WRONG WAY DOWN Slips, trips and falls are a leading cause of lost workday injuries among healthcare professionals.

Over the course of my career, I've seen a number of colleagues fall prey to on-the-job injuries. One stands out. A nurse hurried across the OR to grab an urgently needed supply, tripped on a cord and broke her ankle. She was out of work and lost a portion of her wages for months. Her time off meant her colleagues had to work overtime and extra call shifts to cover her absence, which heightened their stress levels. Sound familiar? It might, considering 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. There's more than the personal health of your employees at stake when it comes to following these tips to keep staff upright and injury-free.

• Organize the space. I've only ever worked in 1 or 2 operating rooms that were less than 15 years old. As you know, the trouble with old ORs is new technology. Adding equipment crowds the workspace and clutters the floor with power cords and data cables, which poses a significant occupational hazard for your employees. But no matter when your ORs were built, it's likely that space is tight. The rooms are crowded with necessary equipment, and then you've got to find a place for supply storage and space for surgical personnel to stand. The more your staff has to bend over or duck under the equipment, the more they risk a potentially painful and all-too-preventable loss of balance or bruising collision.

TANGLED MESS Cords and cables on the floor should never be left unsecured or unbundled.

Preventing slips, trips and falls in your ORs must therefore begin by adapting the physical environment to alleviate the liabilities of modern technology. It might be time to invest in newer, slimmer equipment with smaller footprints, hang devices from floor-based boom systems or use wireless video routing. At the very least, assess the setup of your rooms to determine if equipment can be rearranged to keep common traffic areas clear of clutter. Make sure that your ORs (and your storage rooms and corridors as well) leave enough of a clear pathway for safe stretcher passage, foot traffic and room setup. It also helps to standardize the arrangement of your ORs as much as possible. Set up rooms that are used for the same procedures in the same way. That way staff will know exactly where equipment is placed — no matter what room they're in — how to get to it, and how to avoid potential hazards.

• Corral cords. Managing cords and cables is a huge challenge, but a critical step in maintaining safer OR floors. They should be bundled and consolidated, either with commercially available or homemade containers, whenever possible. If the spaghetti must be underfoot, route it through the areas that see the least traffic. If a frequently traveled path is unavoidable, place an anti-fatigue mat on top of it during a case. Power stands or other pole-mounted outlet options do a good job of keeping cords off the floor and offer the centralized, close-by power ability of an equipment boom without the need for extensive installation.
• Manage fluid waste. Don't neglect the fluid on the floor, especially if your ORs host arthroscopies or other fluid-heavy cases. Spills and slicks must be cleaned up promptly, if they're allowed to form at all. Drapes with fluid collection pockets and absorbent or suction floor mats help to prevent floors from getting wet, while floor-based and mobile direct-to-drain suction devices can dispose of runoff before you've even retrieved a microfiber mop.
• Light the way. Adequate lighting is also essential for making pathways and safety hazards visible. When the lights are dimmed for laparoscopic, endoscopic and other video-image-driven procedures, supplemental illumination such as portable or ambient lights can help staff, especially those who enter mid-case, find their footing.
• Discuss the dangers. You can't eliminate all the slip, trip and fall risks in the surgical workplace. And you can't train people not to fall. But you can train them to be more aware of their surroundings, and to make safety-minded behaviors part of their daily routines. An awareness of their surroundings should be second nature in order to anticipate and prevent slip, trip and fall accidents. Increasing their awareness of the risk they face simply by walking though an OR needs to come from regular reminders and educational sessions.

Safety training that addresses the physical limitations of your facility shouldn't be limited to new hires' orientations and annual in-services. Incorporate the reminders into daily morning huddles, which offer opportunities to address and possibly resolve your staff's safety concerns and remind them of recent incidents or near-misses that provide lessons of how injuries could occur.

If your employees have been unfortunate enough to experience or witness an on-the-job slip, trip and fall injury, you might even want to recreate the incident as a safety drill, to make them aware of the consequences of momentary missteps and to invite feedback on actively correcting the situation to prevent it from happening again. OSM