TRAFFIC IN THE O.R.By Nancy Brazell, MA, RN, CNOR : TRAFFIC IN THE O.R.By Nancy Brazell, MA, RN, CNOR What is “Traffic?” : What is “Traffic?” “Traffic” means movement in and out of the individual operating room – as well as movement within that operating room.
“Traffic” increases the number of contaminants in the air and can effect the sterility of instruments and supplies.
What kinds of “traffic” do you routinely see in your O.R.? TRAFFIC CAN INCLUDE : TRAFFIC CAN INCLUDE Movement of persons in and out of room, either before or during procedure.
Unnecessary persons in room during procedure.
Unnecessary equipment in room.
Patient belongings in room during transfer from SPU.
Unnecessary movement during the surgical procedure.
Patterns of moving within the room.
Methods of interacting with the sterile field. HAVE YOU CONSIDERED? : HAVE YOU CONSIDERED? Gum chewing and talking force additional respiratory organisms into the air? They are “traffic,” too. HOW DOES O.R.TRAFFIC INFLUENCE SURGICAL SITE INFECTION? : HOW DOES O.R.TRAFFIC INFLUENCE SURGICAL SITE INFECTION? Opening any O.R. door disrupts airflow patterns.
Every extra person in room brings more respiratory bacteria and skin cell shedding.
Unnecessary equipment clutters room, restricts pathways for movement, and can disrupt air flow if close to wall vent.
Movement near sterile setup creates air currents that move contaminants onto sterile items.
Movement near sterile setup increases chance of inadvertent contamination of field.
Unscrubbed persons reaching or leaning over a sterile field are contaminating it.
Talking and gum chewing force more contaminants into the air. HOW DOES TRAFFIC INCREASE OPERATIVE TIME? : HOW DOES TRAFFIC INCREASE OPERATIVE TIME? The surgeon has to wait for items that are not readily available in the room.
Surgeons often look up when they hear the door open or when they hear a new person’s voice in the room.
Extra people create distraction from the procedure.
Unnecessary conversation takes focus away from the patient and makes error easier. Research Shows : Research Shows As the operative time increases, so does the rate of Surgical Site Infection.
Unnecessary people in the Operating Room may be violating the patient’s privacy, as well as adding pathogens.
Movement, talking, and uncovered skin can contribute to airborne contamination.
Patients notice loud conversation and laughing among staff members and find it disturbing and unprofessional. CAN YOU LIST A FEW WAYS TO DECREASE TRAFFIC ? : CAN YOU LIST A FEW WAYS TO DECREASE TRAFFIC ? Think before you gather – What else might be needed? Bring in all “possible” items, within reason.
Move unnecessary items out before case.
Take care of the obvious – have plenty of extra gloves and gowns for your team, and plenty of the sutures they will be using.
Use the phone to communicate with an OR or with the core. Don’t go in and out, if you can avoid it.
Do not lean over or reach over a sterile field. Let the scrubbed person reach out for the item, or flip it onto the field if appropriate. DO A SELF AUDIT : DO A SELF AUDIT Notice the number of times the door opens during one case. How many of those times could have been avoided?
Watch the sterile field. Are people passing too close? Are they always facing the field?
Who is in the room? Do they need to be there?
Is there unnecessary talking?
Is the team’s focus always on the patient? ITEMS FOR ACTION : ITEMS FOR ACTION Look for more ways that traffic could be decreased, and act to make it happen.
Do your best to minimize the effects of necessary traffic.
Speak up to keep your patient infection free. Unnessary persons need to leave.
UNNECESSARY TRAFFIC WILL BE
TOWED! BE EMPOWERED : BE EMPOWERED When you see a “traffic violation,” suggest a way to avoid it.
Discourage movement near the sterile field. If someone is too close, ask them to move away.
Never ignore even the smallest contamination. BECAUSE YOU KNOW - : BECAUSE YOU KNOW - THE REASON WE ARE HERE IS FOR
AND, SOMEDAY, THE PATIENT COULD BE YOU OR SOMEONE YOU LOVE Bibliography : Bibliography A.J. Mangram, et al, Centers for Disease Control and Prevention Hospital Infection Control Practices Adivsory Committee, Guidline for prevention of surgical site infection, 1999, American Journal of Infection Control,April 27, 1999, pp. 97-134.
AORN. (2008). Standards, Recommended Practices, and Guidelines, Recommended Practices for Traffic Patterns in the Perioperative Setting pp. 613-617.
The Health Insurance Portability and Accountability Act
of 1996 (HIPAA), Centers for Medicare and Medicaid Services, http://www.cms.hhs.gov/hipaa, December 13, 2005.