WATCH YOUR STEP The floor of a surgical suite is littered with potential slipping and tripping hazards.

Have a nice trip. See you next fall. Taking a tumble in the OR is no laughing matter. From cables and cords to kick buckets and step stools, the surgical suite is a minefield of potential slipping and tripping hazards. Surgical staff hit the deck. A lot. And more than their egos are bruised when they trip over cords or slip on fluid. In an Outpatient Surgery Magazine survey of 379 facility leaders, 60% said a staff member or a surgeon sustained an injury from slipping or falling in the OR. For 25%, it was a serious injury.

Karen Hausteen, RN, CNOR, of Phoenix, Ariz., remembers the time she nearly broke her hip during a case. She was scrubbed in and standing on a step stool to assist. "The circulator had draped the grounding pad cord behind me, without saying anything. When I stepped off the stool I tripped and fell to the side and back. I barely missed hitting the sterile back table. Thank heavens I did not break my hip!"

The hard fall bruised Ms. Hausteen from waist to knee. It was an expensive fall in terms of X-rays and time off work, but it could have been much worse. Circulators, says Ms. Hausteen, need to be aware of where they drape cords, and alert staff members in the room.

It seems most surgical facility administrators know of a staff member or surgeon who sustained an injury from slipping or falling in the OR. Here are a few examples from an online survey we conducted. Could any of these happen in your rooms?

• A nurse walked into the OR and tripped over a stool that was left right in front of the door.
• A surgeon dropped some tissue on the floor. A nurse who was focused elsewhere stepped on the tissue, slipped, fell and broke her wrist.

• A staff member tripped over power cords that were plugged into a wall outlet and laid across the floor.
• A surgical assistant was at the table for a C-section after draping. A nurse hooked up the cautery pad and ran the wire behind the assistant, who fell over the wire when she stepped back.
• The outlets that were installed in an OR weren't flush with the floor. A scrub nurse, who was wearing clogs, tripped on the floor socket and fell, suffering a broken finger that required surgery. The facility installed new floor outlets and also enforced the 'no slip-on clogs' rule and reminded staff that all footwear must have an enclosed heel. Keep in mind that the foot's natural swing during a normal walking gait will hit obstacles higher than ? inch off the ground.
• During an arthroscopy case, the floor became saturated and a nurse slipped, hitting her head.

FALLEN This AORN poster illustrates the tripping and slipping hazards present in most ORs.

A simple solution
The solution to many of your tripping problems? In a word: booms. Whether ceiling- or floor-mounted, booms keep your floors free of tangled cords. The power cables for instruments or other devices installed on a boom's arms or shelves are threaded through the unit, not draped across the room. If there's additional equipment to plug in, outlets built into the boom unit provide closer power sources than the edges of the room. Plus, booms free up the space that would otherwise be occupied by cumbersome equipment carts and towers you'd have to push around and plug in.

When a couple staff members fell after tripping over a cord on the floor, one facility invested in a wireless video tower, hung anesthesia cables from the ceiling and secured cords on the floor with bright orange tape.

Keep floors dry
You of course also want to keep floors free of slipping hazards by cleaning spills immediately and letting surfaces dry after mopping between cases. Still, slips can happen. Myron E. Lawson, lead operating room assistant at Carolinas Medical Center-NorthEast in Concord, N.C., tells the story of a circulator who helped take a patient to the PACU. In the interim, the OR floor was mopped. "He returned, not knowing the floor was wet," says Mr. Lawson. "As he rushed in, he lost traction and fell."

Fluid runoff pools on the floor, especially during fluid-intensive cases, such as knee arthroscopies. Many products are available to keep your floors safe and dry, including drapes with pockets that capture runoff, and floor wicking pads and suction devices that quickly clean up spills.

Absorbent mats work well, but not all mats automatically filter away collected fluid. 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 to the hopper for disposal. That's a potentially dangerous chore that heightens back injury and tripping risks if the canisters throw off the nurses' balance or block their view of the pathway to the disposal area.

Plan ahead
Take a few minutes before procedures start to assess the placement of cords and equipment, along with the cases' expected workflows, in order to keep hazards out of the walking pathways most often crossed by your staff, says Edward Hernandez, RN, BSN, the operating room nurse manager at James A. Haley Veterans Hospital in Tampa, Fla. He co-authored a September 2007 AORN Journal report that focused on eliminating slip and trip hazards in the surgical setting (osmag.net/5BJhKx).

"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," says Mr. Hernandez. "My idea for eliminating the 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." OSM