Are your ORs more obstacle course than procedure room, constantly challenging your surgical team to high-step over cords and splash through puddles of fluid waste? You're not alone. Falls caused by slips and trips account for 20% of lost time in health care due to injury. Let's look at 5 ways to prevent the accidents that can bruise and batter your staff and jeopardize the quality of care you provide patients.

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1 Keep pathways clear
If at all possible, place OR equipment on booms to keep it off the floor and out of major walking pathways. Booms feature built-in outlets, meaning most power cords are also kept off the floor, removing one more tripping hazard from the risk equation. To maximize walking space, place the bases of equipment booms on the sterile side of the OR and away from the door.

Unfortunately, booms can't completely eliminate having to work with cords stretched across the floor. Take a second look at how your ORs are set up. Can you move equipment around to route cords away from high-traffic walking pathways? Try to bundle or braid cords together, which eliminates the all too common "spaghetti effect" and reduces the number of potential tripping hazards. If there's no way to move bundled or braided cords out of major thoroughfares, keep them as taut as possible so they sit tight against and straight across the floor. Place a plastic cord cover over the cords or, in a pinch, fold a towel lengthwise, lay it on the cords and tape its edges to the floor.

Also keep in mind that low-profile moveable items such as buckets, stools and Mayo stands are potential tripping hazards. Keep these seemingly harmless objects away from where members of your surgical team walk during cases.

Positioning equipment properly not only keeps tripping hazards away from walking pathways, but also gives staff clear views of the floor. Staff are less likely to distinguish tripping hazards in cluttered pathways and lose the ability to notice visual cues — the reflection of a fluid puddle, perhaps — that drive them to instinctively alter their gait and stay balanced.

Try to limit how far your staff must walk to grab needed supplies so they don't have to navigate tripping hazards along the way. For example, we place often-used items such as surgical gloves and 4x4 pads in cabinets along one wall of the ORs that's away from the surgical equipment. Do all you can to give staff clear access to the surgical bed and the circulating nurse unimpeded walking pathways between the bed, supply storage shelves, wall-mounted equipment and computer workstations. Standardized room set-ups facilitate clinical efficiencies and let staff familiarize themselves with where equipment, and therefore potential tripping hazards, is located.

2 Light the way
Adequate visualization of the floor is further hampered during laparoscopic procedures, when many surgeons prefer to work with the OR's general lighting dimmed in order to better see the surgical monitors. That creates 2 issues: Staff have a more difficult time seeing tripping or slipping hazards, and their vision is slow to adjust to the severe lighting differences as they move between the bright sterile field and the dimly lit room.

Ask your surgeons to keep general room lighting turned up at all times, even during minimally invasive cases. Installing high-def monitors with high contrast ratios and surface materials that minimize the impact of reflected light, or playing with the angles at which monitors are positioned in order to reduce glare will help convince surgeons that they can in fact clearly see images with the general lighting on.

If your surgeons remain steadfast in their need to operate with the general lighting dimmed, focus task lighting on high-traffic areas and potential tripping hazards or place brightly colored tape on the edges of obstacles in walking pathways. Finally, consider this: Bathing ORs in green ambient light during minimally invasive procedures maintains image quality on video monitors and brightens the outskirts of the sterile field, according to research conducted at Massachusetts General Hospital in Boston.

3 Manage fluid waste
Fluid pools on the floor carry the potential for severe injury to your staff members, who can easily break an arm or leg — or worse, crack their heads — if they slip and fall heavily to the floor. Focus on minimizing spills during fluid-intensive cases such as knee arthroscopies. Absorbent mats work well, just be sure the surface materials are slip-resistant and the edges are beveled so surgical team members don't trip while stepping on and off of them. Mats that don't automatically filter away collected fluid can lose their non-slip properties due to oversaturation or even swell in size, raising the tripping risks for staff working in the area.

Direct-to-drain systems are perhaps the ideal fluid-collection option. These automated units collect excess fluid straight from the surgical site to keep OR floors bone dry. When it's time to dispose of fluid, nurses wheel the mobile collection units to a docking station, where fluid is automatically drained without exposing the nurses to infectious waste. Keep in mind, too, that nurses don't have to remove and replace containers filled with fluid waste during cases and carry them for disposal, a potentially dangerous chore that heightens back injury and tripping risks if the canisters throw off the nurses' balance or block in any way their view of the pathway to the disposal area.

4 Plan ahead
Take a few minutes before procedures start to assess the placement of cords and equipment along with the cases' expected workflows in an effort to keep hazards out of the walking pathways most often crossed by your staff. Pre-planning also ensures the right equipment and supplies are on hand, reducing foot traffic in and out of the OR and, in turn, the number of times someone could potentially trip or slip. Having solid workflow plans in place will let your staff dictate the pace of procedures instead of reacting to unexpected disruptions, which can cause them to rush around to catch up and not watch where they're going as carefully as they normally would.

We used to meet every morning before the first case of the day for about 10 to 20 minutes to discuss the upcoming schedule. I've done away with that meeting. (If I have important information to pass along, I can always gather the team in front of our whiteboard for a few minutes.) My idea for eliminating the daily morning meeting was to give my staff an extra 20 or so minutes to focus on setting up ORs in the safest way possible. With the added time, they're able to move tripping hazards out of harm's way, secure or cover cords that can't be moved and ensure the equipment is set up and positioned to make walking around the rooms easier and safer.

5 Care for your staff
Make sure your staff is well rested and able to take regular breaks. Physical and mental fatigue can hamper their abilities to focus on the job at hand, and raise the possibility of muscles reacting a split second too late to avoid a slipping or tripping hazard. Those of you managing ORs in a large hospital understand the difficulty in balancing the schedule so your nurses are given enough time off between shifts and, if they take call, between their on-call duties and their next scheduled day in the OR. Also ensure your ORs and equipment are set up with staff and surgeon comfort in mind. Provide adequately padded seats at workstations, make sure equipment controls are within easy reach and consider ergonomic factors when shopping for new instruments and capital equipment.

The tortoise had it right
One of my nurses once tripped on a Bovie cord and injured her knee on the floor while rushing from one side of the bed to the other. She luckily escaped with nothing more than a severe bruise, but the injury kept her on light duty restrictions for 3 weeks, leaving us short-staffed and scrambling to fill her role in the OR. Time is money, especially in the surgical setting. I get that. But slips and trips happen when you move too fast. Slow down and watch what you're doing and where you're going. Cases will still start on time and you'll still be able to keep patients moving through your ORs. You'll just be able to do it more safely.