Fostering collaboration between the perioperative staff and infection preventionist

With George Allen, PhD, RN, CIC, CNOR
Downstate Medical Center
Brooklyn, NY

AMC: The great chicken and egg question in regard to collaboration between OR staff and infection preventionists is, who takes the first step to ensure everyone is working together to prevent infections and promote safety? Does the OR manager approach the infection preventionist about visiting the operating room, or does the infection preventionist have to approach the OR manager?

George Allen: It is a chicken and egg process. First of all, there are two things. People in general, including some infection preventionists, are not very comfortable going into the OR. People see the OR as a closed area where it’s supposed to be sterile and you can’t touch anything, which is not entirely true. The operating room staff needs to open its doors and facilitate bringing other people in the room to help them build a safe environment for staff and patients.

An additional set of eyes can make a difference. A new pair of eyes can help out those that are accustomed to seeing things the same every day – it’s something that can be very important in preventing various kinds of infections. If there is any kind of a problem, an inkling of a cluster or anything, and the infection preventionist has not been in the OR recently, the OR manager should take the initiative and invite them in, even if it’s just to observe and listen to recommendations. It’s important to ask the infection preventionist, “Are we doing everything we can to keep people safe in the operating room?” Particularly if the infection preventionist does not routinely make visits to the OR, the manager really should invite them in.

AMC: From the infection preventionist’s side, how can they help staff, or what can they do to make staff more efficient in their efforts to prevent infections?

Allen: One of the things that has worked in the past is ensuring that the staff knows what the data are. For instance, almost every institution in the United States has policies and protocols in place to report an infection. The keepers of the data who perform analyses as to the reasons why an infection occurs are infection preventionists. If that data is fed back to the specific departments of a facility, we can understand how important it is that there are processes for staff to safely perform tasks. That’s where infection preventionists can help – through looking at data gathered in the OR, analyzing it, generating reports and helping staff translate the data into meaningful gains through recommendations on how to improve.

AMC: Is working with an infection preventionist’s data and recommended practices difficult for perioperative staff to adapt to?

Allen: Not necessarily. The issue is making perioperative staff aware of what’s happening in their setting.

Say there are 10 rooms in the operating suite. In one room, somebody got stuck with a needle while they were re-capping. Not everyone in the OR will know about it, or the circumstances under which it occurred. Staff in the other operating rooms don’t get that information and two injuries occur this week, and then another couple weeks pass by and more injuries occur. If an infection preventionist looks at the reports from any incidents, and identifies a cluster, that’s when the entire OR staff should be notified.

It’s not as easy as I say it is, though. The infection preventionist prepares a report and shares it with the OR managers. It is up to the managers then to disseminate that information among staff. Managers play an equally important part as the infection preventionist. When the manager and infection preventionist work together, injuries and infections can be prevented from occurring in the operating room. The infection preventionist’s role is to be watchful of occurrences and infections; the manager’s responsibility is to inform the OR staff of the infection preventionist’s recommendations and make sure everyone is following through.

Work for a level of collaboration where it’s not just the infection preventionist and manager working together, but all of the staff as well.

AMC: What else would you like to add?

Allen: Collaboration does not stop with infection prevention. People should be working collaboratively. I firmly believe when people work together, the work gets done quickly, efficiently and effectively. I have many stories to tell about working collaboratively with people in other disciplines.

Even when you look at the OR setting itself, there’s a team. You have the housekeepers who turn the room over, you have the anesthesiologist, you have the surgeon, you have the scrub nurse and you have the circulating nurse. To get one case done you need every single person helping each other. I’m not saying it’s doing the other person’s work because each person has their own area of expertise. No one person in the operating room can do everything. There has to be collaboration among every single person in the OR setting. Once we understand how important working as a team is, the more efficient we become, and the less likelihood we have of instances occurring. Like I said, two sets of eyes are always better than one – you can save a life by noticing something someone else didn’t notice.

George Allen is an infection preventionist with more than twenty years experience in infection control and perioperative practice. Allen is a member of the AORN Journal Editorial Board, writes the monthly column "Evidence for Practice" in the AORN Journal and is the author of Infection Control: A Practical Guide for Health Care Facilities.

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