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How to Create a Healthy or Workspace

Surgical tools

While the modern operating room is sure to rank as one of the most sterile environments in a healthcare facility, the following tips for a healthy OR workspace may help mitigate some of its health hazards. The Association of periOperative Registered Nurses, and two of the organization's perioperative nursing experts -- Perioperative Education Specialist Ellice Mellinger, MS, BSN, RN, CNOR, and Senior Perioperative Practice Specialist Mary J. Ogg, MSN, RN, CNOR -- weigh in on what perioperative nurses can do to help make their workplaces as healthy as possible for surgical patients and the healthcare professionals who work there.


As the use of lasers and electrosurgery devices in both laparoscopic and open surgeries has increasedin recent decades across the spectrum of surgical specialties, surgical smoke has emerged as a new hazard in the OR. [caption id="attachment_48496" align="alignleft" width="300"]2015 Mary_Ogg Mary J. Ogg, RN[/caption] In recent years, the removal of this surgical smoke has become a major point of emphasis for organizations like AORN, Ogg said. She noted an oft-cited research statistic, which indicates "using an electrosurgery device on one gram of tissue is akin to inhaling the smoke of six unfiltered cigarettes in 15 minutes." The result of these high-energy cutting tools are plumes of surgical smoke, which may contain microscopic bits of tissue, blood, carbon monoxide and other toxic gases, and potentially even live viruses or bacteria. This smoke travels at a high rate of speed, which makes dealing with it quickly essential. To raise awareness among perioperative nurses of the need to mitigate surgical smoke, AORN created its Go Clear program. AORN recommends several steps for dealing with the smoke, including using smoke evacuator devices, with the hose placed within 2 inches of the surgical site; replacing evacuation tubing for each procedure; and wearing personal protective respiratory equipment that goes beyond surgical masks, such as a surgical N95 particulate filtering facepiece respirator. If you can smell the smoke, you are being exposed, Ogg said.


[caption id="attachment_48495" align="alignleft" width="210"]EMellinger_SNIP Ellice Mellinger, RN[/caption] Effective cleaning procedures in the perioperative environment are essential to promote safety and decrease the risk of the spread of infection for surgical patients and team members, according to the AORN Environmental Cleaning Tool Kit. AORN calls for the creation of a multidisciplinary team, including perioperative nurses and others involved in maintaining the OR, to establish specific cleaning procedures,including the frequency of them. Of importance, according to Mellinger, are using specific cleaners and disinfectants on the proper surfaces, determining high-touch areas that may need to be cleaned after each procedure, and establishing when more advanced cleaning procedures are required in the workspace. AORN also now states perioperative nurses should treat anything that touches the floor as if it were contaminated. No matter how long it has been in contact, any item that touches the floor should be disinfected before patient use, according to AORN.


While the perioperative environment may often be stressful, proper communication can go a long way to alleviating stress. To this end, AORN supports and recommends the use of communication devices such as the perioperative brief, which can be either printed or electronic.It is designed to keep all nurses and multidisciplinary team members informed and clear about scheduled procedures and plans for them, and greatly reduces the loss of information from shift to shift. The brief also can cut down on pitfalls and errors that can arise when a patient is handed off from one nursing team to the next.


To keep nurses up to date and knowledgeable on best recommended practices, AORN and other organizations offer their members educational materials, including tool kits, posters and webinars. Perioperative nurses can learn more about concepts such as proper ergonomic techniques for lifting and moving patients, fire safety, emergency preparedness, perioperative efficiency and patient engagement.