Traffic Patterns in the OR: Has it Become a Super Highway?

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Joan Blanchard RN BSN MSS CNOR CIC

Traffic Patterns in the OR: Has it

Become a Super Highway?

RP Traffic Patterns in Perioperative Suite

RP Traffic Patterns in Perioperative Suite Movement of patients and personnel

• Signage

• Design of the perioperative suite • Unrestricted Area

• Semi-restricted Area • Restricted Area

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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

RP Traffic Patterns in Perioperative Suite Unrestricted Area

• Movement of supplies occurs here

– External shipping containers are removed here

– Observe for vector activity in containers

– Observe for moisture

RP Traffic Patterns in Perioperative Suite Transition Zones

• Healthcare Personnel

– Enter unrestricted area inside or outside of surgical suite into locker room with street clothes

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Transition Zones

Patients

• Enter surgical suite into pre-operative holding with clean gown, hair covering, covered with clean linens

-Personal undergarments as appropriate

• Exit into semi-restricted area and then into restricted area

RP Traffic Patterns in Perioperative Suite 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

RP Traffic Patterns in Perioperative Suite Preoperative Patient Holding Area

• Isolation capability

- Capacity for caring for droplet contact airborne

diseases • Nurses station

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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

RP Traffic Patterns in Perioperative Suite 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

RP Traffic Patterns in Perioperative Suite Restricted Area

• Sterile/clean core

• Equipment storage

• Scrub sinks outside of operating rooms

• Operating rooms

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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

RP Traffic Patterns in Perioperative Suite Shedding

• Skin

– Skin cells as carriers for transporting bacteria

– Staphylococcus aureus dispersers – Male versus female disperser differences – Bacterial counts positively associated with

door-opening frequency- human movement

• 5-10% skin debris carries bacteria • a person sheds millions of particles every day

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Dust and bacteria measurement

• Inverse relationship between dust and bacteria

- Study data suggest increased door opening reduced dust but increased bacteria in the OR

RP Traffic Patterns in Perioperative Suite 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

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Central Core – Peripheral Corridor Style

Central Corridor – Racetrack Style

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• 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

Construction and Renovation

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

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Together we can hopefully slow the Super Highway down to a reasonable pace!

RP Traffic Patterns in Perioperative Suite Thank You!

Joan Blanchard RN BSN MSS CNOR CIC

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Recommended Practices Traffic Patterns in the Perioperative Practice Setting. In: Perioperative Standards and Recommended Practices. Denver, CO:AORN, Inc; 2009:327-330.

Recommended Practices for Surgical Attire. In: Perioperative Standards and Recommended Practices. Denver, CO:AORN, Inc; 2009:299-305. Recommended Practices for a Safe Environment of Care. In: Perioperative Standards and Recommended Practices. Denver, CO:AORN, Inc;

2009:415-437.

Phillips N. Care of the Perioperative Environment. In: Berry & Kohn’s Operating Room Technique.11thedition Elsiever:2007:206-230. Phillips N. The Perioperative Environment Physical Facilities. In: Berry & Kohn’s Operating Room Technique.11thedition. Mosby

Elsiever:2007:177-191.

Mangram AJ, Horan T, Pearson ML, Silver LC, Jarvis WR. Guideline for the prevention of surgical site infection., 1999. Centers for Disease Control and Prevention , Hospital Infection Control Advisory Committee. Infection Control and Epidemiology. 1999;20:250-278. 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;36:260-267.

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;14:508-514.

Allo MD, Tedesco M. Operating Room Management: Operative Suite Considerations, Infection Control. Surg Clin N Am 2005;85:1291-1297 Hill J, Howell A. Effect of Clothing on Dispersal of Staphylococcus aureus by males and females. The Lancet Nov 1974:1131-1132. Leonas KK. Effect of laundering on barrier properties of reusable surgical gown fabrics. AJIC 1998, 26495-501

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, 44:119-126.

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. 2007,66:320-326.