Vendors sometimes take liberties with their OR passes, standing in places they shouldn't, breaching OR etiquette, and jeopardizing staff and patient safety. We understand that vendors have a job to do, but when your circulating nurse has to elbow her way to the OR table, it's time to take stock of who you're letting watch surgery. Here's how to track, educate and manage vendor visits to ensure a safe OR environment.

Check them in. Have reps sign in at the front desk when they arrive. Record their company's name, cell phone or pager number, the case they're supporting and their arrival time. Hand them a security badge and record the badge's number on the sign-in sheet.

We also take the vendor IDs reps receive from our purchasing department. You might consider taking their car keys or driver's licenses. By holding those items as collateral, reps are guaranteed to stop by the receptionist's desk to sign out when leaving, giving an accurate time stamp and record of their departure. It also prevents them from leaving with clinical area security passes, which happened to us fairly frequently.

Having an accurate record of vendors' arrival and departure times helps the OR staff when they have questions about equipment. They can call down to the front desk and check to see if the rep has arrived or left for the day, so they aren't left wondering when or if their questions will be answered.

Identify them. Color-coded scrub caps are the easiest way to distinguish reps from your full-time faculty. We have vendors — as well as residents, nursing students and other visitors — wear green caps. That lets our clinical team and surgeons easily identify visitors who may need extra guidance or monitoring in the OR.

Restrict their movement. Some vendors visit your facility often enough to befriend your staff and surgeons. To be fair, schmoozing is part of their job. Your challenge is to keep the unneeded networking to a minimum. Ask reps to arrive 15 minutes before the start time of the case they're supporting and set expectations that they should leave the facility soon after the case concludes. Demand that they're on time and ready to go. Reps shouldn't be giving tips to the clinical team and surgeons or answering their questions while the patient is being anesthetized.

Giving vendors access to your ORs doesn't give them a free pass to go wherever they please. We recently eliminated their access to the surgeons' lounge. That decision was based on HIPAA concerns, on limiting the time our surgeons have to listen to sales jargon and partly because we don't want the reps hanging around our facility longer than necessary.

Also limit vendors' movements during surgery. We performed a mock audit during a recent total hip. The audit revealed that the OR door was opened a staggering 77 times as vendors, staff, anesthesia providers, residents and nursing students came and went. That's unacceptable. While vendors were only part of the problem, we made them aware that surgical infection rates may correlate to the amount of foot traffic moving in and out of ORs during surgery.

Define their role. Reps with clinical backgrounds understand staff roles in the OR. That's not always a good thing. One former OR nurse and current sales rep thought it was acceptable for her to open sterile instrument packs during a case. It's not. Regardless of their level of surgical experience, reps need to understand their roles in the OR. They're there to provide technical support for their products, not to act as scrub nurses or surgical techs. Vendors must remain silent during surgical timeouts and keep talking to a minimum during procedures. Excessive banter is disruptive to both surgeons and staff.

Establish zones in the OR where vendors are allowed to stand. They should be at least 12 inches from the sterile field, always facing it and should never walk between sterile fields. Reaching into the sterile field is prohibited. Reps should carry laser pointers for directing surgeons and staff during procedures.

Set their dress code. Reps shouldn't wear jewelry, fake nails or nail polish. They must don your facility's scrubs and their undershirts must be contained beneath scrub tops. Street shoes are permissible as long as shoe covers are worn. Teach reps the proper way to remove a mask (using the strings, not the filter) and instruct them to wash their hands after mask removal.

Test them. Each vendor visiting our facility must obtain annual in-house accreditation by passing a 13-question, computer-based quiz. The test covers the rationale behind our dress code, infection prevention practices and our facility's vendor visitation policies.

When wrong answers are submitted, the computer program provides the correct answers and the reasoning behind them. Reps must take the test as many times as necessary to answer each question correctly. After passing, vendors fully comprehend the directives they need to understand and follow in order to work with our staff in a safe and productive clinical environment.