WORKPLACE DANGER The OR floor is a tripping and slipping hazard.

Nurses continue to have the highest job-related injury rates of any occupation. Surgical nurses? You could argue that they deserve hazard pay. Take a look around your ORs at all the injuries just waiting to happen. A partial list from the ground up: cords to trip on and bodily fluids to slip on. Then there's surgical smoke and waste anesthetic gases to breathe in. The slice of a scalpel, the prick of a needle or the splash of blood can expose staff to a number of diseases, including HIV and hepatitis. Their backs take a beating from handling heavy patients and being on their feet for hours on end, much of the time hunched over operating tables.

Are you doing all you can to protect your employees? "As a manager, you have the ultimate responsibility to ensure their safety," says David Kasprzak, RN, MSc RNFA, former director of surgical services at Easton (Pa.) Hospital. "You have to put your foot down and take a stand, taking whatever measures are necessary to be sure you maintain a safe environment."

Not just your employees, but your patients as well, he adds. "When you improve the safety of your staff, you improve the level of care for your patients," says Mr. Kasprzak. "You can't have one without the other."

Here are a few innovative ways your colleagues are keeping their surgical staffs free from harm.

ERGONOMICS Elevate your kick bucket to ease staff back strain.

1. Back sprains and strains
Back sprains and strains are the leading causes of work-related musculoskeletal disorders for nurses, according to the Bureau of Labor Statistics. A major culprit: overexertion from lifting. The best way to prevent back injuries from lifting is to avoid lifting tasks, but this is hardly practical in surgical facilities. The answer lies in ergonomics.

Here's a simple thing you can do to ease back strain. Elevate the kick bucket, which is customarily low to the floor, in one of your ring stands to decrease the amount of bending the floor nurses must do when they pick up the dirty Ray-Tec sponges and place them in your count bags, says Christopher M. Lomboy, RN, BSN, RNFA, MBA, perioperative manager at Kaiser Permanente San Jose Ambulatory Surgery Center in San Jose, Calif.

Then there's patient handling. The Lexington Medical Center in West Columbia, S.C., purchased 6 air-assisted safe patient handling mattresses to reduce caregiver injury, and increase patient comfort and safety while transferring, repositioning and handling patients. Since staff began using the air mattresses to move patients from a stretcher to a bed and back in the OR, there've been zero back injuries due to patient handling, says Maureen Spangler, RN, CNOR, director of perioperative services.

"This is a comfortable, secure way to move the patient with no lifting or back strain for the staff," says Ms. Spangler. "The air mattress is inflated, allowing the patient to virtually glide from one bed to another with minimal effort by the staff."

If you use a sheet or a roller to move patients, remember that many hands make light work when it comes to patient lifting, says Leslie Mattson, RN BSHM, a nurse consultant with ALM Surgical Solutions in Atlanta, Ga. "We use an all-hands-on-deck approach to moving the patient from the stretcher to the OR table and back," she says. In pre-op and PACU, however, the care is typically one-on-one, as is moving the patient. After having a nurse injure her back attempting to move a patient up in the stretcher by herself, Ms. Mattson adopted a team-lift approach in pre-op and PACU as well. She educated staff to get help and use proper body mechanics when they need to reposition patients or help them ambulate. She reminded staff that adjusting stretcher heights, lowering rails, and using the sheet to lift and move can make the task easier.

WATCH YOUR STEP Cords might be the biggest tripping hazard in the OR.

2. Slips, trips and falls
Slips, trips and falls are the second most common cause of lost workday injuries in health care, according to the CDC, which says the mishaps are more likely to result in fractures and multiple injuries than other types of workers' compensation claims. Keep the OR floor dry and free of clutter.

There are many ways to keep the OR floor dry, including wicking devices, absorbent mats set around the table and fluid waste suction systems. You can also prevent fluid from ever reaching the floor by using drapes that have built-in fluid collection bags.

Cords might be the biggest tripping hazard in the OR. Rather than plugging cords into wall outlets and draping them across the floor, think of ways to keep your equipment power cords off the floors. Suspended outlets and booms are a great idea. You can also plug equipment in at the side of the table so that cords aren't trailing on the floor where there's foot traffic. If you do drape cords across the floor, you should conceal them. You can buy disposable cord covers or cover them with bath blankets. Perhaps the best alternative: wireless equipment that eliminates cords, such as increasingly popular wireless foot pedals for arthroscopic procedures.

SHARP ALERT An orange safety mat alerts reprocessing techs that sharps are in the decontamination tray.

3. Protect your SPD Staff
Once the case is over, do you toss away those bright orange mats used to designate a neutral zone for the hands-free transfer of sharps? Mr. Lomboy found another use for the orange mats: to alert his sterile processing staff to the presence of sharps. OR staff place knife handles, hooks, drill bits and all other sharps atop the orange mat so that your SPD staff know right away there are sharps in the decontamination tray. Call it a repurposed sterile processing safe zone.

TWICE AS NICE Wearing 2 pairs of gloves can significantly lower your risk for contamination and punctures.

4. Double-glove
Much of what your team does in the OR is for the benefit of the patient. While double gloving provides patient safety, it also offers protection for the OR team. Wearing double gloves helps prevent surgical site infections and creates a double barrier, preventing microbial transfer from team members to patients or vice versa. Studies say that anywhere from 600,000 to 800,000 percutaneous medical injuries occur annually in this country, but also point out this is an underestimate because many sharps injuries go unreported.

"My team and surgeons have had numerous instances where double gloving has protected not only the surgeon and surgical assistants, but also the patient," says Thomas Peltzer DMD, of Oral and Maxillofacial Surgery and Anesthesia in Plainville, Conn. "For longer surgeries especially, double gloving has been very beneficial for all providers involved in direct patient contact." OSM