved-formed glove, they need to feel exactly what they’re doing,” says Ms. Spratt, who adds that many surgical instruments, including gloves, are made for male hands and could potentially fit uncomfortably on female surgeons.

Gloves should feel like an extension of your hand, but also should be made from the right material.
Christine Kramer, MHA, RN, CNOR 

Of course, surgeons aren’t the only ones in the OR, and Ms. Spratt stresses that leaders must take into account the feedback from nurses, techs and the team in SPD who need to be protected to do their jobs safely. In other words, facilities that focus only on what their docs want do so at their own peril. “If you’re changing vendors or product types, go back and make sure everybody fits well in the new gloves,” says Ms. Spratt. “If something doesn’t work, the team is going to speak up. You’ve got to have the right gloves.”

Finding the right product is more challenging than it seems, as staff needs gloves that keep them safe without feeling cumbersome or awkward. “Tactile sensibility plays a critical role in surgical practice,” says Christine Kramer, MHA, RN, CNOR, patient care manager of surgical services for United Hospital – Hastings (Minn.) Regina Campus. “To prevent surgical site infection and protect the staff, gloves should feel like an extension of your hand, but also should be made from the right material.”

Until it’s hard-wired

In addition to enlisting the input of — and listening to — a multidisciplinary team, your gloving policy should be crystal clear to anyone who is required to abide by it. “A safety-conscious policy should have detailed steps that are easy for the employee to follow,” says Ms. Kramer.

If change is required, however, even the most clear-cut policies are often met with resistence from a few folks who lack the flexibility needed to ensure standardization takes place. In these cases, Ms. Kramer advises facilities to lean on the leaders until the changes become second nature for staff. “Leaders need to be consistent with follow-through — not just in the first few weeks or months after a change, but up to a year after so the new process becomes hard-wired,” she says.

Ms. Spratt also cites leadership as the most important factor in the success or failure of a gloving policy, one that encourages the right behavior through team education and is supported by evidence-based research. “Leadership determines the culture,” she says. And good leaders understand that compliance without clarity is a zero-sum game.

“It’s extremely difficult to enforce policies if your staff doesn’t know why the policy is important,” says Ms. Spratt. “That’s why the strongest safety cultures involve multidisciplinary education where everybody hears the same message and understands exactly why you are implementing the policy in the first place.”

Forward progress

Surgical gloves play a pivotal role in safe surgery, and the evolution of this PPE is nothing short of remarkable — especially to staff who have practiced through the changes that have taken place in the design. “As researchers learned more about aseptic technique and infection, it’s amazing how much gloves have changed,” says Ms. Kramer. “When I started, all the gloves were latex and we only single-gloved. I would hear stories from the more senior nurses about how after procedures they would wash, dry and re-sterilize the gloves.”

Like gloves themselves, our policies and practices have certainly come a long way. OSM

Note: This three-part article series is supported by Mölnlycke.