July 16, 2021

These four interventions can help speed up an all-important process.

CREDIT: Karen Tjelmeland
DELICATE DANCE Informed coordination among staffers can speed up turnover times, but leadership should inform them in advance of potential bottlenecks that could derail their efforts.

Even the most well-oiled OR turnover teams can find ways to shave precious minutes off of their room resets without compromising the quality of cleaning and surface disinfection needed to set everything up for the next case. Here are four turnover best practices from four efficiency-minded surgical leaders:

• Designate high priority areas. Surgical leaders can often anticipate spots in a busy schedule where bottlenecks and delays will most likely occur. Preempt delays by alerting everyone to these potential problem rooms. "Place red magnets on the schedule whiteboard so staff and turnover teams can focus their efforts on the suites you've identified as high priorities," says Carol Fairchild, RN, BS, CASC, director of the Crane Center for Ambulatory Surgery in Pittsfield, Mass.
• Get an early start. To keep nurses from scrambling between cases to find items that aren't on the case cart — a mishap that derails the flow of any efficient turnover process — make sure everything is where it should be. "Prior to the start of the day, OR personnel should look at all their case supplies for the day to include instruments and equipment," says Kelly Norman, RN, CNOR, administrator at Advanced Family Surgery Center in Oak Ridge, Tenn. "This helps organize the day so they are not looking for instruments and equipment in between cases."
• Look for unnecessary downtime. Sometimes staff are so focused on the process that they fail to see the inefficiencies inherent to it. Ashley Soloski, MHA, project manager for surgical services at Geisinger Community Medical Center in Scranton, Pa., advises facilities to pay close attention to what's happening when patients are first wheeled into the OR — a time when inefficiencies often occur. "Look at how the room is set up and how it is cleaned," says Ms. Soloski. "Are your nurses opening their trays and counting everything before the patient is wheeled in?" In some instances, a scrub tech can continue to set up the table and complete the count after the patient is wheeled into the room.
• Focus on flow. Sometimes minor process changes can make major differences in turnover times. For instance, at Riverside County Regional Medical Center (RCRMC) in Moreno Valley, Calif., the prior workflow dictated that after a procedure finished, the surgeon, anesthesiologist and a nurse converged on the next patient for the next procedure. A critical tweak improved that process. "Now a member of the nursing, surgical and anesthesia teams sees the next patient while the prior surgical procedure is ongoing," says David Ninan, DO, medical director and chairman of the anesthesia department at RCRMC. "That way, at the conclusion of the prior procedure, the team only needs to verify important elements, which in turn reduces the time needed for processing the patient."

There's no ultimate solution for making room turnovers more efficient. Rather, it's a matter of spotting and eliminating inefficiencies wherever they exist and however possible through creative thinking and staff discipline.

Research links hospital-acquired outbreaks of epidemic keratoconjunctivitis (EKC) to less-than-stellar hand-washing processes.

CREDIT: Wendy Wellott
GERMS REVEALED Lotions that glow under UV light can show how thorough a provider's hand-washing technique really is.

Inconsistent and subpar hand-washing practices are a major infection control challenge for leaders at high-volume ophthalmology facilities. In fact, multiple studies have identified poor hand hygiene as a major cause of nosocomial outbreaks of epidemic keratoconjunctivitis (EKC).

Those are the findings of research published last year in Current Opinion in Ophthalmology. Specifically, that study's authors noted that "some studies of EKC outbreaks are able to support direct observation of hygiene lapses with molecular analysis that can match viral strains on particular instruments to those found in infected patients."

Barriers to hand hygiene are pronounced during short ophthalmic cases. "Proper hand hygiene in eye clinics requires special attention because of the potential to examine many patients at a time and because multiple instruments are often used during a single exam," note the authors.

The average clinical day of an eye surgery center, with many quick cases and providers shuttling from patient to patient, presents its own unique hand hygiene challenges. However, proper hand hygiene is a must in any clinical environment. Administrators who have observed or been informed of lapses in hand hygiene need to address the problem as quickly and effectively as possible.

One fun but effective way to ensure your staff practices proper hygiene at all times comes from the playbook of The Oregon Clinic Gastroenterology East at Gateway in Portland, Ore. At this infection-control focused facility, staff apply a lotion that glows under UV light to their hands, let it dry for a few minutes and then wash it off. Another team member shines a UV flashlight on the provider's hands to see how thorough their hand-washing technique truly is.

Wendy Wellott, RSN, BSN, an endoscopy nurse who also serves as the facility's safety and infection coordinator, says it's been a winning strategy. "The exercise emphasizes the importance of following our facility's hand hygiene protocols, which we audit each month by observing if staff wash their hands or use hand sanitizer before and after they touch patients, surfaces, supplies and medications," she says.

Bottom line: Hand hygiene is a practice that is easy for busy physicians and staff to forget to perform, or not perform enough. Administrators and infection preventionists need to put the right protocols and auditing in place to ensure it's being done correctly on an ongoing basis. The all-too-costly alternatives, such as surgical site infections and viral spread among patients and staff, are something every surgical facility should resolve to avoid.

Infection prevention challenges can be met with a new product that has strong efficacy and prolonged material compatibility.

Credit: Metrex
Surface disinfection with CaviWipes^™ 2.0.

As the COVID-19 pandemic made all too clear, frontline OR teams continuously face challenging infection prevention needs to keep their patients and their staffs safe. That challenge is constant as existing and emerging pathogens keep the threat of infection front and center.

In early April, Metrex released its new CaviWipes^™ 2.0 surface disinfectant wipes that are effective against 42 pathogens, including SARS-CoV-2, and is fully qualified for the Environmental Protection Agency's (EPA) Emerging Viral Pathogen Claim.¹ The multi-purpose disinfectant wipes have a two-minute universal contact time for one-step cleaning and disinfection of hard, non-porous surfaces in healthcare settings.

"During unpredictable public health crises, infection preventionists and healthcare professionals learn new behaviors and use new tools to maintain employee and patient safety," said James Chia, Director of Research and Development at Metrex. "As front-line workers navigate today's extremely demanding environment, access to quick-working surface disinfectants like CaviWipes^™ 2.0 gives them confidence that they are cleaning and disinfecting against ever-evolving pathogens."

In the last decade, the EPA created a voluntary, two-stage process to enable the use of certain EPA-registered disinfectant products against emerging viral pathogens not identified on its original product label. With the approval of an emerging viral pathogen claim, EPA-registered disinfectant products can make specific claims against an outbreak virus.

EPA's Emerging Viral Pathogen claim indicates that CaviWipes^™ 2.0 meets current and future infection prevention needs for all virus types, including enveloped, large and small non-enveloped viruses. It is on the EPA's List N as a disinfectant for use against SARS-CoV-2, the virus that causes COVID-19.

Proven to kill a broad spectrum of bacteria, viruses and pathogenic fungi quickly and efficiently, CaviWipesTM 2.0 is effective against a total of 42 pathogens, including SARS-CoV-2, Candida auris, Norovirus, Mycobacterium tuberculosis (TB), Methicillin-Resistant Staphylococcus aureus (MRSA) and Human Immunodeficiency Virus Type 1 (HIV-1).

With a neutral pH of 7.5, the low alcohol disinfectant wipes contain a next-generation formula that uses a multi-pronged approach for attacking and destroying pathogens while remaining gentle on material surfaces.

"With a new, powerful formula, CaviWipes^™ 2.0 maximizes the synergies among its ingredients to kill infectious pathogens found in healthcare environments," said Chia. "Compatible across a wide variety of hard, non-porous surfaces, CaviWipes^™ 2.0 delivers on Metrex's 30-year-old, proven record of distributing infection prevention products that are gentle on the surfaces of medical materials and equipment."

Personal gadgets are the stuff of nightmares for infection preventionists.

Surface disinfection protocols in surgical environments typically focus heavily on high-touch operating room surfaces. What often doesn't get the attention it deserves in these protocols, however, are the massive infection risks that are seemingly forever at staffers' fingertips: their smartphones.

Personal mobile devices, which also include tablets and laptops, have become a mainstay at even the most paper-driven surgical facilities. Used by staff and vendors alike, they are a breeding ground for the types of bacteria that can derail facilities' most strident infection control efforts.

While most providers are aware that these devices are often filthy, you might be surprised to discover how filthy they really are. Lynn Radzinski, BSN, RN, CNOR, of UCHealth Inverness Orthopedics and Spine Surgery Center in Englewood, Colo., performed an investigation on the issue, and her findings are eye-opening.

Ms. Radzinski collected random observations of personal devices used in an OR during a single day, and then utilized a rapid Adenosine Triphosphate (ATB) test and a luminometer to assess their surface hygiene. For the assessment, a unit of cleanliness as a relative light unit (RLU) was revealed, ranging from ultra clean (0 to 10 RLUs) to filthy (more than 1,000 RLUs), and the level of cleanliness was measured before and after a cleansing wipe was used.

What Ms. Radzinski uncovered: Before cleaning, vendors' devices harbored the most bacteria at over 1,500 RLUs (filthy). CRNAs' devices came in second with an average RLU score of 305 (dirty).

Those results, which are likely typical, are certainly alarming, but the good news is that it only takes a few seconds to sanitize these devices with disinfecting wipes. That's exactly what the team at Ms. Radzinski's facility does now. "We stock touchscreen cleaning wipes that staff and vendors use to wipe down their devices," she says. The wipes are available in locker rooms, at the nurse's desk and outside ORs. "It takes only seconds to sanitize cell phones, tablets and laptops," says Ms. Radzinski "Providers should make sure these items don't transmit pathogens to patients."

The lesson: Superior surface disinfection practices go beyond wiping down built-in surfaces and medical equipment. Personal device disinfection should become part of any surgical facility's infection prevention protocols.

COVID-19 put infection prevention under the microscope and forced facilities to prioritize disinfection protocols.

While most individuals struggle to find anything positive about the pandemic, infection preventionists see at least one plus to the nightmare we have collectively endured: A reemphasis on proper surface disinfection protocols.

This enhanced focus on proper surface disinfection is likely to carry over into the post-COVID-era, according to Donna Nucci, RN, MS, CIC, infection preventionist at Lawrence and Memorial Hospital in New London, Conn. and owner of her own consulting business. In fact, Ms. Nucci believes healthcare facilities may face more stringent oversight of their practices moving forward. Regulatory agencies and patient advocacy groups may require facilities to have structured environmental cleaning programs in place, she says. Facilities should also expect to implement more checks and balances, and use only EPA-approved cleaning products for surface disinfection.

For high-volume outpatient surgical facilities, reconciling speedy OR turnover times and a backlog of cases with proper surface cleaning can be challenging, but there are some proven ways to make it work. For instance, to save time, they should consider using the fastest-acting surface cleaning solutions. That's what Stephen Branch, director of environmental services at Yale New Haven's York Street facility, does. "We use a product with a one-minute dwell time," he says. "It will kill most pathogens in one minute or less."

While time constraints and speedy room turnovers will always play a role in the world of outpatient surgery, the pandemic has likely helped ease some of the pressure staff faced pre-pandemic, according to Mr. Branch. "In the past, environmental services workers were sometimes instructed to hurry cleaning along and asked how long their process would take," he says. Now, because of COVID-19 and the heightened awareness of proper and thorough infection prevention standards, he says facility leaders are more cognizant of the time it takes to properly clean and disinfect ORs.

Of course, facility leaders can't simply assume staff is disinfecting everything, every time; they must regularly verify the process. That's why administrators at Yale New Haven monitor staff performance by marking 17 high-touch areas based on CDC recommendations with Tide pens. They then use black lights to make sure staff cleaned those areas. "The CDC recommends recleaning the room if three or more points still have a mark," says Mr. Branch.