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How Do You Prevent Slips & Trips in the OR?
From fluid to cords to kick buckets, the operating room floor can be a dangerous place.
Dan O'Connor
Publish Date: September 20, 2013   |  Tags:   Staff Safety
disposable cord covers ◙ TOP TRIPPING HAZARD Conceal cords with disposable cord covers or with bath blankets.

Did you hear the one about the anesthesiologist who tripped over the electrical cord in the OR? He wasn't going where he was looking. "That was me," says Gary Lawson, MD, of Moonlight Anesthesia in Fort Myers, Fla. "I tripped over the fluoroscopy machine cable cord because I was looking in the opposite direction." Then there was the surgical tech who literally put his foot in it. Andrew Forgach, CST, of the Center For Special Surgery in Wall, N.J., stuck his foot into a carelessly placed kick bucket and went flying head over heels, crashing down hard on his backside. "I was backing up out of the way of a surgeon," he says. "I went flying. It was like I'd stepped on a skateboard."

Dr. Lawson and Mr. Forgach can laugh about their misadventures now, but trips, slips and falls in the operating room are no laughing matter. How do you prevent slips and trips in the OR for both staff and patients? Let us count the ways, based on our online survey of surgical facility leaders.

1. Keep floors dry. There are many ways to keep the OR floor dry, including wicking devices, absorbent mats set around the table and fluid waste suction systems. "We use intraoperative floor suction devices in high-fluid-volume cases such as arthroscopies, and absorbent wicking pads for traumas and high-fluid-irrigation procedures," says Kim Hager, CST, of Aultman Hospital in Canton, Ohio.

You can also prevent fluid from ever reaching the floor by using drapes that have built-in fluid collection bags. "All of our surgeons do shoulder procedures in the lateral position," says Mr. Forgach. "With these drapes, we don't have to worry about water on the floor, which is a major hazard."

Other good practices to keep floors dry: Clean spills immediately, and let floors 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 the circulator who helped take the patient to PACU during the room turnover. In the interim, the floor of his OR was mopped. "He returned to the OR not knowing the floor was wet," says Mr. Lawson. "As he rushed in, he lost traction and fell."

Clearly post signs in halls and rooms that are wet from spills or cleaning, suggests Roseann Mulliken, CST, RN, of Jersey Shore ASC in Somers Point, N.J.

Don't forget about your staffers' footwear. Require non-slip soles on shoes and establish a no slip-on clogs rule. "All footwear must have an enclosed heel," says Rhonda Winter, RN, nurse manager of the False Creek Healthcare Centre in Vancouver, B.C.

2. Conceal cords. Cords might be the biggest tripping hazard in the OR. Rather than plugging cords into wall outlets and draping them across the floor, think of ways to keep your equipment power cords off the floors. You can contain and bundle them on homemade hangers (tinyurl.com/mbsx4wn) or use suspended outlets and booms. A manager tells of an RN who fell and injured her back when she leaned over to plug something in rather than going around to the outlet. Another tells of having to remove the plug and covers that were installed in the original ORs because they weren't flush with the floor. "A plug in the floor stuck out and a scrub nurse tripped on it and fell," says a surgery center administrator. "She broke a finger and required surgery."

Others suggest plugging equipment in at the side of the table so that cords aren't trailing on the floor where there's foot traffic. If you do drape cords across the floor, you should conceal them. You can buy disposable cord covers or cover them with bath blankets. Remember that the more outlets you have, the shorter the cord length you'll need. The best alternative: wireless equipment that eliminates cords, such as increasingly popular wireless foot pedals for arthroscopic procedures.

3. Keep the lights on. Never turn all the lights off in the OR while surgery is being performed. In such low-lighting situations as cystoscopy or laparoscopy, make everyone in the room or entering the room aware of cords or trip hazards that may not be easily visible, says Jodie Biston, RN, BSN, OR circulator at the Florida Medical Clinic Ambulatory Services Center in Zephyrhills, Fla.

4. Keep everything in its place. Your ORs can be crowded spaces — there are people, furniture, equipment and cords to contend with. Keep pathways clear and reduce the clutter. Keep equipment that's not in use (C-arms and lasers, for example) against the wall and out of the traffic flow.

5. Protect patients. Issue patients well-fitting non-skid slippers (footies or slipper socks) on admission. If patients ambulate in the OR, a nurse should escort them and no cords should be in the patient's path. Some facilities make patients ride into the OR on a gurney if they've received any sedation. "We secure patients on gurneys or in wheelchairs using safety straps before the team positions the patient on the OR bed," says Chris Eggert-Rosenthal, MSN, CNOR. Lock the brakes on the stretcher or wheelchair before moving a patient, says Ms. Biston. "And make sure the patient's blanket or gown doesn't hinder movement if you're ambulating the patient to the OR table," she adds.

Patients using the restrooms in admitting and discharge areas are big fall risks, especially those who aren't comfortable using crutches. A patient using crutches took a spill in the restroom at the Central Oklahoma Surgical Institute in Norman, Okla. "Next time, we'll just use a wheelchair or walker for all patients with ambulating devices," says Kasey Ryan, RN. You can also give unsteady patients a walker to use to ambulate to the bathroom.