Q Is it necessary to mop OR floors between cases when there's no visible soiling? How about if there is just fluid such as irrigation fluid on the floor around the perimeter of the bed? Must the entire OR floor be mopped, or just within the perimeter that was wet? I'm working in an ASC with staff who are used to a hospital setting.
A This is sacred cow. In a 2000 survey by OR Manager, 80 percent of managers said that mopping is confined to the immediate area around the OR table or the soiled area only. When you think about it, this makes sense. These are the only areas that could impact any infectious problems. Those who mop the entire area fell from 28 percent in the 1998 survey to 20 percent in the 2000 survey. The CDC guidelines have no recommendations for disinfecting environmental surfaces between operations in the absence of soiling since these surfaces are rarely implicated as sources of infectious pathogens. AORN says that it's necessary to clean only a 3-foot to 4-foot circumference around the surgical field when visibly soiled. Note that you should clean the entire floor daily.
Infection Prevention columnist
Can scrubs techs close with a skin stapler?
Q A couple physicians in our facility want OR techs to close skin with a skin stapler when the doctors are out of the room. We always thought that the physician must do wound closure. What is the standard of practice for wound closure?
A In Texas, for example, stapling is considered a function of the first assistant. Anyone who functions in the first assistant's role in Texas must be registered with the state, having proven her qualifications for the role. Scrub techs shouldn't perform this task unless they're registered as first assistants with the state. Check with your state authority.
Ramona Conner, RN, MSN, CNOR
Clinical nurse specialist at AORN
Outpatient surgery on pregnant patients
Q A surgeon at our freestanding surgery center wanted to perform an I&D of a breast abscess on a pregnant patient scheduled for an elective C-section in a few days. I was hesitant because of the risk of inducing labor and fetal distress. Are there limitations on procedures we can perform on the outpatient pregnant patient?
A Your hesitation about doing this case at your center is understandable. It's probably not a good idea to operate on a pregnant patient in the third trimester at an ambulatory facility without obstetric backup. Ideally, a labor and delivery nurse, midwife or an obstetrician should be available intraoperatively to monitor fetal heart tones (FHTs) and uterine contractions. Normally, I&D of a breast abscess is a quick procedure but monitoring FHT and uterine contractions isn't practical in the outpatient setting. As a general rule, I'd avoid surgery during pregnancy in the ambulatory setting - especially during the first trimester (when the risk is high for abortion and congenital anomalies) and the third trimester (when the risk is high for inducing labor).
Ashu Wali, MD, FFARCSI
Baylor College of Medicine