Manufacturers' Guidelines, All in One Place
Where do you keep the manufacturer's guidelines for that? It's a question you can expect to hear amid the increased scrutiny of infection control practices at ambulatory surgery facilities. For example, a CMS, state or accreditation surveyor might ask how long a certain prep needs to be left on the skin for effectiveness. Or how many ounces per gallon a cleaner should be mixed for effectiveness. Can you expect your staff to know the answers to such questions on the spot?

An easy solution is to create a "Manufacturers' Guidelines" notebook that contains the directions for use of every cleaning, prepping, disinfecting and sanitizing product that you use in your facility. It's easy to do. You can obtain most of these product instructions from the label or online. We've gathered them in one easy-to-access spot: a 3-ring binder located in our recovery room along with other important reference books. A handy table of contents makes it easy to find what you're looking for quickly.

Encourage staff to review the instructions even for products they've used for years. Like me, you might be surprised by what you don't know about some products. For example, we've long used a baby-wipe-type product to clean surfaces in our ORs between cases. When we looked at the instructions clearly printed on the dispenser, it stated that 1 application is needed for cleaning and a second application is needed for disinfection. We'd only been performing a 1-pass wipe down, thus not fully disinfecting the surfaces.

Kelly Parkes Wilson, RN, BS
Nurse Manager/Surgery Center Manager
Ponte Vedra Plastic Surgery
Ponte Vedra Beach, Fla.
[email protected]

Online Virtual Tour Eases Children's Anxieties
It's hard to say who's more nervous when a child is about to undergo surgery: the child or the parents? To put everyone's mind at ease, we developed an online virtual tour of our facility (www.browardhealth.org/surgerytour) that teaches children and their families about the surgical process.

Our pediatric pre-op photo tour consists of 15 slides with captions that convey basic facts about what children will experience the day of surgery, from arrival to discharge. The slides are easy to read and include detailed photos of each step of the process. By viewing the tour, children "meet" some of the staff who'll care for them, and learn about what's going to happen and what they'll see.

On a few slides, we included links to KidsHealth (www.kidshealth.org), a fun, interactive website designed specifically for parents, teens and kids that explains medical terminology. We also listed the phone number to our pre-op department so parents can call if they have questions after viewing the slides with their children.

To create the tour, we reviewed each step of the perioperative process from the patient's perspective, took pictures that portray the steps and designed the slides to provide easy-to-understand information. The "mother" is actually a nurse who works in our center; the "patient" is her daughter. Our pediatric surgeons really like the tour. In fact, many of them have linked to it from their own practices' websites.

Betty Capozzi, RN, CAPA
Regional Manager Surgical Services
Surgery Center of Weston at Broward Health Weston
Weston, Fla.
[email protected]

A Sterile Method for Securing Catheters
When it comes to looking for ways to improve infection prevention, anyone who starts IV catheters should look at the tape they're using to secure the catheters, because it could be a vector for bacteria. In research that we published in the Winter 2010 issue of the Anesthesia Patient Safety Foundation's Newsletter, we found that 67% of providers who start IV catheters in a county hospital used non-sterile tape to secure a catheter followed by sterile transparent dressing on top of the non-sterile tape. Our lab study found that non-sterile tape, both freshly opened and previously used rolls, carried coagulase-negative Staphylococcus, Micrococcus, diphtheroids, Viridans streptococcus and 2 types of fungi.

We've come up with a 5-step sterile taping technique to secure IV catheters in a non-emergent setting.

1. Sanitize hands and put on gloves.

2. Wipe the puncture site with alcohol before and after inserting catheter.

3. Put the sterile, transparent dressing over the catheter hub first.

4. Put a piece of non-sterile or sterile tape that extends from the skin across the transparent dressing and onto the IV tubing distal to the catheter hub.

5. Put more tape, as needed, over the tubing.

Melissa Cady, DO, and Leah Gross, MD
University of Texas Health Science Center
San Antonio, Texas
[email protected]

2 ID Bands for Pediatric Patients
We place 2 identification bands on our pediatric patients. The first is the routine hospital ID band. A second, colored band, placed on the same extremity, correlates with their admission weight and corresponding color from the Pediatric Advanced Life Support (PALS) guideline. This simple safety step will save us time in case of an emergency. We have now extended this simple safety measure to our emergency department and designated pediatric inpatient unit.

Nancy Kellett, RN, BSN, CPAN
Columbia-St. Mary's Ozaukee
Mequon, Wis.
[email protected]

Bar Codes Save Time Ordering Supplies
Keeping the shelves in your supply room stocked is a time-consuming task when you do the job with paper and pencil. Automating the process with a bar-code scanner can make materials management a breeze.

Most of today's surgical supplies have bar codes on them, right? Using a keychain-sized scanner, all you have to do is scan the items you want to order. The scanner connects to a PC that creates purchase orders for the scanned items. Once you've created the orders, you can review them and make any corrections. In a matter of minutes, you're ready to submit orders to each vendor with the click of a button.

Some vendors are set up to accept your orders via an online portal. Otherwise, you print out the order to be faxed or submit it via e-mail. Either way, the bar-code system beats walking around supply areas with clipboards, recording what needs to be ordered by hand and then entering each item into the computer and faxing the orders to the vendors.

Automating the process has additional perks besides the time savings. The system notifies us quickly via the online portal of any back orders or pricing issues, letting us take swift action to avoid running out of supplies or overpaying for them.

We served as a test site for MedProcure (www.medprocure.com). There's a one-time $295 installation and training fee (includes scanner) and a $495 annual fee.

Debbie Straw, CST
Materials Manager
Allied Physicians Surgery Center
South Bend, Ind.
[email protected]