Traffic Patterns in the OR: Has it Become a Super Highway?
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1 Traffic Patterns in the OR: Has it Become a Super Highway? Joan Blanchard RN BSN MSS CNOR CIC Movement of patients and personnel Signage Design of the perioperative suite Unrestricted Area Semi-restricted Area Restricted Area
2 Unrestricted Area Entrance to the perioperative suite - Locker rooms - Control desk- monitor traffic - Offices - Pre-operative Patient Holding area Street clothes may be worn here Unrestricted Area Movement of supplies occurs here External shipping containers are removed here Observe for vector activity in containers Observe for moisture Transition Zones Healthcare Personnel Enter unrestricted area inside or outside of surgical suite into locker room with street clothes Exit into semirestricted area in surgical attire
3 Transition Zones Patients Enter surgical suite into preoperative holding with clean gown, hair covering, covered with clean linens -Personal undergarments as appropriate Exit into semi-restricted area and then into restricted area Preoperative Patient Holding Area Provide privacy for patients Individual cubicles or curtained areas - Hair removal if necessary - Insertion of IV lines - Placement of indwelling urinary catheter gastric tubes - Anesthesia provider and surgeon preoperative visit - Equipped with 0² suction monitoring devices Preoperative Patient Holding Area Isolation capability - Capacity for caring for droplet contact airborne diseases Nurses station
4 Semi-restricted Area Attire perioperative personnel - Head covering - Surgical scrub clothing - Identification badge Peripheral storage area for clean and sterile supplies Post Anesthesia Care Unit Authorized personnel only Restricted Area Attire for perioperative personnel - Head covering - Surgical scrub clothing - Identification badge - Warm-up jacket for circulator anesthesia provider/observer - Shoe covers if required - Scrub team- surgical gown, gloves, mask, eyewear, shoe covers if required Restricted Area Sterile/clean core Equipment storage Scrub sinks outside of operating rooms Operating rooms Substerile rooms
5 Movement of personnel in invasive and noninvasive procedures Assessment of procedure and patient needs Operating room -Keep doors closed except when moving patients, personnel, equipment, supplies -Ventilation air exchanges temperature humidity - Keep the number of people to those needed for the procedure document all personnel involved in the patients care - Limit movement within the OR Movement of personnel in invasive and noninvasive procedures Dust contains Human skin and hair Fabric fibers Pollens mold Fungi Insect parts Glove powder Paper fibers Shedding Skin Skin cells as carriers for transporting bacteria Staphylococcus aureus dispersers Male versus female disperser differences Bacterial counts positively associated with dooropening frequency- human movement 5-10% skin debris carries bacteria a person sheds millions of particles every day
6 Dust and bacteria measurement Inverse relationship between dust and bacteria - Study data suggest increased door opening reduced dust but increased bacteria in the OR Movement of clean sterile and contaminated supplies and equipment Protecting clean and sterile supplies in transportation - Covered carts Remove external shipping container in unrestricted area Contaminated instruments should be covered and moved to decontamination area Sterile/Clean Core Central Corridor Hotel Style
7 Central Core Peripheral Corridor Style Central Corridor Racetrack Style Cluster Combination Peripheral and Central Corridor
8 Construction and Renovation Specific traffic plans - movement of personnel supplies equipment debris Minimize contamination ICRA Barriers- maintenance of barrier integrity Attire of workers Entrance and exits Negative pressure high-efficiency particulate air filters Monitor compliance Containment of airborne particles - TB Most ORs have positive pressure Exhaled gas from TB patient may place personnel at risk Comparison of HEPA units - In the OR freestanding HEPA unit - Disruption of airflow - Noise - Outside OR doors PAS-HEPA unit - Cleared air effectively in short period of time
9 Together we can hopefully slow the Super Highway down to a reasonable pace! Thank You! Joan Blanchard RN BSN MSS CNOR CIC [email protected]
10 References Recommended Practices Traffic Patterns in the Perioperative Practice Setting. In: Perioperative Standards and Recommended Practices. Denver, CO:AORN, Inc; 2009: Recommended Practices for Surgical Attire. In: Perioperative Standards and Recommended Practices. Denver, CO:AORN, Inc; 2009: Recommended Practices for a Safe Environment of Care. In: Perioperative Standards and Recommended Practices. Denver, CO:AORN, Inc; 2009: Phillips N. Care of the Perioperative Environment. In: Berry & Kohn s Operating Room Technique.11 th edition Elsiever:2007: Phillips N. The Perioperative Environment Physical Facilities. In: Berry & Kohn s Operating Room Technique.11 th edition. Mosby Elsiever:2007: Mangram AJ, Horan T, Pearson ML, Silver LC, Jarvis WR. Guideline for the prevention of surgical site infection., Centers for Disease Control and Prevention, Hospital Infection Control Advisory Committee. Infection Control and Epidemiology. 1999;20: Olmsted RN. Pilot study of directional airflow and containment of airborne particles in the size of Mycobacterium tuberculosis in an operating room. Am J Infection Control.2007;36: Sehulster L, Chinn RY. Guidelines for environmental infection control in health-care facilities. Centers for Disease Control and Prevention Hospital Infect ion Control Advisory Committee. MMWR Morb Mortal Wkly Rep. 2003;52[RR-10]:1-44. Pisani S, Fibres found during cataract surgery. Brit J Periop Nurs. 2004;14: Allo MD, Tedesco M. Operating Room Management: Operative Suite Considerations, Infection Control. Surg Clin N Am 2005;85: Hill J, Howell A. Effect of Clothing on Dispersal of Staphylococcus aureus by males and females. The Lancet Nov 1974: Leonas KK. Effect of laundering on barrier properties of reusable surgical gown fabrics. AJIC 1998, Tammelin A, Domicel P, Hambraeus A, Stahlet E. Dispersal of methicillin-resistant Staphylococcus epidermidis by staff in an operating suite for thoracic and cardiovascular surgery: relation to skin carriage and clothing. J Hosp Inf. 2000, 44: Scaltriti S, Cencetti S, Rovesti S, Marchesi I, Bargellini A, Borella P. Risk Factors for particulate and microbial contamination of air in operating theatres. The Hosp Infec Soc. 2007,66:
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