Tame the equipment clutter, the fluid runoff, the tangle of cords and other hazards that make most operating rooms such dangerous places to work.

The C-arm's electrical cord was bridge-cable thick, yet it was easy to miss in the dark and crowded operating room. Too bulky to lie flat, it curled and kinked, rising just high enough to catch the foot of Susan Schuldt, RN, MS, CNOR, as she dashed toward the door to get a sterile drape from the supply room down the hall. Ms. Schuldt tripped over the cord and fell hard to the black OR floor on her outstretched hands. She fractured both radial heads, suffered a hairline wrist fracture and opened a nasty gash on her forehead. "Had I hit my head a little differently," she says, "I would have fractured my jaw."

She missed only 3 days of work, but doctors wouldn't let her drive for 6 weeks; the hospital paid for a taxi service to take her to and from work, 30 miles each way. When she returned to duty at Onslow Memorial Hospital in Jacksonville, N.C., she couldn't work in the OR because she had a 1-pound weight restriction. They gave her a desk job, running the OR schedule. "I could pick up the phone, but that's about it," says Ms. Schuldt, who's now the OR clinical coordinator at Onslow.

This nasty spill happened to Ms. Schuldt 9 years ago. Her injuries have healed and Onslow's ORs have since been renovated and enlarged, but could such an accident happen at your facility?

How big of a problem are slips, trips and falls in ORs? Perhaps much bigger than you think.

Slips, trips and falls as a whole are the second most common cause of lost-workday injuries in hospitals, and were more likely to result in fractures and multiple injuries than were other types of workers' compensation claims, according to a 2011 OSHA study, "Slip, Trip and Fall Prevention for Healthcare Workers". Of the 379 facility managers we recently surveyed, 60% say a staff member or a surgeon has sustained an injury from slipping or falling in their ORs.

Have slips, trips or falls injured your OR personnel?

Yes, a serious injury	25%
Yes, a minor injury	35%
No	40%

Source: Outpatient Surgery Magazine InstaPoll, April 2014, n=379

Why wait?
Yet many of the managers we surveyed about preventing OR falls ignore the problem and hope it goes away — until, that is, a surgeon or staff member hits the deck. Only after a slip, trip or fall do they take preventive action, be it covering cords, insisting on slip-resistant footwear or buying a fluid management device. This begs the question: Why wait?

Only after a nurse tripped on a cord during an arthroscopy did St. Luke's Cornwall Hospital in Newburgh, N.Y., purchase cord covers, says Laura Delarose, RN, the clinical nurse manager. Only after a surgeon slipped on the wet floor by the scrub sink did Sound Eye and Laser in Seattle, Wash., turn its attention to keeping the floors dry, says Patricia Walat, RN, BS, the nurse manager. And only after surgeons and staff complained of sloshing around in water during arthroscopies did a hospital invest in water collection devices.

Tales of 'Whoa!'
The risks for slips, trips and falls are everywhere you look and even where you can't see. With the rise in minimally invasive surgeries, most procedures today are done with the lights off, notes Ms. Schuldt, so you can add darkness to the growing list of hazards lurking inside your ORs. Rushing, too.

Take the circulating RN at Chickasaw Nation Medical Center in Ada, Okla., who went dashing after hours to get some paperwork from pre-op. As luck would have it, at the time she was dashing, the night cleaning crew was mopping the floors and hadn't yet posted up the wet floor signs. The nurse fell and sustained a large laceration to her scalp plus an injury to her shoulder that will require surgery. The hospital purchased additional wet floor signs and asked the cleaning crew to post them sooner, says Ralania Tignor, BSN, RN, CNOR, the surgery center manager at Chickasaw.

You know about the dangers of cords and of fluid on OR floors and under scrub sinks. But what about paper? A circulator at the Mobile (Ala.) Infirmary Medical Center slipped on excess drape adhesive paper that fell to the floor after drapes had been removed. "We do not allow the paper to hit the floor," says Sherri Wall, MSHA, BSN, RN, CNOR, Mobile's executive director of surgical services. "Someone must capture the paper and maintain a clear path."

Even hand hygiene dispensers can be tripping and slipping hazards. Place hand hygiene products in the room so that staff doesn't need to cross cords to reach the dispenser, says one reader. And make sure your alcohol-based rub dispensers come with lips to catch excess solution, says another.

Cord control
Many of the tripping hazards at Onslow are gone now that the hospital has modernized its ORs. For one, the ORs are bigger, so they're not crammed with equipment, making it easier to keep the passageways clear. The cords have been tamed. Bright orange adhesive strips cover and tamp down the cords that lie on the floor. The cords that used to stretch across the floor to reach wall outlets plug neatly into outlets built into the head and foot of equipment booms.

If you don't have the benefit of a boom and must use wall outlets, you can still keep cords off the floor. Try these simple cord-consolidation strategies you can do quite easily, like arranging the equipment so that the cords lie on the floor rather than hang in the air. "Position equipment as close to the outlet as possible and on the correct side of the room," says Stacy Meadows, RN, clinical supervisor of North State Surgery Centers in Redding, Calif. You can also zip-tie cords together and hang anesthesia cables from the ceiling. Plug electrical equipment into the receptacles in groups to avoid stretching extra cords across the floor from multiple power boxes. Even the placement of the anesthesia provider matters. Make sure he's not in the path of the staff and make sure that he has everything he needs so that he doesn't need to get up.

"Keeping cords off the floor is a huge challenge. The more equipment you have, the more cords you have," says Chris Eggert-Rosenthal, MSN, RN, CNOR.

Other ideas require more time and expense. You can mount power strips on your electrosurgery stands, says Ms. Eggert-Rosenthal. Or next time you upgrade your video system, consider going wireless, as they did at the University of New Mexico Cancer Center in Albuquerque, N.M. "We implemented a wireless system for the video tower and slave tower system to reduce the numbers of cords as trip hazards," says Robert Payette, the charge RN.

IT'S GOTTA BE THE SHOES Footwear alone is not adequate in preventing slip-related accidents, but non-skid shoes help.

Non-slip footwear
Don't overlook the preventive powers of non-slip footwear for patients (gripped-bottom slipper socks) and staff (rubber-soled shoes). Christa Aycock, BSN, RN, CNOR, director of surgical services at Clearfield (Pa.) Hospital, says a staff member slipped and fell on a freshly mopped floor despite the presence of appropriate signage. The reason: She didn't have shoe covers on.

But shoe covers can be slippery. A better choice might be prescriptive leather-soled, skid-resistant shoes like the ones Scottsdale Healthcare Thompson Peak Hospital in Scottsdale, Ariz., recommends for its OR staff. The hospital spends about $30,000 each year on high-tech footwear, giving employees $40 to put toward the purchase of non-skid shoes that cost between $80 and $90. Thomas W. Kraus, MSN, RN, CNOR, clinical coordinator at Thompson Peak Hospital, estimates that three-fourths of the OR staff wear the skid-resistant shoes. "Slips and trips were enough of a problem that we did have people fall and get hurt and have to get days off to recuperate," says Mr. Kraus.

"They're not very attractive, but they're comfortable," says Karla Lynch, BSN, RN, CNOR, Thompson Peak's spine surgery coordinator, of the Mary Jane-style shoes with the Velcro strap. "Even when I walk on wet floors, I don't slip around. These shoes make a significant difference."