Bugs in the operating room? It's best to spray for them after the last case on Friday, but you should spray the outside of the facility before spraying the insides of your ORs. That's the consensus of facility managers who weighed in on our Second Opinions Discussion Board, a free service at www.outpatientsurgery.net/discussions that lets readers ask and answer questions.

A facility that's had problems in the autumn with spiders reports that it arranges for an exterminator to spray on Friday after cases. Environmental services then terminally cleans the OR on Sunday so cases can safely resume on Monday morning. A few points to keep in mind:

• Collect the pests for the exterminator to see. Treatments can differ depending on what kinds of pests that you're facing.
• Treat the outside perimeter of the surgery department first. If the insecticide treatments on the outside don't work, the exterminator can return on Friday to apply the insecticide within the operating rooms.
• No food in the OR. Don't eat in OR suites and keep doors closed to limit the amount of pests. "Although eating in the OR suites is against policy, it is still an issue," says the OR manager of a suburban Philadelphia hospital that recently had an issue with ants.

Must You Credential a Surgeon's Personal Scrub?
You'll likely have to credential an MD-employed scrub tech and grant her privileges as an allied health professional, say those who sounded off in Second Opinions. Check your state regulations and accrediting standards. One administrator said his center's policy bans outside techs from being credentialed to work in the OR.

You must notify the patient in advance of any outside personnel that will be in the room during the procedure, says Jay A. Shorr, administrator of the Advanced Cosmetic Laser Center in Ft. Lauderdale, Fla. "It is best to have a document signed by the patient acknowledging that he's in agreement with an outside party being in the OR," he says.

Also ask about malpractice insurance. Does the tech carry her own or is she under the umbrella of the physician's?