AT YOUR FINGERTIPS Jennifer Brown, RN, endoscopy nurse manager at Gastroenterology Associates of Central Virginia in Lynchburg, Va., opens the contents of her GI turnover kit while Sandy Fout, LPN, performs scope setup.

This is what cleaning the OR between cases should be like. Fast, efficient and economical. Just tear open a pre-packaged kit that contains all of the supplies you need to ready the room for the next case so that you can get the OR back in order — and back in business — quickly. From disposable sheets and armboard covers to plastic bags, mopheads and wiping cloths, OR turnover kits put everything right there, right at your fingertips, so that you can start the next case as soon as possible and avoid cross-contamination.

"Because all of the items are in one place, it's grab and go," says Connie Harsh, RN, special procedures clinical coordinator at Parrish Medical Center in Titusville, Fla. "It has decreased out turnover times by 4 to 5 minutes on average. Say we save 5 minutes for each case and it takes 20 minutes to do an EGD. After 4 cases, I can do a fifth case."

You can custom-build turnover kits to contain all the everyday supplies you need to turn over a room. Inside the turnover kits at White River Medical Center in Batesville, Ark., you'll find a bedsheet, a draw sheet, 2 armboard covers with Velcro straps, 4 trash bags and a disposable mop head.

"Having all the supplies in one easy-to-grab kit makes the turnovers not seem as long," says Michelle Franks, BSN, RN, White River's surgical services inventory specialist.

Diane Smith, RN, clinical director of Grove Place Surgery Center in Vero Beach, Fla., custom-made her kits to include an OR bed cover, armboard covers with safety straps, a lift sheet, an OR trash bag, an anesthesia trash bag and a bucket bag. "It's less expensive than buying each item on its own," she says.

Fewer footsteps, fewer dollars
A good part of the lure of OR turnover kits is that they're pre-packaged, so your techs and orderlies don't have to open cabinets and pull drawers to gather supplies after every case — or perform the time-consuming task of restocking your rooms with turnover supplies at day's end.

"Having everything together helps reduce turnover and staff time to put the kits together," says Cynthia Cash, RN, BSN, CNOR, ST, perioperative services nurse manager at Patewood Memorial Hospital in Greenville, S.C.

A typical turnover kit costs between $8 to $12 apiece, says an industry source. Not only do they reduce your non-reimbursable downtime in the OR, but they lower your laundry bill — although, to be balanced, they do create more trash. But all in all, they make cleaning up economical, especially if you negotiate a good price with your vendor and pare your kits so that you use all of its contents and waste not.

"We use everything that's in that kit. If I don't use it, I don't put it in there. We throw nothing away," says Sharyon Maverick, RN, endoscopy nurse at Texas Health Harris Methodist Hospital Azle. To clean up after and prepare for 90 GI cases per month, Ms. Maverick's kits include 2 gowns, surgilube, a 30cc syringe, 2 bowls for water, 1 disposable biopsy cap, 4x4's of gauze and a cinch table cover.

PRE-PACKAGED CONVENIENCE Fredi Estevez RN, CNOR, tears open a turnover kit at Winthrop University Hospital in Mineola, N.Y.

At your fingertips
Before they began using OR turnover kits at Gastroenterology Associates of Central Virginia in Lynchburg, Va., a couple years ago, cleaning a room between every GI procedure took a little longer and cost a little more than it does now, says Jennifer Brown, RN, the endoscopy nurse manager. Techs had to rummage through cabinets and drawers to pull cleaning supplies between every GI procedure. This made room turnover longer, more tedious and more expensive than it needed to be, says Ms. Brown. And now? "Everything we need is at our fingertips and our room turnover times have decreased," she says. "As far as infection control compliance is concerned, you can't beat the kits."

Her customized endo turnover kits come with a leakproof cinch pad that makes it easier for techs to carry scopes to the soiled scope room. They used to transport scopes in Rubbermaid bins. "Too cumbersome," says Ms. Brown. Now, techs lay the cinch pad over the cart, tighten the drawstring and carry the scope out of the room. Her kits also contain a small, square water bowl for water, a cleaning brush, a tube of lubricant, 2 disposable gowns and 4x4 gauze.

Her turnover times dropped from 4 or 5 minutes for bedside cleaning to 90 seconds. "It is so fast. You open up the kit. Everything's right there. It's done," says Mr. Brown. "The fewer steps you take every day, the less tired you are. And infection control loves it. Single-patient use means there's no crossover contamination."

InstaPoll

Do You Use OR Turnover Kits?
The market for OR turnover kits is largely untapped, according to our survey of managers at nearly 300 surgical departments. Less than one-fifth (19%) currently use them. The results:

yes, and we're very satisfied with them	16%
yes, but we're less than thrilled	3%
no, and we don't intend to try them	47%
no, but we might look into them	34%

Source: Outpatient Surgery Magazine InstaPoll
February 2013, n=271

Tumbling turnover times
Ms. Maverick wanted her GI case turnover time to be 5 minutes, but it was always creeping up toward 8 to 10 minutes. She credits turnover kits with getting her back under the 5-minute mark. "Even when we stored the supplies in bath basins, it still took us longer than we'd like," she says.

As an added benefit, patients are guaranteed clean supplies every time. "When we used linens, sometimes you'd get a torn or a thin sheet that would let blood soak through," she says. "Plus, lint was a problem."

Debbie Amos, RN, director of surgical services at Sunnyside (Wash.) Community Hospital, appreciates the disposable impervious mattress cover her kits come with, saying there's less drainage on her pads and mattresses and fewer repairs to her OR tables. Impervious linens also wick fluid away from the patient's skin, helping to prevent skin breakdown, she adds. One vendor's table linens feature antimicrobial coating on the back.

Find a vendor that lets you customize your kits. You don't want anything left over that you have to throw away. Plus, as Laura Allen, RN, BSN, CGRN, clinical director of the Endoscopy Center at St Francis in Indianapolis, Ind., discovered, if you can purchase an item for less, go for it. "We had suction tubing in our kits to start, but the added expense of that one item was so much more than we could get in bulk ourselves that I couldn't justify the addition, so we had it removed," she says.

SUPPLY "BURRITOS"
Do-It-Yourself Turnover Kits

ON A ROLL Wrap basic supplies together for a head start on room turnovers.

They make their own turnover kits at the Texas Health Women's Specialty Surgery Center in Dallas, Texas. They call the rolled kits "burritos," says Vicki Schultz, RN, CASC, president of the ASC. They roll a bedsheet, garbage bag, linen bag and draw sheet together into a tight spiral. "The burritos are a handy and compact way to organize the basic supplies needed for every case," says Ms. Schultz. "Your staff can grab a burrito between cases, unroll it on the surgical table and hit the ground running during room setups, letting them quickly prepare the OR for the next procedure."

— Daniel Cook

Not exactly eco-friendly
With many ORs trying to go green, some complain that using turnover packs isn't an environmentally friendly practice. There are lots of items to discard after each case, including heavy disposable mopheads. For Sandra L. Myers, MSN, a clinical nurse specialist at Naval Medical Center Portsmouth (Va.), the debate comes down to laundering reusable sheets versus filling up landfills with the disposable sheets you'll often find in turnover kits.

"Our OR green team is really vigilant that we recycle single-use items and blue wrap. Then we have all this disposable stuff from our turnover packs," says Ms. Myers. "I don't know which is worse: the cost of buying sheets and the cost of laundering them versus getting 1 item that you use and then throw away. I'm personally torn. I am on the fence because I'm torn between the environment and efficiency."

Lisa Waters, RN, chief operating officer at Columbia (S.C.) Eye Surgery Center, agrees that turnover kits produce too much waste. "My personal opinion: It's better to recycle. In a previous center, we used disposable kits, but there was too much trash that accumulated and was being sent to the landfill." Ms. Waters would be attracted to a turnover kit that contained linen sheets that you'd launder. (Another complaint about disposable sheets? Their plastic backing can cause patients to slide in reverse Trendelenberg.) For now, her center makes its own kits (see "Do-It-Yourself Turnover Kits" on page 60).

Some turnover kits are eco-friendly. At the Multi-Specialty Surgery Center in Indianapolis, Ind., the turnover kits come with a green bag for recyclables, says Kristy Verbish, CST, RN. At Riverside (Calif.) County Regional Medical Center, where the turnover kits are delivered with the case carts, Amy Siegfried, BSN, says they use the bag that the kits comes in as a trash bag at the computer console.