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June 22, 2022
Publish Date: June 21, 2022   |  Tags:   Staff Safety

THIS WEEK'S ARTICLES

A Four-pronged Approach to Sharps Safety

Safer From the Start

Ansell's Partners In Protection Webinar Series Offers Continuing Education Opportunities - Sponsored Content

Make Malignant Hyperthermia Training Stick

Ensure Your Staff Can Handle Surgical Fires

 

A Four-pronged Approach to Sharps Safety

This prevention play sheet can keep your staff safe from nicks and jabs.

Double Glove VISIBLE ISSUE Under-glove indicators with a different color than the outer glove enable staff to easily tell when there is a puncture.

The Association of periOperative Registered Nurses estimates that a sharps injury occurs during as many as 15% of surgeries. It also found that about 64% of these injuries are preventable, while as many of 90% of them go unreported.

"It's 2022, two years after the 20th anniversary of OSHA's Needlestick Safety and Prevention Act, and here we are, talking about the same thing," says Deborah L. Spratt, MPA, BSN, RN, CNOR, CHL, a perioperative consultant based in Rochester, N.Y. "We're still not getting it right."

Here are four components of sharps safety that could boost prevention at your facility:

Double gloving. Switch to a latex-free bio-gel double glove system with colored under-glove indicators so staff can easily tell when the outer layer has been punctured. Glove vendors should be part of the education process to advise staff on how to properly size the outer and inner gloves and explain the added safety of wearing two layers of protection. Staff should understand that the volume of blood and viral load on a suture needle is vastly reduced when it passes through two gloves, and that the risk of exposure to a patient's blood is significantly decreased when the outer layer is punctured because tiny perforations can be immediately noticed, signaling it is time to immediately don a new pair.

Neutral zones. Institute a hands-free passing area for the exchange of sharps at the sterile field. Ms. Spratt notes there are multiple barriers to initiating this practice and making sure it remains in place, as some staff often don't believe the lack of a zone is an issue, and some surgeons might not want to introduce an additional step into surgery. Surgical teams should identify the neutral zone during the time out, and verbal notifications should be issued each time a sharp is placed into the zone. Sharps should be arranged for easy retrieval by surgeons, their assistants or scrub techs, and should always be handled by one surgical team member at a time.

Safety devices. Blunt-tip suture needles are appropriate for use in fascia closures, muscle and perineal lacerations and episiotomy repairs. Safety-engineered scalpels include single-use models, shielded or sheathed blades that can be covered when not in use, blades with rounded tips, and devices with retractable blades that go into the handle before being passed.

Disposal practices. Sharps still in the sterile field at the end of a case should be placed in temporary, puncture-resistant, leakproof receptacles labeled to denote they contain devices that could harbor bloodborne pathogens. Disposal containers should always be in the upright position, replaced before they're overfilled and securely closed. The containers should have tamper-free locks, allow team members to deposit sharps with one hand and be designed to prevent hands from entering.

While gains have been made in sharps safety, there remains ample room for growth. "You can't provide safe patient care if the team isn't safe," says Ms. Spratt. "The operating room is a team sport. Collective changes in practices are needed to benefit the entire team and their patients."

Safer From the Start

At a new surgical facility, traditional problems and bad habits were nipped in the bud before they could manifest.

Height adjust UCF Lake Nona Medical Center
ONE SIZE FITS ALL Height-adjustable sinks that rise and fall at the push of a button accommodate reprocessing techs of any height to avoid back strain.

When Brandy Ginzinger, RN, became the director of surgical services at the then-new UCF Lake Nona Medical Center in Orlando, Fla., she immediately set out to ensure no outdated, unsafe practices would make it into the facility's ORs and perioperative spaces from the get-go. One area that received a lot of her focus was the safety of the employees who would work in them. Here are some of the major changes she made.

Smoke evacuation. "We made sure that we opened on day one with only smoke evacuation cautery pencils, so there was no temptation to use the regular ones," says Ms. Ginzinger. Surgeons were provided the chance before the facility opened to sample the smoke evacuation devices, helping them become comfortable with the product before they used it for the first time in a live surgery. The trialing also enabled Ms. Ginzinger to get a consensus on which activation mechanism surgeons preferred on the pencils so the facility only needed to invest in one type; the push-button version won over the rocker switch version. Additionally, suction irrigators that included a smoke evacuation component were stocked in the ORs.

Safety sharps. All sharps throughout the entire facility are safety-retracted models. As with the smoke evacuation pencils, Ms. Ginzinger offered physicians an "all or nothing" proposal. Only safety sharps would be stocked and they would always be used; the only option offered to surgeons was to determine which safety sharps products they preferred.

Height-adjustable sinks and workstations. Reprocessing techs of different heights often complain of working at sinks that are either too high for them to reach all the way in, or too low, which leads to back strain. To address her entire reprocessing staff's ergonomics, Ms. Ginzinger acquired height-adjustable sinks. "They rise and lower at the push of a button so every staff member, regardless of their height or size, can comfortably work in that space for long periods of time," she says. Sterile processing staffers enjoy height-adjustable workstations that go up and down at the touch of a button as well. Ms. Ginzinger also bought 24-inch-by-48-inch workspaces that rise up and down with a button tap for her circulating nurses. "This way, nurses can stand or sit while they work," she says. "It's been a huge staff satisfier."

Safe patient transfers. In many facilities, a typical transfer device is placed on the floor and turned on to inflate, which isn't great for the provider's back or knees. To make it easier on staff, Ms. Ginzinger purchased lateral air-assisted transfer devices that are much easier to use. "Instead of laying horizontal, they stand vertically upright on a mobile cart," she says. "The ‘on' button is at waist height, so you're not bending down to inflate the mattress."

Ms. Ginzinger accomplished a lot from the start, but she is aware that enhancing employee safety is an ongoing process. She continues to focus on keeping her team healthy and happy and empowers them to help create a safer work environment where they know their concerns are being heard and used to make positive change. "If we can give them the proper tools, it's going to make them safer and happier employees who can focus on patient safety needs," she says.

Ansell's Partners In Protection Webinar Series Offers Continuing Education Opportunities
Sponsored Content

Learn from industry-led thought leaders who share their evidence-based strategies for best practices in healthcare.

As a global leader in safety solutions, Ansell offers a variety of complementary opportunities to earn continuing education credits throughout the year. Learn from industry-led thought leaders who share their evidence-based strategies for best practices in healthcare.

Explore our expansive library of on-demand webinars covering a range of topics to expand your knowledge.

Webinar Spotlights:

A Surgical Technologists' Perspective on Glove Selection

Kathleen (Katie) Karus, CST, reviews the latest gloving practice guidelines from AST and AORN in her day-to-day practice in a real-world surgical environment and discusses how these guidelines came into play through the history and evolution of glove technology. Program content approved for 1 CE for Registered Nurses. Ansell is a recognized provider of continuing education approved by the California Board of Registered Nursing, provider #CEP 15538.

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Strategies for Improving Operating Room Turnover

Dana Goossen, MSN, RN, and Daniel Jones, MSN, RN, MBA, discuss key strategies for improving operating room turnover including efficient time, environmental risk and the impact of cross-contamination. Based on their experiences in the operating room, they will touch upon best practices in establishing efficacy for long-term utilization. Program content approved for 1 CE for Registered Nurses. Ansell is a recognized provider of continuing education approved by the California Board of Registered Nursing, provider #CEP 15538.

Register Now

Redefining Partnerships Between IDNs and Manufacturers

A group of supply chain leaders comes together to review the latest strategies for developing agile and informed partnerships, corporate social responsibility, clinical integration, demand planning and more! Join our panel of thought-leaders, Joe Walsh, Founder of Supply Chain Sherpas, Allison Campbell, VP of Global Logistics at Ansell, Jeromie Atkinson, Senior Director of Supply Chain at UC Health and Mike McDonough, System Director of Sourcing & Vendor Management. Program content approved for 1 CE for Registered Nurses. Ansell is a recognized provider of continuing education approved by the California Board of Registered Nursing, provider #CEP 15538.

Register Now

Make Malignant Hyperthermia Training Stick

Anesthesia-led sessions every six months will ensure your staff will be ready if an emergency occurs.

Malignant hyperthermia (MH) is such a rare condition that there is a very real possibility that every provider on your perioperative team has never even experienced an MH event. However, if and when an event does occur, time is of the essence. That's why it's so important to ensure your team is ready to react on the off-chance one of your patients shows the warning signs that MH is in play.

To do this effectively, bake training into your regular education sessions. "MH training should be conducted every six months or at least annually," says Robert Simon, DNP, MS, CRNA, CHSE, CNE, chief CRNA at Huntington Valley (Pa.) Anesthesia Associates and assistant program director at Frank J Tornetta School of Anesthesia at Einstein Medical Center Montgomery in Norristown, Pa. Dr. Simon also encourages facilities to lean heavily on anesthesia providers to participate in or even conduct the training sessions.

Why anesthesia? "MH is an emergency that primarily occurs after use of an anesthetic triggering agent, medications that are actively administered by anesthesia professionals across the country," says Dr. Simon. Anesthesia providers are also responsible for monitoring the patient's vital signs and remaining vigilant to identify and manage potential complications. You want to rely on your anesthesia team to communicate the onset of MH symptoms to the surgeon and the OR team and guide the treatment protocols. "This is why it's important for anesthesia providers to be involved in MH drills and help prepare the OR team for a real-life event," says Dr. Simon.

Dr. Simon focuses a lot of energy on helping his OR team recognize signs of trouble. He created and distributed several easy-to-remember staff handouts based on material pulled from the informative Malignant Hyperthermia Association of the U.S. (MHAUS) website. One handout included information about what to look for in patients who might be experiencing MH, including an unexplained and sudden rise in end-tidal CO2; decreased SaO2; unexplained tachycardia or arrhythmias; tachypnea; labile blood pressure; masseter muscle or generalized muscle rigidity; rising body temperature; and mottled, cyanotic skin.

Even with the most comprehensive training, staff could freeze in the moment and forget what they've learned. Dr. Simon suggests avoiding that procedural paralysis by papering clinical areas with documents staff can easily look to for help. "Post the MHAUS hotline number on the MH cart and in every OR, the PACU and procedure rooms where triggering agents are administered," he says.

Ensure Your Staff Can Handle Surgical Fires

Assigning specific roles and enhancing your education efforts can help.

All providers hope they will never experience a surgical fire, which can occur when a patient's airway catches fire, surgical equipment starts to spark or flames erupt in the sterile field. While these incidents are rare, surgical facilities should be prepared and vigilant to prevent them, and protect the wellbeing of everyone in the operating room.

Michelle Robison, MSN, RN, AGCNS-BC, CNOR, a clinical nurse specialist at UCLA Medical Center-Santa Monica (Calif.), says every facility should develop a fire safety policy based on the input of a multidisciplinary team, conduct regular audits to measure staff compliance and educate staff on the fundamentals of fire risk assessment and response protocols. Ms. Robison also recommends designating specific roles to each surgical team member in the event of a surgical fire emergency. Here are recommended roles for three possible scenarios.

Patient airway. The anesthesia provider should immediately disconnect and remove the endotracheal tube and the breathing circuit, pour saline into the airway and turn off the flow of oxygen at the anesthesia machine. They must also reestablish the airway and resume ventilating the patient using room air until they are certain nothing is burning in the airway, after which they can switch to using 100% oxygen. The scrub nurse, meanwhile, should pour saline or water from the back table onto the burning endotracheal tube or drop a wet towel on it and push the back table away from the field.

Surgical equipment. The anesthesia provider should immediately inform the circulating nurse to close the oxygen shut-off valve, announce the need for evacuation, disconnect the breathing circuit from the patient, turn off the oxygen flow, convert to room/medical air and release the surgical drapes. Anesthesia techs, if present, should assist the anesthesia provider in ventilating the patient, obtain necessary vital signs and monitor the oxygen tanks and equipment needed to support the patient during evacuation.

Sterile field. The scrub nurse should immediately pour sterile saline or water from the back table onto the fire or smother the flames with wet towels and remove any burning material from the patient. The anesthesia provider must stop the flow of oxygen to the patient and convert to room air until the fire is under control.

Ms. Robison says your staff should be able to articulate how to manage specific types of surgical fires, discuss evidence-based prevention interventions and actions, and clearly discuss with their colleagues during time outs the fire risks associated with specific surgical supplies and equipment before every case.

"Preparing your staff to handle fire emergencies develops skills they hopefully won't have to use," says Ms. Robison, "but better knowledge and understanding of how to prevent surgical fires is essential, and leads to a safer surgical environment."

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