The surgical suite presents many opportunities for slips, trips and falls, which are among the leading causes of workplace injury in the United States. Here are 7 simple things you can do to keep your staff from taking a spill on the job.

1. Cut the clutter. When was the last time you de-cluttered your facility? Over time, particularly in smaller facilities where storage space is limited, ORs can become dumping grounds for supplies and equipment that don't need to be there for every case. When cleaning and organizing your facility, make sure aisles, walkways, entrances and exits are clear and wide enough for people to pass through. Carve out adequate storage space for all your supplies and equipment so they aren't taking up space needed for foot traffic. "Pay attention to the way you arrange rooms and equipment, so you're not having to climb over things," says Mary C. Wilson, BSN, RN, CNOR, clinical preceptor for the Ruby Day Surgery Center in Morgantown, W.Va. For example, when her facility recently added a new image-guided sinus procedure, Ms. Wilson worked with one of the physicians to create a floor plan for the OR in advance, so everyone would know how to situate equipment for maximum safety and efficiency.

2. Secure electrical cords and cables. The more high-tech equipment you add to your ORs, the more electrical cords you've got snaking across the floors, posing a tripping hazard for staff. "We used to tape cords down, but this isn't the best way to do it," says Ms. Wilson. "You end up with all that gunk on the cord, it sticks to the floor and it doesn't come up with mopping — ?you have to use an adhesive remover." Instead of using regular tape, invest in products specifically designed to cover cords on the floor, hold them in place and prevent people from tripping on them. At Ms. Wilson's facility, they use disposable adhesive covers that, similar to Post-It Notes, hold cords down, but don't leave a sticky residue behind when they're removed at the end of a case or the end of the day. You may also opt for more heavy-duty plastic covers that can be cleaned and re-used. Make sure you're routing cords outside of potential walkways. The Occupational Safety and Health Administration recommends installing electrical outlets in the floor or in the ceiling so you're less likely to have cords blocking pathways.

3. Install equipment booms. For a more high-tech solution to floor clutter, consider installing boom systems that can house everything from your video monitors and light sources to cautery units and fluid pumps. Equipment booms eliminate the need for mobile equipment carts and the tangled webs of cables and cords that often accompany them. They can be mounted either on the ceiling or on pedestals affixed to the floor (see "Retrofitting Your ORs With Booms" in the August 2009 issue of Outpatient Surgery).

4. Flag potential tripping hazards. "Falling over portable equipment of a color that visually blends into the floor" is one of the 3 main causes of slips, trips and falls in the surgical suite, according to OSHA. Buckets, stepstools, low-profile carts and supply boxes can all pose potential tripping hazards. Keep your OR floors as uncluttered as possible, but if you need to have such equipment around during a case, OSHA recommends that you mark it with a bright color or taped "X" so it's easily visible and doesn't blend in with the floor.

5. Prevent puddles. Many products are available to keep water from pooling on the floor during procedures that require a lot of irrigation (arthroscopy, for example):

• drapes with pockets that capture runoff from the surgical site;
• mats that absorb and drain fluid that falls to the floor; and
• suction devices you can roll over the floor to suck up fluid spills.

When shopping for the best fluid waste management solution for your facility, consider the amount of fluid your procedures generate. "You have to see what works depending on what kind of surgery you're doing and what the doctors will tolerate," says Ms. Wilson, who notes that some suction devices are noisier than others. She recommends that you also consider placing mats or suction devices in other areas of your facility that are at a high risk for fluid spills, such as sterile processing. Brian Lewis, ORT, clinical director of the Bone & Joint Clinic in Franklin, Tenn., warns that some of these fluid waste management devices can pose safety hazards themselves, such as if they're connected to a lot of suction tubing or if water runs out of them after reaching a certain threshold.

6. Use microfiber mops to quickly and efficiently clean fluid spills on surfaces that have no gross contamination, suggests Laurie Tostenson, housekeeping training and quality assurance manager for the Dartmouth-Hitchcock Medical Center in Lebanon, N.H. "Lightweight and easy to use," these mops can be stored right in the room in their own container filled with clean solution, she says. They use much less water than standard mops do so the floor dries quickly, and they require no re-dipping into the mop water, which can lead to additional spillage on the floor. However, Ms. Tostenson stresses that you should continue to use cotton string rags or mops — not microfibers — to clean up blood and other bodily fluids.

7. Provide adequate lighting. For certain procedures, particularly those that use video technology, it's not uncommon to dim the general lighting in the OR while focusing brighter lights just on the surgical site. This lighting scheme makes it difficult for staff moving about the room to adjust their eyes from the monitor and surgical site to the dimly lit floor, where potential tripping hazards may lie. Experts recommend that you take this into consideration when purchasing monitors — make sure they can be easily seen without having to dim the lights.1 Also try to keep the contrast between surgical site illumination and general lighting in the room to a minimum.

References
1. Brogmus G, Leone W, Butler L, Hernandez E. Best practices in OR suite layout and equipment choices to reduce slips, trips and falls. AORN J. 2007 Sep;86(3):384-94.