All posts by Marrianne

Clinical Quality & Safety, Education, Operating Room Workflow, Perioperative Nursing, Technology, Workflow Operations

Are We Losing the Fundamentals of Aseptic Technique in Modern Operating Rooms?

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Modern operating rooms are faster, busier and more technologically advanced than ever before.
But as surgical throughput increases and experienced perioperative clinicians leave the workforce, many healthcare professionals are asking an important question:

Are the fundamentals of aseptic technique and sterile workflow being unintentionally diluted?

 

 

Operating rooms today are under immense pressure:

  • increasing surgical demand
  • workforce shortages
  • rapid turnover expectations
  • rising procedural complexity
  • growing technology integration

Yet despite these pressures, one principle remains unchanged:

Every movement in the operating room matters.

The Operating Room Is a Workflow Environment

Aseptic technique is not simply about sterile gloves and gowns.

It is a coordinated clinical workflow built around:

  • movement discipline
  • contamination prevention
  • environmental awareness
  • communication
  • surgical conscience
  • team coordination

The way perioperative staff:

  • open sterile supplies
  • move around sterile fields
  • don masks and PPE
  • position equipment
  • manage cables and robotics
  • control theatre traffic
  • protect sterile setups

all contribute directly to infection prevention and patient safety.

These behaviours are often learned not from policy alone, but through:

  • mentorship
  • observation
  • repetition
  • correction
  • supported perioperative education

“Aseptic technique is not just taught. It is passed on.”

 

International Perioperative Standards Exist for a Reason

Globally recognised perioperative organisations including:

  • Association of periOperative Registered Nurses (AORN)
  • Australian College of Perioperative Nurses (ACORN)
  • Operating Room Nurses Association of Canada (ORNAC)
  • European Operating Room Nurses Association (EORNA)

have developed standards and guidelines to support:

  • aseptic technique
  • sterile field management
  • operating room traffic control
  • surgical attire and masking
  • environmental cleaning
  • patient preparation
  • surgical hand antisepsis
  • sterile supply handling
  • infection prevention and control

These standards exist because variability in sterile practice increases risk.

They reinforce principles such as:

  • never walking between two sterile fields
  • maintaining sterile boundaries
  • reducing unnecessary door openings
  • minimising operating room traffic
  • correct sterile opening technique
  • maintaining visual awareness of sterile items
  • appropriate mask use in restricted areas
  • protecting airflow integrity

Yet maintaining these standards consistently requires:

  • education
  • reinforcement
  • supervision
  • competency development
  • perioperative culture

Every Movement Around a Sterile Field Matters

Many perioperative clinicians remember being taught:

  • to walk around sterile fields
  • not between two sterile setups
  • never turn your back on an open sterile trolley
  • avoid reaching over sterile equipment
  • maintain clean-to-dirty workflow
  • protect sterile boundaries at all times

These principles may appear simple.

But they are critical infection prevention behaviours developed over decades of perioperative practice.

Clinical workflow examples include:

  • circulator nurses walking around sterile fields to adjust room equipment
  • correct opening of sterile supplies without contaminating contents
  • safe handling of sterile instruments
  • controlled patient skin preparation techniques
  • minimising airflow disruption
  • maintaining sterile awareness during robotic surgery setup
  • safe positioning of equipment and cables around the sterile field

“The basics are not basic. They are the invisible safety systems that protect patients every day.”

Throughput Pressure May Be Reducing Teaching Opportunities

Modern operating rooms are balancing:

  • efficiency targets
  • staffing shortages
  • increased case complexity
  • onboarding of novice staff
  • rapid orientation requirements
  • increasing reliance on temporary workforce models

Under these conditions, perioperative education can unintentionally become compressed.

Yet many of the most important sterile workflow skills are experiential.

Learning:

  • how to safely circulate around a sterile field
  • how to recognise subtle contamination risks
  • how to safely open sterile consumables
  • how to protect a sterile setup during room movement
  • how to anticipate contamination before it occurs takes time, mentorship and repetition.

Research examining missed nursing care in Australia in perioperative settings identified workload, organisational and communication pressures contributing to omitted or delayed care activities. These pressures may indirectly affect sterile workflow vigilance and education opportunities.

Infection Prevention Starts Before the Incision

Infection prevention begins long before surgery starts.

It begins with:

  • correct patient preparation
  • appropriate PPE use
  • sterile equipment setup
  • environmental control
  • disciplined operating room workflow

Research has demonstrated associations between:

  • operating room traffic
  • door openings
  • airflow disruption
  • microbial contamination risk
  • surgical site infection risk

A 2025 systematic review identified evidence suggesting increased operating room door openings may contribute to increased surgical site infection risk.

Another study found that increased theatre traffic and longer surgical duration were associated with increased airborne microbial contamination within operating rooms.

These findings reinforce an important principle:

Human behaviour within the operating room environment matters.

 

Modern Operating Rooms Are Becoming More Complex

Today’s perioperative environments include:

  • robotic surgery systems
  • advanced imaging integration
  • multiple digital platforms
  • increased equipment density
  • complex cable management
  • multidisciplinary workflow coordination

While technology supports surgical advancement, it also increases cognitive and workflow complexity.

This makes strong perioperative education more important than ever.

Because technology alone cannot replace:

  • sterile awareness
  • workflow discipline
  • situational awareness
  • contamination anticipation
  • perioperative teamwork

 

Surgical Conscience Must Be Protected

Historically, perioperative culture has relied heavily on experienced clinicians passing on sterile discipline to the next generation.

This includes:

  • correcting unsafe movement
  • reinforcing sterile awareness
  • teaching contamination prevention
  • supporting psychological safety
  • encouraging staff to speak up

When experienced perioperative clinicians leave without structured succession and mentorship, organisations risk losing:

  • institutional knowledge
  • workflow discipline
  • contamination prevention behaviours
  • confidence within teams
  • perioperative culture itself

Key Concerns Facing Modern Operating Rooms

  • Reduced perioperative orientation time
  • Increased surgical throughput pressure
  • Loss of experienced perioperative clinicians
  • Reduced mentorship opportunities
  • Workflow interruptions
  • Increased operating room traffic
  • Cognitive overload
  • Inconsistent aseptic technique reinforcement
  • Increased technology complexity
  • Pressure to prioritise efficiency over education

Why This Matters

  • Surgical site infections remain a significant global patient safety concern.
  • Operating room traffic and door openings have been associated with increased contamination risk.
  • Missed perioperative nursing care has been linked with workload and communication pressures.
  • Perioperative workflow directly influences sterile field protection.
  • Replacing experienced perioperative clinicians is costly and time intensive.
  • International perioperative standards exist to reduce preventable harm and support safe surgical practice.

The Future of Safe Surgery Depends on the Basics

Modern surgery will continue to evolve through:

  • robotics
  • digital integration
  • advanced technology
  • artificial intelligence
  • complex procedural innovation

But no technology can replace:

  • surgical conscience
  • sterile awareness
  • disciplined workflow
  • perioperative mentorship
  • human vigilance

The future of safe surgery will not depend solely on innovation.

It will depend on whether we continue to protect and teach the fundamentals that keep patients safe every single day.

Because the basics are not “basic.” They are the foundation of safe perioperative care.

References

  1. Gillespie BM, Harbeck E, Kang E, et al. Missed nursing care in Australian perioperative settings: A cross-sectional study. Journal of Advanced Nursing. 2024. Available at: https://pubmed.ncbi.nlm.nih.gov/38380764/
  2. Blomberg AC, Lindwall L, Bisholt B. Operating room nurses’ experiences of maintaining aseptic technique and safe practice in the surgical environment. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12465459/
  3. Dancer SJ, et al. Operating room door openings, microbial contamination and surgical site infection risk: systematic review. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12159596/
  4. Andersson AE, Bergh I, Karlsson J, Nilsson K. Traffic flow in the operating room: an explorative and descriptive study on air quality during orthopedic trauma implant surgery. American Journal of Infection Control. 2018. Available at: https://www.ajicjournal.org/article/S0196-6553(18)30156-1/pdf
  5. Gillespie BM, et al. Simulation-based patient safety education for perioperative clinicians: improving safety competencies and teamwork. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10649324/
  6. Scoping Review of Aseptic Technique Definitions and Practices in Healthcare Settings. International Journal of Nursing Practice. 2025. Available at: https://www.sciencedirect.com/science/article/pii/S019567012500266X
  7. Joint Commission International. Surgical Site Infection Prevention Toolkit. Available at: https://digitalassets.jointcommission.org/api/public/content/assets/3/7/jci_ssi_toolkit.pdf
  8. AORN Guidelines for Perioperative Practice — Association of periOperative Registered Nurses
  9. ACORN Standards for Perioperative Nursing in Australia — Australian College of Perioperative Nurses
  10. ORNAC Standards and Recommended Practices — Operating Room Nurses Association of Canada
  11. EORNA European Perioperative Guidelines and Resources — European Operating Room Nurses Association
Clinical Education, Clinical Governance, Clinical Quality & Safety, Healthcare Education, Healthcare Leadership, Operating Room, Operating Room Education, Patient Safety, Perioperative Nursing, Staff Wellbeing

The Hidden Cost of Losing Operating Room Expertise

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Why perioperative workforce retention is becoming one of healthcare’s greatest global challenges 🛡️

 

Experience Matters in the Operating Room

 

 

Behind every safe surgical procedure is a highly skilled perioperative team balancing patient safety, workflow coordination, communication, anticipation, technology, and critical decision-making in real time.

Yet globally, operating rooms are approaching a major workforce transition.

The World Health Organization estimates a projected global shortage of approximately 4.5 million nurses by 2030, with workforce gaps continuing to impact healthcare systems worldwide.

Within perioperative care, the challenge is even more complex.

Perioperative nursing is one of the most specialised areas of healthcare. It requires years of procedural exposure, situational awareness, technical skill, communication, anticipation, adaptability, and hands-on clinical experience developed within real operating room environments.

Unlike many other clinical areas, perioperative clinicians must continuously coordinate multiple moving parts simultaneously:

⚕️patient safety

🩺sterile technique

🔄surgical workflow

🧠instrumentation

💻technology integration

⚙️equipment troubleshooting

⏳emergency response

🤝communication between multidisciplinary teams

📋procedural anticipation under pressure

 

 

These are not skills learned overnight.

 

Research highlights that it may take 6–12 months for a perioperative nurse to achieve proficiency, with training and orientation costs estimated between $80,000–$88,000 AUD per nurse. Australian workforce studies have also estimated average nursing turnover costs of approximately $49,255 AUD per full-time nurse, with specialty workforce losses significantly higher due to orientation, productivity reduction, temporary staffing, and lost expertise.

 

 

 

 

But perhaps the greatest cost is the one least measured:

 

The Loss of Experience

Every experienced perioperative nurse, surgical technologist, ODP, anaesthetic nurse, technician, or operating room support professional who leaves healthcare takes with them years of accumulated procedural knowledge, pattern recognition, workflow intelligence, communication ability, equipment familiarity, troubleshooting capability, and patient safety expertise that cannot simply be replaced by orientation alone.

 

Experienced perioperative teams contribute far beyond task completion.

 

They:

🧠identify risk early

🛡️anticipate surgeon needs before requests are verbalised

🩺recognise subtle patient deterioration

✅coordinate teams during emergencies

🎯troubleshoot equipment failures rapidly

🧠maintain sterile workflow under pressure

🛡️mentor junior clinicians

🩺reduce procedural delays

✅improve communication and theatre efficiency

💙strengthen safety culture within operating rooms

 

 

Research continues to show that insufficient staffing and burnout contribute to workflow disruption, increased stress, reduced team stability, cancelled surgeries, adverse patient outcomes, and growing pressure on remaining clinicians.

 

This is no longer simply a staffing issue.

It is:

  1. a patient safety issue
  2. a healthcare sustainability issue
  3. a workforce resilience issue
  4. an operational efficiency issue
  5. a clinical governance issue

 

The Future of Surgical Care

 

Technology must support the humans delivering care

 

 

The future of surgical care will not depend solely on advancing technology.

It will depend on how well we:

 

🧠 preserve knowledge

🤝strengthen mentorship

💙support workforce wellbeing

🛡️improve retention

💰invest in perioperative education

🛡️create psychologically safe workplaces

⚕️support clinicians at the point of care

 

Technology should not replace clinical experience.

It should help preserve, support, and strengthen it for the next generation of perioperative professionals.

Because when we support perioperative teams, we support patients.

References

  1. World Health Organization. Nursing and Midwifery Fact Sheet. World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery
  2. Xie A, et al. Perioperative Nursing Shortages: An Integrative Review of Contributing Factors, Impacts, and Strategies. 2024.
  3. Roche M, et al. Nursing Workforce Turnover and Associated Costs in Australia.
  4. Li Y, et al. Understanding Burnout Among Operating Room Nurses. 2025.
Perioperative Safety, Surgical Best Practice

Electrosurgery & Cautery Safety: Protecting Patients Through Vigilance, Communication, and Best Practice

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⭐ A Personal Note on Perioperative Practice

Every day in the operating room, perioperative professionals carry an extraordinary level of awareness and responsibility. Our roles — whether as nurses, surgeons, anaesthesiologists, surgical technologists, ODP’s or surgical assistants — require us to think about far more than the technical steps of a procedure.

We are constantly managing:

  • the safety and comfort of our patient

  • the surgeon’s needs and the flow of the operation

  • sterility, equipment, instrumentation, and positioning

  • oxygen levels, fire risks, energy devices, and electrosurgical safety

  • implants, allergies, comorbidities, medications, and documentation

  • communication across multiple teams

  • and the unexpected events that can arise at any moment

This level of complexity is part of what makes perioperative practice so unique — and so demanding. Electrosurgical and airway safety are only one piece of our daily responsibilities, yet they require constant vigilance and teamwork. A single decision, moment of inattention, or missed communication can have serious implications for patient safety.

What keeps patients safe is not any one person, guideline, or device.
It is the collective, coordinated awareness of every member of the surgical team.

This blog reflects the real clinical reality we face every day:
that perioperative care is a blend of technical skill, professional judgement, continuous learning, and shared responsibility. These high levels of awareness are the quiet work we do every single day to protect our patients — often without them ever knowing.

Electrosurgery is an essential tool in modern surgery, enabling effective cutting, coagulation, and hemostasis. But despite its benefits, electrosurgery carries real risks — including patient burns, fire hazards in oxygen-rich environments, alternate-site current injuries, and complications involving metal implants and external monitoring devices such as CGM sensors.

Improving safety requires situational awareness, strong communication, proper equipment use, and ongoing education. This blog highlights key risks, best practices, international standards, and emerging considerations for perioperative teams.

🔎 Understanding the Risks of Electrosurgical Burns

Electrosurgery-related burns arise from:

  • Poor grounding pad adhesion

  • Incorrect pad placement over hair, scars, or bony prominences

  • Insulation failure of laparoscopic instruments

  • Capacitive or direct coupling

  • Alternate current pathways involving metal implants such as hip or knee replacements, plates, and screws

These injuries can be deep, severe, and require further surgery — nearly all preventable.

Fire Risk in Oxygen-Enriched Settings

During head, neck, and airway procedures — especially under sedation — oxygen accumulates under drapes. In combination with electrocautery, this forms the fire triangle:

Ignition (ESU) + Oxygen + Fuel (drapes, alcohol prep)

Consequences may include facial burns, airway injury, and equipment damage.

🔒 Oxygen & Airway Safety (AST & ASA Best Practice)

Safe electrosurgery near the airway is a team responsibility shared by surgeons, anaesthesiologists, nurses, and surgical technologists. Both the Association of Surgical Technologists (AST) and the American Society of Anesthesiologists (ASA) provide clear guidance to reduce surgical fire risk in oxygen-enriched environments.

AST Key Recommendations

  • Keep oxygen concentration below 30% whenever possible.

  • If higher oxygen is required, avoid open delivery systems and consider ETT or LMA.

  • Stop or reduce supplemental oxygen or nitrous oxide for at least one minute before activating electrosurgery, battery-powered cautery, or lasers during head, neck, and upper-chest procedures.

ASA Practice Advisory

  • Surgeons must alert anesthesia before activating any ignition source.

  • Anesthesia must alert surgeons if oxygen concentration is elevated or if an oxygen-enriched atmosphere is present.

  • Reduce oxygen to the lowest level that maintains safe saturation whenever clinically feasible.

Why this matters

These recommendations help all perioperative professionals minimise ignition risk, coordinate timing, and maintain safe oxygen practices when using electrosurgery near the airway.

Metal Implants & External Metal Devices

Perioperative teams must confirm the presence and location of:

  • Joint replacements

  • Orthopaedic plates, screws, rods

  • Cardiac/neurostimulators

  • Metal-backed electrodes

  • Diabetic glucose-monitoring systems with metal components

These items may unintentionally divert electrical current and cause burns.

⭐ Global Consensus

Every major organisation agrees:

Electrosurgery safety is a non-negotiable core competency for all perioperative practitioners — nurses, surgical technologists, and assistants.

This includes:

  • ESU physics

  • Pad placement

  • REM monitoring

  • Implant/CGM identification

  • Fire prevention

  • Airway safety

  • Insulation failure recognition

  • Oxygen management

  • Documentation and communication

What the data actually shows (2020–2025)

There is no single global registry that counts “all ESU burns” per year, so we have to pull from several reliable signals: medico-legal claims, sentinel event reports, and national safety alerts. All of them agree on one thing: burns and fires from electrosurgery are real, ongoing, and under-reported.

United Kingdom (NHS Resolution – diathermy burns)

NHS Resolution FOI data for England & Wales show clinical negligence claims where diathermy burns were the primary cause:

  • 2018/19 – 40 claims

  • 2019/20 – 26 claims

  • 2020/21 – 22 claims

  • 2021/22 – 17 claims

  • 2022/23 – 23 claims

  • 2023/24 – 21 claims

So from 2020/21 to 2023/24, there were around 20–25 closed claims per year specifically for diathermy burns in England and Wales alone. These are only cases serious enough to progress to a claim, so they almost certainly underestimate the true number of burns.

United States (energy-device injuries & surgical fires)

For the US, data sources point to both burn injuries and surgical fires where ESUs are the main ignition source:

  • A MAUDE database analysis of surgical energy-based device injuries (1994–2013) found 3,553 injuries and 178 deaths; thermal burns were 63% of injuries (~2,353 cases), and dispersive-electrode burns were a major mechanism. PubMed+1

    • This is older but still the key reference used in guidelines; there’s no newer 2020–2025 MAUDE summary yet.

  • A national review of surgical fires in the US from 2000–2020 identified 565 surgical fire events causing harm over 20 years (median 25 per year); in 82% of these, an electrosurgical device was the ignition source. ScienceDirect

  • A 2024 continuing-education article summarising Joint Commission data reports that from 1 Jan 2018 to 29 March 2023, 85 sentinel events related to fires or burns during surgery or procedures were reported, and notes that around 70% of surgical fires are caused by electrosurgical devices based on ECRI data. ast.org+2pedsurgeryupdate.com+2

Again, these are only the tip of the iceberg (fires and serious burns that get reported centrally), not every minor or moderate ESU burn is reported.

Australia (NSW & Victoria – incidents and sentinel events)

Australia doesn’t publish a national annual count of ESU/diathermy burns, but safety alerts and sentinel-event frameworks show clear concern:

  • NSW Health Safety Notice SN 013/23 reports a laparoscopic case where degraded insulation on a diathermy electrode caused a bowel burn requiring further surgery. NSW Health

  • The updated Safety Notice SN 020/25 notes that 10 additional incidents involving insulated laparoscopic instruments were reported across NSW since the original notice, prompting a strengthened response. NSW Health

  • Safer Care Victoria’s 2024 Sentinel Event Guide explicitly lists “in theatre diathermy accident or burn or where there is an explosion or fire” as a reportable sentinel event – meaning even a single case is treated as very serious. Better Safer Care

So, while we don’t have a neat “X per year” number for Australia, we do have clear evidence of ongoing patient harm, enough to drive repeat safety notices and inclusion as a sentinel event.

📌 IMPORTANT: Continuous Glucose Monitoring (CGM) in Surgery

With increasing community use, many patients arrive for surgery wearing CGM sensors, such as:

  • FreeStyle Libre

  • Dexcom

  • Medtronic Guardian

These devices contain metallic components, which can behave like unintended electrodes during monopolar electrosurgery, posing burn and interference risks.

⚠️ Device Interaction & Burn Risk

  • Manufacturers instruct removal before diathermy.

  • Research demonstrates increased tissue heating around metal implants/sensors with monopolar ESU.

  • Case reviews recommend positioning CGM away from the diathermy arc and considering alternative devices.

  • Mechanism mirrors documented ECG-electrode burns.

🧑‍⚕️ Perioperative Recommendations

  • Ask all diabetic patients about CGM use.

  • Document location and remove before ESU use.

  • If not removable:

    • Keep the device outside the current pathway

    • Place dispersive pad to route current away

    • Prefer bipolar or ultrasonic devices

Include in the surgical time-out:

“Is the patient wearing a CGM or metal glucose sensor?”

📝 CGM Safety Action Plan for Surgery

1. Inform the Healthcare Team. Patients must tell their surgeon, anaesthetist, and perioperative nurse if they wear a CGM device.

2. Remove the Device Before Surgery. Stop the current sensor session and remove all wearable components before entering the OR.

3. Monitor Glucose with Fingerstick While Removed. Use a standard glucose meter for monitoring and treatment decisions while CGM is off.

4. Replace the Sensor After Surgery. Apply a new CGM sensor after the procedure and confirm accuracy using a fingerstick glucose test.

5. Follow Manufacturer Guidance. Refer to official Dexcom, FreeStyle Libre, or Medtronic instructions for removal and replacement.

🧑‍⚕️ Best Practice Principles for Safe Electrosurgery

1. Pre-operative Screening & Communication

  • Identify metal implants, CGM sensors, and piercings.
  • Communicate clearly during team briefings.

2. Correct Grounding Pad (Dispersive Electrode) Placement

  • Apply to clean, dry, hair-free skin
  • Choose large muscular areas
  • Avoid scars, prostheses, bony areas
  • Recheck after repositioning
  • Document placement

3. Return Electrode Monitoring (REM): Audible Alarms Matter

  • REM provides an audible tone confirming contact.
  • Loss of contact triggers a loud alarm and cuts monopolar output.
  • ESUs may be placed out of view — making audible cues essential.
  • Audible alarm can be turned up or down, volume button is usually situated at the back of the ESU.

4. Safe Use Near the Airway

  • Minimise open oxygen
  • Use lowest flow possible
  • Allow oxygen to disperse before activation
  • Apply suction under drapes
  • Keep sterile water ready

5. Choosing the Safest Energy Modality

  • Prefer bipolar
  • Use advanced bipolar or ultrasonic devices when implants/CGM present
  • Avoid monopolar cautery near oxygen-rich environments

6. Education, Competency & Culture

Structured, ongoing training reduces preventable harm from burns and fires.

All perioperative staff, connecting ESU leads should be aware of Patient Safety and ESU protocols.

🌍 International Standards & Best Practices for Electrosurgery Safety

Safe ESU use is considered a mandatory competency worldwide. Major perioperative organisations outline strict expectations for education and practice.

AORN — USA

AORN’s Guideline for Safe Use of Energy-Generating Devices requires:

  • Mandatory ESU/energy-device education
  • Competency verification
  • Fire-prevention protocols
  • Standardised ESU setup and REM response
  • Annual competency review

ACORN — Australia

ACORN’s Standards for Perioperative Nursing include Electrosurgical Safety as a core clinical standard:

  • Monopolar/bipolar principles
  • Safe pad placement
  • Preventing alternate-site burns
  • Airway & oxygen management
  • Novice nurse education through Fundamentals of Intraoperative Nursing

AfPP — United Kingdom

AfPP’s standards emphasise:

  • Training & competency assessment
  • Equipment checks and risk management
  • ESU safety as part of routine clinical audits

ORNAC — Canada

ORNAC’s guidelines identify ESU safety as:

  • A foundational competency for perioperative RNs
  • A required component of approved perioperative education programs
  • A standard requiring annual review and validation

EORNA — Europe

EORNA’s Best Practice for Perioperative Care includes a full electrosurgery section covering:

  • Generator checks
  • REM
  • Burns from implants, piercings
  • Fire and oxygen risk
  • Safe handling of energy devices

AST / NBSTSA — Surgical Technologists (USA)

Surgical technology bodies require competency in:

  • ESU setup
  • Pad placement
  • Cautery-pencil safety
  • Insulation-failure identification
  • Fire prevention
  • Alternate current pathway risks

References

  1. AORN. Guideline for Safe Use of Energy-Generating Devices. In: Guidelines for Perioperative Practice. Association of periOperative Registered Nurses, USA.
  2. ACORN. Standards for Perioperative Nursing in Australia – Electrosurgical Safety Standard; Fundamentals of Intraoperative Nursing education resources. Australian College of Perioperative Nurses, Australia.
  3. AfPP. Standards and Recommendations for Safe Perioperative Practice. Association for Perioperative Practice, United Kingdom.
  4. ORNAC. Guidelines for Perioperative Nursing Practice in Canada. Operating Room Nurses Association of Canada.
  5. EORNA. Best Practice for Perioperative Care – Electrosurgical Safety section. European Operating Room Nurses Association.
  6. AST / NBSTSA. Core Curriculum for Surgical Technology and NBSTSA Certification Examination Content Outline – Surgical Energy and Electrosurgical Unit (ESU) Safety. Association of Surgical Technologists / National Board of Surgical Technology and Surgical Assisting.
  7. NHS Resolution (UK). FOI 6813 – Diathermy burns / reaction to prep – hospital-acquired infection claims data (2018/19–2023/24).
  8. NHS Resolution (UK). FOI 6278 – Diathermy burns – clinical negligence claims/incidents (2017/18–2022/23).
  9. NSW Health. Safety Notice SN 013/23 – Risk of burn injury from degraded insulated laparoscopic instruments. New South Wales Health, Australia.
  10. NSW Health. Safety Notice SN 020/25 – Further incidents involving insulated laparoscopic instruments. New South Wales Health, Australia.
  11. Safer Care Victoria. Victorian Sentinel Event Guide 2024 – In-theatre diathermy accident or burn, explosion or fire as a reportable sentinel event. Safer Care Victoria, Australia.
  12. U.S. Food and Drug Administration (FDA). MAUDE database analysis of energy-based surgical devices – injuries, deaths and proportion of thermal burns.
  13. ECRI Institute. Surgical Fires in the Operating Room – root causes and contribution of electrosurgical devices as ignition sources.
  14. The Joint Commission. Sentinel Event Data Summary (2018–2023) – Fires and burns during surgery and procedures.
  15. Canadian Medical Protective Association (CMPA). Intraoperative burns: learning from medico-legal cases – analysis of 53 intraoperative burn cases (2012–2016).
  16. CMPA. Surgical fires: managing the risks – summary of 54 medico-legal cases related to surgical fires in Canada.
  17. Health Canada. Medical Device Recall Notices – Patient return electrode pads used with electrosurgical units (2023–2024).
  18. Ontario Ministry of Labour, Immigration, Training and Skills Development. Alert: Preventing Surgical Fires in Hospital Operating Rooms (updated 2025).
  19. Abbott Diabetes Care. FreeStyle Libre Sensor – Important Safety Information (diathermy and high-frequency electrical treatment warnings).
  20. Dexcom. Dexcom Continuous Glucose Monitoring System – Safety Information (guidance regarding electrosurgery and imaging).
  21. Medtronic. Guardian / Medtronic CGM Systems – MRI and diathermy safety guidance.
  22. Studies examining tissue heating around metallic implants and glucose sensors during monopolar electrosurgery, demonstrating increased local temperature near metal.
  23. Electrosurgical safety literature describing ECG-electrode and external-electrode burn mechanisms caused by high current density and unintended alternate pathways.
  24. Case reports and reviews of electrosurgical pad burns, insulation failures, alternate-site burns and oxygen-related fires in head and neck / airway surgery.
  25. SAGES. Fundamentals of the Use of Surgical Energy (FUSE) – educational program highlighting common knowledge gaps in surgical energy safety among surgeons and perioperative clinicians.
  26. Association of Surgical Technologists (AST). Guidelines for Best Practices: Safe Use of Energy Devices. AST Standards of Practice for Surgical Technology and Surgical Assisting. (Includes recommendations for oxygen management, reducing oxidizer concentration, and pausing oxygen flow ≥1 minute before using electrosurgery or lasers during head, neck, and upper-chest procedures.)
  27. American Society of Anesthesiologists (ASA). Practice Advisory for the Prevention and Management of Operating Room Fires. ASA Task Force on Operating Room Fires. (Provides guidance for ignition-source control, team communication, and safe oxygen practices during electrosurgery and airway procedures.)
Human factors, Human factors, Operating Room, Perioperative Practice

✈️From Pilots to Perioperative Practice: Why Organisation and Readiness Save Lives in the OR

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Instrument nurses anticipate, troubleshoot, and act quickly under the direction of the surgeon and surgical team. This readiness is not spontaneous—it’s practised, structured, and supported by systems that make efficiency possible.

Which is why it’s essential that supplies are restocked, accessible, and organised in a way that supports those using them. When instruments and equipment are easy to locate, workflows become smoother, communication clearer, and patient care safer.

Healthcare facilities are unique. Multiple surgeries often take place at the same time, across different specialties and with varying surgeon preferences. Balancing and anticipating the requirements of each case can be challenging. The ability to maintain surgical flow depends on robust systems that support real-time visibility of supplies, streamline communication, and ensure that all teams can access what they need—when they need it.

In critical moments, seconds matter. Organisation, preparation, and anticipation aren’t just about tidiness—they’re about saving time, reducing stress, and optimising outcomes.
The best teams don’t just react; they prepare.

Evidence Supporting Organised Workflows in the OR

🧩 Human Factors & Cognitive Load

Operating rooms are complex, high-stakes environments where even small inefficiencies increase cognitive load and the likelihood of error. Research in the Journal of the American College of Surgeons (2018) found that structured equipment layouts improve situational awareness and reduce team stress, particularly during intraoperative crises.

🏥 ACORN, AORN, EORNA, AfPP & ORNAC Standards

Global perioperative standards—including those from ACORN, AORN, EORNA, AfPP, and ORNAC—all recognise that organised, accessible, and standardised supplies underpin surgical safety and efficiency.
These organisations advocate for environmental readiness, equipment control, and preparation practices that enable clinicians to respond effectively when events change rapidly.

  • AORN Guidelines for Perioperative Practice (2024) highlight the impact of organised sterile fields on reducing inefficiency and risk.

  • ACORN Standards for Perioperative Nursing (2023) emphasise stock control, setup, and environmental preparation as foundational to safe surgical care.

  • EORNA Best Practice for Perioperative Care (2023) promotes safety through standardised processes and structured preparation.

  • AfPP Standards and Recommendations for Safe Perioperative Practice (2022) outline best practice in equipment accountability and intraoperative safety.

  • ORNAC Standards, Guidelines and Position Statements (2021) provide comprehensive frameworks for perioperative readiness across Canadian healthcare settings.

⏱ Efficiency and Patient Safety

Studies indicate that missing or misplaced instruments can delay procedures by 10–20 minutes per case (BMJ Quality & Safety, 2019), compounding anaesthesia time and risk exposure. Efficient organisation reduces these delays and enhances both safety and morale.

🧭 Crisis Resource Management (CRM)

Borrowed from aviation, CRM focuses on anticipation, communication, and structured preparation. Maintaining a “ready environment” mirrors a pilot’s pre-flight checklist: ensuring all essential items are accessible before takeoff—or incision.

Conclusion

Efficiently stocked and accessible supplies don’t just support the team—they protect the patient.
Organisation in the operating room isn’t housekeeping—it’s clinical readiness, situational awareness, and patient safety in action.
In a busy theatre environment, where multiple procedures occur simultaneously, robust systems that streamline stock management, standardisation, and communication are key to keeping teams safe, focused, and efficient.

Short Reference List 

Perioperative Education, Professional Development

🌟 Building Competence in the OR Takes Time—And Pays Off

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Instrument and circulator nurses and technologists perform some of the most complex, high-pressure roles in healthcare. Their work demands clinical competence, situational awareness, and theory-based practice—skills that take time, mentorship, and structured exposure across multiple surgical specialties to develop.

For example:

  • 🩺 Perioperative nurses: structured programs (AORN Periop 101, ACORN transition programs, UK AfPP Frameworks, EORNA and ORNAC competency guidelines) typically span 6–12 months of intensive training, with an additional 12–24 months to build independent multi-specialty proficiency.

  • 🧰 Surgical technologists/instrument nurses: require 12–24 months of formal education plus continuing clinical mentorship to achieve advanced practice levels.

Healthcare facilities that invest beyond orientation—offering rotational learning, mentorship, and team-training—see measurable benefits:
✅ Stronger safety culture and teamwork
✅ Reduced surgical complications and near-misses
✅ Improved staff confidence, engagement, and retention

When organisations fail to train and rotate junior or novice staff appropriately, senior “all-rounders” end up carrying the load. This imbalance leads to burnout, turnover, and risk to patient safety.

By contrast, structured perioperative education—aligned with AORN, ACORN, AfPP, EORNA, and ORNAC standards—builds teams that are competent, confident, and collaborative, ultimately delivering higher standards of surgical care.

Investing in time-based competence is not a cost—it’s patient safety assurance.

📚 Selected References

  • AORN (US): Perioperative 101 Program & RN Residency Guidelines (6–12 months structured training).

  • ACORN (Australia): Standards for Perioperative Nursing Practice (2024)—competency-based education and role delineation.

  • AfPP (UK): Perioperative Career Framework (2022)—progressive skill development across roles.

  • EORNA (Europe): Core Curriculum for Perioperative Nursing (2019)—emphasises mentorship and safety culture.

  • ORNAC (Canada): Standards, Guidelines and Position Statements (2021)—education and safe practice framework.

  • Team-training outcomes: WHO Surgical Safety Checklist (NEJM 2009); VA Medical Team Training Program (JAMA 2010)—linked to lower surgical mortality and improved teamwork.

🩺 #PerioperativeNursing #OperatingRoom #SurgicalTeamwork #ClinicalEducation #PatientSafety #NurseLeadership #ScrubNurse #CirculatorNurse #SurgicalTechnologist #HealthcareCulture #BurnoutPrevention

Healthcare Leadership, Operating Room Workflow, Patient Safety, Perioperative Nursing, Staff Wellbeing

Why Interruptions in the Operating Room Put Safety, Efficiency, and Staff Wellbeing at Risk

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The Hidden Cost of Interruptions in the OR: Why Focus Matters

Imagine this: mid-operation, a circulator is executing the instrument count and prepping for the next step. Suddenly, someone enters asking a question unrelated to the task. A phone rings. A colleague requests “just one small check” that could wait. In that instant, the smooth flow fractures, attention shifts, and the risk for error rises.

Operating rooms are high-stakes environments. Interruptions, distractions, and disruptions (DIDs) occur frequently. Research shows these DIDs are linked to slower operative times, degraded team performance, errors, and staff burnout【see references】.

Evidence: How Interruptions Affect Workflow

  • A meta-analysis of 27 studies found that interruptions accounted for about 22% of total operative time.

  • Observations show surgical teams complete 64 tasks per hour, nearly half involving communication — many of which are interruptions.

  • In 1,015 surgeries observed, there were 697 interruptions during surgical counts, averaging 8.7 interruptions per hour.

  • Noise and distractions contribute to burnout and emotional exhaustion among OR nurses.

Why These Disruptions Matter

Interruptions in the operating room:

  • Increase task switching costs and cognitive load.

  • Erode team coordination and communication.

  • Lead to errors in counts, instruments, and protocols.

  • Raise stress, fatigue, and burnout risk.

Downstream Risks

Domain Impact
Time & Efficiency Slower turnovers, lost OR capacity
Errors & Safety Incorrect counts, protocol breaches, retained items
Patient Outcomes Higher complication risk, reduced safety
Staff Wellbeing Burnout, fatigue, turnover
Team Dynamics Miscommunication, conflict, mistrust

Global Professional Standards on Disruptions & Surgical Counts

Leading perioperative associations across the world are clear: minimise interruptions and protect focus during critical workflows like surgical counts.

  • AORN (USA) – Guidelines for Perioperative Practice emphasise that surgical counts should occur in a distraction-free environment, with interruptions minimised.

  • ACORN (Australia) – Standards for Perioperative Nursing in Australia state that all team members must respect the surgical count process, with policies to reduce non-clinical disruptions and noise.

  • ORNAC (Canada) – Standards, Guidelines, and Position Statements highlight that accuracy in counts depends on staff focus, and interruptions jeopardise patient safety.

  • AST (USA) – Standards of Practice for Surgical Technology require that a “no-disruption zone” be established during counts, ensuring clear focus and communication.

  • AfPP (UK) – Standards & Guidance for Perioperative Practice mandate that surgical counts are conducted in an environment free of unnecessary distractions.

Across these global guidelines, the message is consistent: Interruptions increase the risk of errors, delay workflow, and compromise patient safety.

Standards Exist for a Reason — But Why Aren’t They Always Respected?

Every major perioperative association — AORN, ACORN, ORNAC, AST, AfPP — has clearly written standards to protect surgical counts and minimise disruptions. These are not optional. They are evidence-based frameworks designed to:

  • Prevent retained surgical items.

  • Support team communication and accuracy.

  • Protect staff from unnecessary stress and fatigue.

  • Ensure patients receive safe, high-quality care.

👉 In short, the standards are there to be followed, and supported by all operating room professionals.

So why aren’t they always respected?

  • Cultural norms: Hierarchy or habit can override policy.

  • Time pressure: Case turnover speed may be prioritised over protocol.

  • Resource gaps: Understaffing forces multitasking and shortcuts.

  • Awareness: Staff may not always be trained or reminded.

  • Leadership enforcement: Without strong backing, policies risk becoming “paper standards.”

⚠️ The result? Standards meant to safeguard patients and professionals are diluted by daily realities.

This is why leadership support, accountability, and a culture of patient safety are essential for making standards meaningful.

Strategies to Protect Workflow

  1. “No interruption zones” / Sterile cockpit periods

  2. Structured communication windows

  3. Training in human factors & non-technical skills

  4. Role clarity & leadership support

  5. Noise and environment control

The Financial Cost of Interruptions

Interruptions in the operating room aren’t just a human factor issue — they carry real financial consequences for hospitals.

  • Every minute in the OR is expensive.

    • In the U.S., the average cost of OR time ranges from $36 to $100 per minute, depending on procedure and facility type (Macario, 2010; Childers & Maggard-Gibbons, 2018).

    • In Australia and the UK, estimates range from AUD $29–$52 per minute (ACORN, 2023; NHS data).

  • Turnover inefficiencies add up.

    • If nearly 1 in 4 minutes of OR time is lost to interruptions or inefficiencies, this could mean thousands of dollars per case in wasted resources.

    • For a hospital performing 10,000 surgeries annually, even a 5-minute delay per case can translate to $1.8–$5 million in annual lost capacity or added costs.

  • Knock-on effects:

    • Delays can push surgeries past rostered hours, increasing overtime pay.

    • Prolonged turnover times reduce surgical throughput, limiting revenue opportunities.

    • Staff burnout and turnover from constant disruption create downstream costs in recruitment, onboarding, and agency nurse reliance.

👉 Bottom line: Interruptions don’t just affect workflow — they directly erode hospital finances, efficiency, and workforce sustainability. Investing in structured communication, role clarity, and leadership enforcement of standards can save hospitals millions annually, while protecting patients and staff.

Conclusion & Call to Action

Interruptions aren’t minor inconveniences — they directly impact patient safety, staff wellbeing, and hospital efficiency. By adopting structured communication, enforcing no-interrupt periods, and promoting supportive leadership, we can protect workflow and reduce risk.

Will your team commit to one small change this week to minimise OR interruptions?

📚 References

  1. McMullan RD et al. Operating room distractions and patient safety. Int J Qual Health Care.

  2. Göras C et al. Tasks, multitasking and interruptions in the OR. BMJ Open.

  3. BMC Nursing. Interruptions during surgical counts.

  4. Zhang Y et al. Noise annoyance & burnout in OR nurses. PLOS One.

  5. JAMA Network Open. Nurse burnout and patient safety, satisfaction, and quality of care.

  6. Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010;22(4):233–6.

  7. Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg. 2018;153(4):e176233.

  8. ACORN. Standards for Perioperative Nursing in Australia (2023).

  9. NHS Improvement. Reference costs: elective surgery per minute estimates.

  10. AORN. Guidelines for Perioperative Practice (2024). Association of periOperative Registered Nurses.

  11. ACORN. Standards for Perioperative Nursing in Australia (2023). Australian College of Perioperative Nurses.

  12. ORNAC. Standards, Guidelines and Position Statements (12th edition, 2021). Operating Room Nurses Association of Canada.

  13. AST. Standards of Practice for Surgical Technology (2022). Association of Surgical Technologists.

  14. AfPP. Standards & Guidance for Perioperative Practice (2022). Association for Perioperative Practice, UK.

Healthcare Safety, Healthcare Systems, Infection Prevention, Perioperative Nursing, Quality Assurance, Surgical Nursing Infection Prevention Operating Room Education Perioperative Practice Clinical Guidelines Nursing Education Patient Safety, Surgical safety

Surgical Site Infections: Reducing the Burden Through Teamwork and Collaboration

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Introduction

Surgical Site Infections (SSIs) are among the most common healthcare-associated infections worldwide. They cause preventable patient suffering, extend hospital stays, and place billions of dollars of pressure on healthcare systems.

Across Australia, the USA, the UK, and Canada, the numbers tell the same story: SSIs remain costly and impactful. Yet, it is important to acknowledge that perioperative professionals — operating room nurses, surgical technologists, and Operating Department Practitioners (ODPs) — are already doing their best in highly complex environments.

The opportunity lies not in asking individuals to “do more,” but in creating collaborative systems and workflows that allow best practices to be followed seamlessly, every time.

The Global Burden of SSI

  • Australia: Around 16,500 SSIs annually in public hospitals, costing A$323 million in direct care and up to A$2.9 billion in broader indirect costs. Each infection adds about 20 extra hospital days costing approximately A$18,814, per case.

  • United States: SSIs account for 20% of all healthcare-associated infections, costing the system US$3.3 billion annually. Each infection adds ~9–10 extra hospital days and US$20,000–25,000 per admission .

  • United Kingdom: Risk varies by surgery — 0.5% in hip replacements, up to 19.9% in biliary procedures. On average, 5% of surgical patients experience SSIs. The cost of treating a wound infection ranges from £2,500–£4,900, with NHS England recording nearly 40,000 SSI cases annually .

  • Canada: SSIs occur in 2–5% of surgeries, with an average cost of CAD $28,000 per case and 7–11 additional hospital days. Surveillance shows SSI rates are improving in some specialties, but the burden remains high .

The Human Impact

For patients, an SSI is more than a complication. It means longer recovery, repeat surgeries, lost income, and sometimes life-threatening sepsis. Families bear emotional and financial strain, while healthcare staff experience frustration when complications could have been prevented.

Behind every statistic is a patient who deserved better.

The Role of Perioperative Professionals Are Aligned

👩‍⚕️ Operating Room Nurses

  • Safeguard the sterile field and ensure aseptic handling.

  • Advocate for patients by confirming antibiotics, prep, and environmental readiness.

  • Monitor surgical counts and documentation that prevent error and infection.

🔧 Surgical Technologists (Scrub Techs)

  • Handle sterile instruments, sutures, and implants with precision.

  • Anticipate contamination risks and act quickly to address them.

  • Model best practice during critical moments under surgical pressure.

🎓 Operating Department Practitioners (ODPs)

  • Support both anaesthetic and scrub teams to maintain safety at every phase.

  • Ensure antibiotics, warming, and oxygenation protocols align with guidelines.

  • Act as communication bridges across disciplines, enhancing teamwork.

From Individual Vigilance to Team-Based Prevention

Perioperative teams are already vigilant. The real challenge is ensuring that systems support them to succeed.

  • Collaboration, not silos: Every team member — nurse, ODP, tech, anaesthetist, surgeon — must share accountability for infection prevention.

  • Seamless best practice integration: SSI bundles (antibiotic timing, antisepsis, normothermia, glucose control) should be built into workflows so they don’t feel like “extra tasks.”

  • Culture of speaking up: Hierarchy must never block action. Every voice in the OR matters when safety is at stake.

  • Continuous learning: Regular audits, debriefs, and education ensure evolving practices are embedded without adding stress.

Conclusion: A Shared Responsibility

Operating room professionals already give 100% to every patient, every day. The way forward is not to expect more from individuals but to enable teams to work more collaboratively, with systems and processes that make the safest practices and the easiest to follow.

By embedding best practices seamlessly into workflows, empowering all voices, and reinforcing teamwork, we can significantly reduce surgical site infections.

Together, through collaboration and by supporting quality assurance to maintain clinical standards, we can protect patients, strengthen surgical teams, and ease the financial and emotional burden of SSIs worldwide.

📑 References

  1. Royle R., Gillespie B. M., Chaboyer W., et al. The burden of surgical site infections in Australia: A cost-of-illness study. Journal of Infection and Public Health, 2023. (2018–19). https://www.sciencedirect.com/science/article/pii/S1876034123000989

  2. CDC. National Healthcare Safety Network (NHSN) Patient Safety Component Manual: Surgical Site Infection (SSI) Event. 2025. CDC SSI Manual PDF

  3. Anderson DJ, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals. Infection Control & Hospital Epidemiology, 2022.https://pubmed.ncbi.nlm.nih.gov/37137483/

  4. Guest J.F., Fuller G.W., Griffiths B. Cohort study to characterise surgical site infections after open surgery in the UK’s NHS. BMJ Open. 2023;13:e076735. https://pmc.ncbi.nlm.nih.gov/articles/PMC10748996/

  5. Jenks PJ, et al. Clinical and economic burden of surgical site infection (SSI) and prediction of risk. BMJ Open, 2014;4:e003765.https://pubmed.ncbi.nlm.nih.gov/24268456/

  6. PHAC (Public Health Agency of Canada). Device and surgical procedure–related infections in Canadian hospitals, 2011–2020. Canada Communicable Disease Report (CCDR), 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC10278973/

  7. CPSBC & ORNAC. Surgical Site Infection Surveillance and Standards in Canada. College of Physicians and Surgeons of BC / ORNAC, 2020. https://www.cpsbc.ca/files/pdf/NHMSFAP-AS-Environmental-Cleaning-Operating-Procedure-Rooms-and-Sterile-Core.pdf

  8. StatPearls. Postoperative Wound Infections. SSIs affect ~0.5%–3% of inpatient surgeries. https://www.ncbi.nlm.nih.gov/books/NBK560533/#:~:text=Approximately%200.5%25%20to%203%25%20of,develop%20a%20surgical%20site%20infection.
  9. Rezaei, A. R., Zienkiewicz, D., & Rezaei, A. R. (2025). Surgical site infections: A comprehensive review. Journal of Trauma and Injury, 38(2), 71–81.https://doi.org/10.20408/jti.2025.0019
Healthcare Safety, Perioperative Nursing, Surgical Best Practice

Jewellery, Piercings & Metal in the Operating Room – The Hidden Burn Risk

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Why This Matters

Electrosurgical units (ESUs)—both monopolar and bipolar—are essential to modern surgery, but they carry the risk of burn injuries when electricity strays from its intended path. Metal items—such as jewellery, piercings (including tongue and genital), or internal implants—can potentially become unintended pathways. This post highlights how to mitigate those risks, why it matters for patient safety, and the financial consequences for hospitals.

The Numbers – Global Perspective

Electrosurgical burns are rare but costly:

  • Canada: 53 reported cases over five years involving OR burns or fires, nearly half linked to electrosurgery.

  • USA: State safety data reveal over 50% of ESU-related incidents involve burns, often due to accidental activation or poor return pad contact.

  • UK: ~80 electrosurgical burn incidents annually, with ~35% involving grounding pad issues.

  • Australia: Fewer published stats—but repeated safety alerts highlighting risks like instrument insulation failure underscore ongoing concerns.

Globally, 2–5 electrosurgical burns per 1,000 laparoscopic procedures translate to thousands affected yearly across high-volume health systems.

Jewellery & Piercings – Myth vs. Reality

Modern studies—including one in JAMA Surgery—show that most jewellery and piercings don’t cause burns when the ESU system is functioning properly. Electricity prefers the low-resistance return pad over small metal objects covered by drapes.

But caution remains necessary. In rare cases of pad failure or equipment malfunction, any metal can become a hazard.

When Risk Increases

The danger spikes when metal is very close to the surgical site or in a high-risk combo:

  • Tongue Piercings: During oral surgery (e.g., tonsillectomy), having a metal tongue bar plus cautery and supplemental oxygen presents a notable risk of alternate-site burn or fire. Tongue jewellery should always be removed pre-op.

  • Genital Piercings: Piercings near operative sites (e.g., groin, perineal, or urological procedures) similarly elevate burn risk; removal and patient awareness are essential.

Why Nurses Tape Rings and Secure Piercings

When a ring or piercing cannot be removed—due to swelling, embedded design, cultural significance, or patient refusal—nurses will often tape over the item.
This is not done to prevent electrical conduction (tape doesn’t insulate against electrosurgery current) but to:

  1. Prevent mechanical injury – Jewellery can scratch or tear surgical gloves, drapes, or delicate equipment insulation.

  2. Avoid snagging – Metal can catch on surgical gowns, patient positioning devices, or instrument cables.

  3. Protect from loss or damage – Taping secures the jewellery in place during patient transfer or positioning.

This practice is a secondary safety measure, not a substitute for removal. Whenever possible, jewellery and piercings should be fully removed before surgery to eliminate risk.

Internal Metal Implants

Although theoretically concerning, no documented burns have occurred due to internal hip or knee implants in recent years. However, grounding pads must never be placed over or near implants, as soft tissue routes are vastly safer for current flow.

The Real Culprits Behind ESU Burns

Far more common causes include:

  • Poor return pad adhesion

  • Damaged instrument insulation

  • Contact with conductive OR fixtures

  • Accidental activation when the active electrode rests on drapes or the patient

Financial Cost to Hospitals

Burn incidents from electrosurgery aren’t just patient safety issues—they carry significant financial burdens:

  • General surgical complications increase hospital costs by nearly $19,600 per case, while reducing profit margins to nearly zero compared to uncomplicated surgeries.

  • Burn-specific care is especially resource-intensive:

    • Average total cost per burn patient in the U.S.: $51,770, with daily costs averaging $8,845.

    • Severe burns can range from $300,000–$500,000 per patient.

    • Hospital stays for burn-related injuries average $24,000, double the cost of typical admissions.

    • In the U.S., burn-related hospital costs exceed $1 billion annually—about 1% of all hospital spending.

Preventing even a handful of ESU burns annually can translate into significant cost savings and reduced patient harm.

Standards of Practice – Minimizing Risk and Cost

To protect patients—and hospital resources—adhere to these best practices:

  1. Remove all jewellery and piercings, including tongue and genital ones, especially if near the surgical field.

  2. Patient education: Clearly communicate burn risks from piercings and implants as part of consent.

  3. If jewellery cannot be removed, tape to secure and protect from mechanical harm—but never rely on tape for electrical safety.

  4. Position grounding pads away from piercings or metal implants.

  5. If the incision is close to metal, consider using bipolar electrosurgery instead of monopolar — this is safer and reduces current spread.

  6. Inspect instruments for intact insulation before use.

  7. Holster the active electrode when not in use; never leave it on drapes or patient.

  8. Prevent patient contact with grounded surfaces.

  9. Use lowest effective power, shortest activation bursts.

  10. Allow surgical prep to fully dry, preventing fires and burns.

Takeaway for the Surgical Team

Jewellery and piercings are rarely direct causes of electrosurgical burns—but eliminating even the slightest risk helps protect patients and hospitals. Burn care is complex, costly, and emotionally taxing. Preventing ESU burns through vigilance and best practices safeguards both human and financial health.

References

  1. Blumenstein N, et al. Bringing to Light the Risk of Burns From Retained Metal Jewelry Piercings in the Operating Room – Torching the Myth. JAMA Surgery. 2022. https://jamanetwork.com/journals/jamasurgery/article-abstract/2789491

  2. Calder LA, et al. Surgical Fires and Burns: A 5-Year Analysis of Medico-Legal Cases in Canada. J Burn Care Res. 2019;40(6):744–750.  https://pubmed.ncbi.nlm.nih.gov/30562214/

  3. Vilos GA, et al. Understanding and Practising Safe Electrosurgery in the Operating Room. J Obstet Gynaecol Can. 2018;40(3):e207–e222. https://www.jogc.com/article/S1701-2163(17)30856-7/fulltext

  4. Pennsylvania Patient Safety Authority. Electrosurgery Safety Issues. PA-PSRS Patient Safety Advisory. March 2006. https://patientsafety.pa.gov/ADVISORIES/Pages/200603_01.aspx

  5. NSW Health. Safety Notice 013/23 – Risk of Burn Injury from Degraded Insulated Laparoscopic Instruments. 2023. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2023_013.pdf

  6. Medicines and Healthcare products Regulatory Agency (MHRA). Medical Device Safety Reports – Electrosurgery. UK, 2010–2020. https://www.gov.uk/drug-device-alerts

  7. Choudhry AJ, et al. Surgical Fires and Operative Burns: A 33-Year Review of Litigation. Am J Surg. 2017;213(3):558–564. https://pubmed.ncbi.nlm.nih.gov/27894644/

  8. Deml MC, et al. Thermic Effect on Metal Body Piercing by Electrosurgery (Ex Vivo). Technol Health Care. 2018;26(1):131–138. https://pubmed.ncbi.nlm.nih.gov/29286953/

  9. Sheldon RR, et al. Microdermal Implants Show No Effect on Surrounding Tissue During Surgery With Electrocautery. J Surg Res. 2019;235:59–63. https://pubmed.ncbi.nlm.nih.gov/30935737/

  10. Lasker Foundation. Burn Injury Fact Sheet. 2021. https://laskerfoundation.org/wp-content/uploads/2021/02/burns_fact_sheet.pdf

  11. Net Health. The Cost of Chronic Wounds. 2023. https://www.nethealth.com/blog/cost-of-chronic-wounds/

  12. American Burn Association. Burn Incidence and Treatment in the United States: 2016 Fact Sheet. https://ameriburn.org/who-we-are/media/burn-incidence-fact-sheet/

Infection Control, Perioperative Nursing, Perioperative Practice, Surgical Best Practice

🚫 Artificial Nails in the Operating Room: More Than a Policy—It’s a Patient Safety Imperative

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In perioperative environments, details matter—especially those that impact infection prevention and patient safety. While acrylic and artificial nails may be fashionable, in the sterile world of the OR and Sterile Processing Department (SPD), they pose a real risk.

🔬 Evidence of Patient Harm

Healthcare workers wearing long or artificial nails have been directly linked to serious infections and even fatalities in patients:

📍 NICU Outbreak (USA)

  • Pathogen: Pseudomonas aeruginosa

  • Impact: 46 infected infants; 16 deaths

  • Source: Nurses with long and artificial nails

  • Outcome: Outbreak ceased after nail-length restrictions were implemented

📍 Spinal Surgery Fungal Infections

  • Pathogen: Candida albicans

  • Impact: Multiple patients developed postoperative osteomyelitis

  • Source: OR technician with artificial nails

  • Outcome: No further cases after technician was removed

🔬 Lab-Based Evidence

Studies show that:

  • Up to 87% of healthcare workers with artificial nails harbored pathogenic organisms, even after scrubbing.

  • Natural nails showed significantly lower colonization rates.

💰 The Financial Toll

Preventable infections don’t just harm patients—they’re expensive:

  • Cost per hospital-acquired infection:
    AUD $18,000–$42,000+

  • 10-case outbreak could cost a hospital $400,000+, not including litigation or reputational damage.

  • Surgical site infections (SSIs) cost hospitals about $20,000 per patient

  • MRSA-related SSIs can exceed $60,000 per case, with longer hospital stays and higher risk of complications

  • Even just 5–10 avoidable cases linked to policy breaches (like wearing acrylic nails) could cost a hospital hundreds of thousands of dollars

  • Infections linked to lapses in infection control—like poor nail hygiene—carry a major financial burden:

  • Hospital-acquired infections (HAIs) cost the U.S. healthcare system an estimated $28–45 billion annually 📉

📜 What the Guidelines Say

✅ AORN (USA)

“Artificial nails should not be worn by perioperative team members who have direct contact with patients.”

✅ ACORN (Australia)

“Staff in the perioperative environment must not wear artificial fingernails or nail enhancements.”

Both standards emphasize natural nails ≤ ¼ inch in length, free from polish chips or artificial coatings.

🔄 Best Practice for OR & SPD Teams

  • Keep nails natural, short, and clean

  • Avoid all artificial enhancements (acrylic, gel, overlays)

  • Practice strict hand hygiene and glove integrity checks

🧠 Bottom Line

Nail hygiene in the surgical space isn’t about appearance—it’s about protecting patients. Even one overlooked fingernail can change a life.

 

 

 

 

 

 

 

 

 

 

 

📚 References

  1. Moolenaar, R. L., et al. (2000). A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role? Infection Control and Hospital Epidemiology, 21(2), 80–85.
    https://doi.org/10.1086/501745

  2. Hedderwick, S. A., et al. (2000). Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Infection Control and Hospital Epidemiology, 21(8), 505–509.
    https://doi.org/10.1086/501795

  3. Centers for Disease Control and Prevention (CDC). (2002). Guideline for Hand Hygiene in Health-Care Settings. MMWR Recommendations and Reports, 51(RR-16), 1–45.
    https://www.cdc.gov/handhygiene/

  4. Association of periOperative Registered Nurses (AORN). (2023). Guideline for Hand Hygiene.
    https://www.aorn.org/guidelines

  5. Australian College of Perioperative Nurses (ACORN). (2023). Standards for Perioperative Nursing in Australia.
    https://www.acorn.org.au/standards

  6. Alberta Health Services. (2020). Artificial Nails and Nail Polish in Healthcare Settings – Fact Sheet.
    https://www.albertahealthservices.ca/assets/info/hp/hh/if-hp-hh-artificial-nails-in-healthcare.pdf

  7. World Health Organization (WHO). (2009). WHO Guidelines on Hand Hygiene in Health Care.
    https://www.who.int/publications/i/item/9789241597906

  8. Scott, R. D. (2009). The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. CDC.
    https://stacks.cdc.gov/view/cdc/11550

  9. Kaye, K. S., et al. (2009). The Cost of Surgical Site Infections in the United States. Infection Control and Hospital Epidemiology.
    https://www.wired.com/2009/12/one-surgical-infection-with-mrsa-61000

  10. Magill, S. S., et al. (2014). Multistate Point-Prevalence Survey of Health Care–Associated Infections. New England Journal of Medicine, 370, 1198–1208.
    https://www.cdc.gov/hai/data/portal/index.html

  11. Graves, N., Halton, K., & Lairson, D. R. (2007). The economics of infection control: Hospital-acquired infections and patient safety. Current Opinion in Infectious Diseases, 20(4), 337–341.
    https://doi.org/10.1097/QCO.0b013e3282638e25

  12. Gillespie, B. M., et al. (2021). The Burden of Surgical Site Infections in Australia: A Cost of Illness Study. Australian and New Zealand Journal of Surgery, 91(3), 387–392.
    https://doi.org/10.1111/ans.16339

  13. Infection Control Today. (2001). Artificial Nails Undermine Infection Control.
    https://www.infectioncontroltoday.com/view/artificial-nails-undermine-infection-control

  14. CIDRAP. (2023). Study: Healthcare-Linked Infections Cost US $10 Billion a Year.
    https://www.cidrap.umn.edu/clostridium-difficile/study-healthcare-linked-infections-cost-us-10-billion-year

 

 

 

 

 

Clinical Quality & Safety, Perioperative Practice

Why Caring for Surgical Instruments Matters: Safety, Efficiency & Smarter Costs

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🔍 Introduction

Surgical instruments are designed to be precise and effective. Whether it’s a scalpel, forceps, or clamps, these tools must be clean, sterile, and in optimal condition to perform their functions. Any deviation from these standards can compromise a surgery’s success.

Neglecting proper maintenance can result in dull blades, rusted surfaces, or—worse—the presence of harmful microorganisms. This not only jeopardizes patient health but also tarnishes the trust patients place in healthcare providers.

Instruments that don’t cut, grip, or function as intended don’t just slow down the procedure—they create clinical risk, frustrate teams, and undermine the flow of surgery. The solution? Consistent, evidence-based maintenance practices that protect performance and patient care.

1. Patient Safety & Clinical Outcomes

  • Poor-quality or poorly maintained instruments are directly linked to adverse safety incidents.

  • Between 2004–2010, the NHS reported over 2,000 surgical incidents involving instrument failure, leading to reoperations, retained fragments, and moderate to severe harm.

  • The U.S. FDA documents hundreds of similar events annually—ranging from infection and tissue injury to fatal outcomes caused by instrument malfunction or debris.

  • Instruments that are dull or contaminated increase the risk of postoperative infections, tissue trauma, and delayed healing—all of which can compromise recovery and the patient experience.

  • Cleanliness and condition aren’t cosmetic—they are foundational to safe surgical practice.

2. Operational Efficiency & Surgical Flow

  • A blunt scissor or malfunctioning clamp can delay critical steps in surgery.

  • When surgical flow is interrupted, anesthesia time increases, procedural accuracy may decline, and tension among staff can escalate.

  • Tray inefficiencies (e.g., including instruments never used) add to setup, sterilization, and audit burdens.

  • Optimizing trays and removing redundant tools can reduce setup time by up to 40% and cut processing costs by 30–60%.

3. Cost Containment & Lifecycle Savings

  • Repair vs. replace: Repaired instruments can cost 30–40% less per use compared to always replacing them.

  • Facilities that implemented preventive maintenance programs reported annual savings of up to $250,000, simply by reducing waste, delay, and loss.

  • Each minute of OR time costs an average of $36–$46 USD. A malfunctioning instrument that causes a 3-minute delay could cost $100+ per case—not counting the clinical risks involved.

4. Infection Control & Regulatory Alignment

  • Instruments with dried biological material or rusted surfaces are more difficult to clean and sterilize—posing infection risks.

  • Compliance with infection control policies, such as those from AORN, ACORN, and WHO, require validated reprocessing and functional assurance for every tool.

  • Instruments must be traceable, inspected, and documented—especially following a reported breach or surgical incident.

✅ What Effective Instrument Care Looks Like

Best Practice Impact
Scheduled sharpening, function testing Ensures sharpness, grip, and safe operative performance
Tray optimization & instrument rationalization Reduces waste, speeds up processing, cuts costs
Strict cleaning & inspection protocols Minimizes infection risk and instrument failure
Documentation & traceability systems Supports quality audits and incident tracking
Collaboration between SPD and OR teams Flags instruments before cases, avoids intra-op delays

🧠 Conclusion

Caring for surgical instruments is not a backroom task—it’s a frontline safety measure.

  • 🛡️ Patients deserve sterile, sharp, safe instruments.

  • 🔄 Teams deserve tools they can trust.

  • 💰 Facilities benefit from cost control, efficiency, and reduced risk.

Investing in instrument care is a small effort with a massive return—one that protects patients, supports surgical teams, and sustains clinical excellence.

🔗 References

  1. Association of periOperative Registered Nurses (AORN). (2022). Guidelines for Perioperative Practice. AORN, Inc.

  2. Australian College of Perioperative Nurses (ACORN). (2023). Standards for Perioperative Nursing in Australia.

  3. Microlin Surgical. (2021). Instrument Maintenance Cost and Lifecycle Analysis. Retrieved from https://www.microlinesurgical.com

  4. Bausch & Lomb Instruments. (2020). Managing Surgical Instruments for Optimal Performance. Retrieved from https://www.bauschinstruments.com

  5. Applied Physics Medical. (2021). How Surgical Instruments Impact Patient Outcomes. Retrieved from https://appliedphysicsmedical.com

  6. Rick Schultz. (2019). The Instrument Whisperer: Why Instrument Quality Matters. Healthcare Purchasing News.

  7. Sullivan Healthcare Consulting. (2020). How a Large Academic Medical Center Uncovered $250,000 in Annual Cost Savings. Retrieved from https://sullivanhealthcareconsulting.com

  8. Journal of Arthroplasty. (2021). Cost Analysis of Operating Room Time and Efficiency. https://www.arthroplastyjournal.org

  9. Duke University Medical Center. (2022). Analysis of Surgical Instrument-Related Adverse Events in U.S. Hospitals. Retrieved from https://dukespace.lib.duke.edu

  10. Infection Control Today. (2022). Best Practices in Surgical Instrument Reprocessing. https://www.infectioncontroltoday.com

  11. World Health Organization (WHO). (2009). Surgical Safety Checklist and Infection Control Guidelines. https://www.who.int

  12. OR Today Magazine. (2019). The Real Cost of an OR Minute. Retrieved from https://ortoday.com

Clinical Education, Credentialling and Professional Development, Perioperative Nursing

🛠️ The Essential Attributes of a Great Instrument Nurse-Scrub Tech- ODP

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Introduction
In the high-stakes environment of the operating room (OR), both scrub techs and instrument (scrub) nurses are indispensable. These professionals not only manage surgical instruments but also play pivotal roles in patient safety, OR efficiency, and team cohesion.

1. Clinical & Technical Mastery

  • Aseptic technique & sterile field control: Managing the sterile field from prep to closure is crucial to prevent surgical-site infections.

  • Instrument knowledge & standardized preparation: Familiarity with instruments and consistent table setup enhances workflow and reduces errors

  • Accurate instrument and sponge counts: Precise counting is essential to prevent retained foreign bodies

2. Non-Technical Skills

  • Situational awareness & multitasking: Staying alert to the OR environment helps anticipate needs and manage unexpected disruptions

  • Teamwork & communication: Clear, timely communication reduces errors and builds team trust

  • Anticipation (“third hand”): Proactively anticipating the surgeon’s needs helps maintain procedural flow

3. Physical & Emotional Resilience

  • Manual dexterity & endurance: Handling delicate instruments plus long periods in surgery demand both precision and stamina

  • Stress management & composure: Maintaining calm under pressure is essential to prevent errors

4. Continuous Improvement & Professionalism

  • Adaptability & lifelong learning: Ongoing education, simulation training, and staying updated with OR advances are vital

  • Ethical conduct & integrity: Upholding standards—even when unsupervised—strengthens trust and safety culture

5. Technology & Innovation

  • Robotic and simulation tools: Emerging tech (robotic scrub nurses, training systems like Nosco Trainer) can augment—but not replace—human anticipation and precision

🧩 Summary Table

Attribute Impact on Patient Care & OR Efficiency
Technical Proficiency Reduces infection risk, expedites setup and transitions
Attention & Awareness Prevents retained items, maintains sterile conditions
Communication & Teamwork Improves coordination, minimizes miscommunication
Resilience & Dexterity Supports long, complex procedures
Continuous Learning Ensures competency with evolving procedures
Ethical Standards Builds credibility and trust through consistent practice

 

 

 

 

 

📚 References

  1. Glaser B, Schellenberg T, Neumann J, et al. Measuring and evaluating standardization of scrub nurse instrument table setups: a multi‑center study. Int J Comput Assist Radiol Surg. 2022 periopnursing.theclinics.com+2BioMed Central+2Wikipedia+2BioMed Central+2Wikipedia+2MDPI+2SpringerLink+1SpringerLink+1.

  2. Mohammadi M, Omid A, Tarrahi MJ, Ghadami A. The impact of intraoperative non‑technical skills training on scrub practitioners’ self‑efficacy: a randomized controlled trial. BMC Med Educ. May 7, 2025 BioMed Central.

  3. “Surgical instrument counting: Current practice and staff perspectives…” SciDirect. 2024 ScienceDirect.

  4. “What are the non‑technical skills used by scrub nurses?: An integrated review.” CORE, 2014 Academia+1core.ac.uk+1.

  5. Mitchell L, Flin R, Yule S, Maran N, Rowley D. Thinking ahead of the surgeon: identifying non‑technical skills for scrub nurse performance. J Adv Nurs. 2010 Academia.

  6. “What skills are essential for a Scrub Nurse?” Nursing‑Science.com Nursing Science+1Nursing Science+1.

  7. “Effects of Simulation‑based Scrub Nurse Education for Novice Nurses…” Nurs Simul. 2021 Wikipedia+15ScienceDirect+15Nursing Simulation+15.

  8. “Understanding stress factors for scrub nurses in the perioperative…” SciDirect. 2021 arxiv.org+7ScienceDirect+7Academia+7.

  9. “Robotic Scrub Nurse: Surgical Instrument Handling…” DeGruyter, 2023 SpringerLink+5De Gruyter Brill+5Nursing Science+5.

  10. Wikipedia: Instrument nurse, updated 1.2 years ago Wikipedia+1MDPI+1.

  11. Royal Cornwall Hospitals Trust: Scrub Practice Standards Clinical Guideline doclibrary-rcht.cornwall.nhs.uk+1BioMed Central+1.

 

Perioperative Practice Nursing Innovation Digital Health Clinical Education Workflow Optimization, Workflow Optimization

✈️Pilots, Procedures & The Power of Memory in the Operating Room

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As a veteran operating room nurse, I’ve often drawn comparisons between flying a plane and supporting surgery. Both roles are high stakes, demand precision under pressure, and require a team working in sync. But one question I often reflect on is this:

How do we decide what we remember—and what we forget—in the operating room?

Why can I instantly recall how to respond to a hemorrhage, but still forget where one surgeon prefers the tower placed or what setting to select on a specific piece of equipment?

🔄 The Pilot’s QRH vs. The Nurse’s Experience

Pilots are trained to memorize what’s known as memory items—a set of actions committed to memory for emergency situations. These are rehearsed over and over again until they become automatic. Only after the immediate threat is addressed do they consult the Quick Reference Handbook (QRH), a structured guide of procedures for troubleshooting and recovery.

Operating room nurses, by contrast, often learn on the job. We rely on exposure, mentorship, repetition, and experience. There’s no QRH for us. What we do have are mental maps, team communication, and countless moments of trial, error, and reflection. We build memory not in a simulator, but in real-time.

But should we? Could a structured, role-specific handbook for scrub and scout nurses, with memory prompts and decision trees, accelerate learning and reduce error?

🧠 Why We Remember Some Things and Forget Others

Cognitive science tells us that memory is shaped by emotion, repetition, relevance, and pattern recognition. We remember what we do often, what is associated with stress (like a surgical fire), and what aligns with a pattern we already understand.

Research shows that procedural memory—the kind used to tie shoelaces or scrub for surgery—forms in a part of the brain called the basal ganglia. This is also responsible for what we call “autopilot” behavior—like driving home without consciously recalling the route (MIT Neuroscience, 2019).

That’s why, after more than a decade in the OR, I can anticipate when a surgeon will ask for suction, or when the scout will need to open extra swabs. It’s not guessing—it’s pattern recognition + procedural memory.

But memory is selective. According to Harvard psychologist Daniel Schacter, we remember what we encode deeply, often emotionally or via repetition—but forget details that lack personal salience or aren’t retrieved often. (Schacter, The Seven Sins of Memory).

So it’s no surprise that I can forget the tower attachment or settings a certain surgeon prefers—I’m not emotionally attached to that information, nor is it reinforced frequently in context.

🧪 Simulation: What We Can Learn from Pilots

Pilots undergo regular simulator training to test their responses to rare but critical scenarios—engine fires, cabin depressurization, bird strikes. These simulations are realistic, stress-inducing, and reinforce both memory and teamwork.

Operating rooms are beginning to adopt similar high-fidelity simulation-based education. In centers like Northwestern Simulation or Cedars-Sinai’s OR360, OR teams train together in lifelike crisis scenarios—practicing not only tasks, but communication, leadership, and debriefing.

“Fly the plane, silence the bell, read the checklist.”
—Classic pilot mantra

“A great OR team runs like a cockpit crew—clear roles, constant communication, and a shared goal: safety.”
—Dr. K. Rosten, OR educator

🧠 What If OR Nurses Had a QRH?

What if nurses had a Quick Reference Handbook tailored to their role, specialty, and learning stage? Imagine a scrub nurse’s QRH including:

  • Memory checklists for laparoscopic cholecystectomy setup

  • Key “emergency items” for hemorrhage, retained sponge, power failure

  • Surgeon-specific reminders (tower height, implant sets, special instruments)

  • Crisis role reminders for scout nurses (e.g., airway emergency support flowchart)

This wouldn’t replace training or mentorship—but it would complement it, much like the QRH supplements the pilot’s training.

🧩 Final Thoughts

Learning in the operating room is layered. It happens through experience, observation, and repetition—but it’s also selective. Some things stick. Some don’t. And that’s normal.But what if we gave our brains the same scaffolding we give our pilots?

“In the operating room, just like in the cockpit, it’s not about memorizing everything—it’s about knowing what matters most, and what to do when everything goes wrong.”

I’m still learning. Still embedding. Still forgetting the occasional monitor and print settings. But I’ve come to respect that our memories are shaped not just by what we do, but by how we practice.

Platforms like ScrubUp help support surgical teams by providing accessible, step-by-step checklists and case preparation tools — enhancing safety, recall, and role clarity under pressure.

🛠️ We Need Systems That Support the Whole Surgical Team

In the operating room, we work in an environment surrounded by cutting-edge technology—robotic arms, real-time imaging, automated charting systems—all designed to support the surgeon, the anesthetist, and ultimately, the patient. But where are the systems that support us—the operating room nurses, surgical technologists, scrub scouts, and circulators? We absorb knowledge on the go. We adjust to new teams daily. We troubleshoot unfamiliar equipment mid-case. We remember thousands of details—until one slips through under pressure.

It’s time we shift the focus.

✅ Let’s invest in role-specific checklists,
✅ Develop quick-reference tools,
✅ Embrace simulation and scenario-based training,
✅ And co-design workflow systems that reflect the real responsibilities of the surgical team.

We don’t just need more equipment in the OR.
We need better systems to support the people who keep it running.

Let’s work collectively—across roles, disciplines, and institutions—to build that future.

✅ References

  1. Schacter, D. L. (2001). The Seven Sins of Memory: How the Mind Forgets and Remembers. Harvard University Press.

  2. MIT News. (2019). Scientists reveal how habits can be broken

  3. AORN. (2022). Perioperative Emergency Checklists and Cognitive Aids.

  4. AirFacts Journal. (2021). Checklist vs. Memory Items: Knowing What Comes First.

  5. Northwestern Simulation. Surgical Skills Lab Overview

  6. PPRuNe Aviation Forum. 737 Memory Items Discussion

Nursing Workforce, Operating Room Leadership

🧱 When Rostering Feels Like Jenga: The Unseen Burden of Building OR Teams

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💥 Introduction: Rostering Is No Small Feat

In a perfect world, every surgical team is consistent—familiar nurses, trusted techs, the surgeon’s “dream team.” But in the real world? Staffing the OR is a high-stakes game of Jenga.

Nurse managers must balance:

  • Leave, breaks, and unexpected absences

  • Maternity cover, new grads, and on-the-fly replacements

  • Skill levels, specialty experience, and surgeon preferences

One wrong piece—and the entire surgical list could collapse.

🧠 The Real Cost of Unseen Stress

While CEOs review performance metrics, the behind-the-scenes chaos of managing staff schedules is rarely noticed—until it impacts patients, delays cases, or increases staff burnout.

According to BMC Health Services Research (2019), communication breakdowns and inadequate team familiarity significantly contribute to flow disruptions in the OR, which can ultimately affect patient safety and surgical efficiency.

🔄 Enhancing Surgical Team Competency Through Cross-Specialty Rotations

In the dynamic environment of the operating room, consistent team composition is often challenged by factors such as staff breaks, holidays, maternity leave, sudden illnesses, and the necessity to train new personnel. These variables can disrupt the continuity that surgeons rely upon for optimal performance.

To mitigate these challenges, structured cross-specialty rotations have been identified as a valuable strategy. A comprehensive review published in the Journal of Surgery and Research underscores several benefits of such rotations:

  • Broadened Clinical Exposure: Trainees gain experience across various surgical disciplines, fostering a more versatile skill set.

  • Enhanced Teamwork: Exposure to different specialties promotes better understanding and collaboration among multidisciplinary teams.

  • Improved Patient Outcomes: A diverse training background equips surgical staff to handle a wider array of clinical scenarios effectively.

Moreover, the British Journal of Surgery emphasizes that cross-specialty training is instrumental in preparing surgeons for the complexities of modern patient care, which often requires a collaborative, multidisciplinary approach.

💡 Implementing Supportive Systems

To fully leverage the benefits of cross-specialty rotations, it’s crucial to establish systems that:

  • Facilitate Knowledge Sharing: Ensure that critical information is accessible to all team members, regardless of their primary specialty.

  • Support Continuous Learning: Provide ongoing educational resources to keep staff updated on best practices across specialties.

  • Promote Flexibility: Develop adaptable protocols that accommodate the dynamic nature of surgical team compositions.

By embracing these strategies, we can create a resilient surgical workforce capable of delivering high-quality care, even amidst staffing fluctuations.

🎯 Let’s Recognize the Real MVPs

To every perioperative manager playing roster Jenga…
To every team that flexes, fills gaps, and keeps surgery moving…
We see you. You’re not just building rosters—you’re holding the OR together.

🧱 The Nurse Manager’s Jenga: Balancing OR Staffing & Schedules

Section 1: The Daily Challenges

  • Staff Availability: Managing unexpected absences due to illness or emergencies.

  • Shift Preferences: Accommodating individual staff scheduling preferences.

  • Skill Mix: Ensuring the right combination of skills for each shift.

  • Compliance: Adhering to labor laws and organizational policies.

 

Section 2: The Impact on OR Efficiency

  • Delayed Surgeries: Scheduling issues leading to postponed procedures.

  • Increased Overtime: Staff working extra hours to cover gaps.

  • Burnout Risk: Elevated stress levels among staff due to scheduling conflicts.

  • Patient Satisfaction: Potential decline in patient experience due to staffing issues.

 

Section 3: Strategies for Stability

  • Advanced Scheduling Tools: Utilizing software to optimize shift planning.

  • Cross-Training Staff: Preparing staff to handle multiple roles as needed.

  • Open Communication: Maintaining transparent dialogue about scheduling needs.

  • Regular Reviews: Assessing and adjusting schedules proactively.Proactive Healthcare Staffing

“Supporting our nurse managers in their balancing act ensures a stable and efficient operating room environment.”

Operating Room Efficiency, Operating Room Workflow

🏥 Behind Every Calm Surgeon Is a Team Absorbing the Storm

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In the high-stakes environment of the operating room (OR), every second counts. While surgeons often take center stage, it’s the cohesive effort of the entire surgical team that ensures patient safety and procedural success. Yet, this intricate dance is frequently disrupted by unforeseen challenges, leading to increased stress, potential errors, and compromised patient outcomes.

 

⏱️ The Hidden Costs of Operating Room Disruptions

Time is a critical resource in the OR. Delays not only escalate operational costs but also heighten risks for patients. Research indicates that each minute in the OR can cost between $15 and $100, depending on the procedure and facility . Factors contributing to these costs include:

  • Extended anesthesia time: Prolonged exposure increases the risk of complications.

  • Staff overtime: Delays can lead to extended shifts, impacting staff well-being and hospital budgets.

  • Reduced surgical throughput: Fewer procedures can be completed, affecting hospital revenue and patient access to care.

🔄 Understanding Flow Disruptions

Flow disruptions (FDs) are interruptions that divert the surgical team’s attention from the primary task. These can range from equipment malfunctions to unexpected staff changes. A systematic review highlighted that FDs are associated with increased surgical duration and heightened stress levels among OR staff .

Common sources of FDs include:

  • Equipment issues: Malfunctioning or missing tools can halt procedures.

  • Communication breakdowns: Misunderstandings or lack of information sharing can lead to errors.

  • Environmental factors: Poor OR layout or lighting can impede workflow.

🧠 The Psychological Toll on Surgical Teams

Beyond the tangible delays, FDs exert a significant psychological impact on OR personnel. A study focusing on robotic-assisted surgeries found that equipment-related FDs were linked to increased staff workload . Persistent disruptions can lead to:

  • Burnout: Continuous stress without adequate recovery can diminish job satisfaction.

  • Reduced team cohesion: Frequent interruptions can strain professional relationships.

  • Decreased vigilance: Over time, constant disruptions may desensitize staff to potential hazards.

🛠️ Strategies for Mitigating Disruptions

Addressing FDs requires a multifaceted approach:

  1. Enhanced Communication Protocols: Implementing standardized communication tools, like checklists, can ensure all team members are aligned.

  2. Regular Equipment Maintenance: Routine checks can preempt equipment failures.

  3. OR Design Optimization: Adjusting the physical layout can streamline workflows and reduce unnecessary movements.

  4. Training and Simulation: Regular drills can prepare teams to handle unexpected disruptions effectively.

📈 The Role of Technology in Streamlining OR Processes

Digital solutions, such as ScrubUp, offer platforms to:

  • Track surgical instruments: Ensuring all necessary tools are available and functional.

  • Manage team schedules: Coordinating staff shifts to maintain consistency.

  • Provide real-time updates: Keeping all team members informed about procedural changes or patient status.

By integrating such technologies, hospitals can reduce the frequency and impact of FDs, leading to improved patient outcomes and enhanced team morale.

🩺 Conclusion

The efficiency of the OR hinges not just on the surgeon’s skill but on the seamless collaboration of the entire surgical team. Recognizing and addressing the challenges posed by flow disruptions is paramount. Through proactive measures, continuous training, and the adoption of innovative technologies, we can foster an environment where both patients and healthcare professionals thrive.

https://qualitysafety.bmj.com/content/29/12/1033

https://link.springer.com/article/10.1007/s00464-023-10162-2

https://scrubupapp.com/surgical-time-cost-patient-risk/

Hospital Efficiency, Perioperative Nursing, Sterilization & Infection Control, Surgical Equipment, Surgical safety

The Intricate Workflow of Sterile Processing

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The SPD operates through a series of well-defined stages, each critical to maintaining instrument integrity and patient safety:

  1. Decontamination: Used instruments are transported to the decontamination area, where they undergo thorough cleaning to remove organic and inorganic materials. This process often involves manual scrubbing, ultrasonic cleaning, and the use of washer-disinfection .specialtycareus.com

  2. Inspection and Assembly: Post-cleaning, instruments are meticulously inspected for cleanliness and functionality. They are then assembled into sets according to specific surgical procedures, ensuring that each tray contains the necessary tools in proper working order .specialtycareus.com

  3. Sterilization: Assembled instrument sets are subjected to sterilization processes, commonly using steam sterilization at temperatures of 121°C (250°F) or 134°C (270°F). The choice of sterilization method depends on the instrument’s material and design .

  4. Storage and Distribution: Sterilized instruments are stored in controlled environments to maintain sterility until they are needed in surgical procedures. The SPD ensures timely distribution to operating rooms, aligning with surgical schedules .

Navigating the Challenges of Loan Instrument Sets

The integration of vendor-loaned instrument sets introduces additional complexity to the SPD’s operations. These sets, often comprising up to 10 +/- trays for a single procedure, require the same rigorous decontamination and sterilization processes as hospital-owned instruments. However, they frequently arrive with limited lead time, pressuring SPD staff to expedite processing without compromising standards .blog.pdchealthcare.com+2ospecsconsulting.com+2sterileally.com+2readysetsurgical.com+1healthtrustpg.com+1

Proper management of loan sets necessitates:presentations.patientsafety-me.com+6infectioncontroltoday.com+6sterileprocessingtech.org+6

  • Advance Communication: Coordinating with vendors to ensure timely delivery and provision of detailed instrument lists and sterilization instructions .aorn.org

  • Thorough Documentation: Maintaining accurate records of sterilization cycles, including biological and chemical indicator results, to verify compliance with safety protocols .specialtycareus.com

  • Staff Training: Ensuring SPD personnel are trained to handle the specific requirements of various loaner instruments, including disassembly and reassembly procedures .readysetsurgical.com+5blog.pdchealthcare.com+5presentations.patientsafety-me.com+5

Specialized Sterilization: Handling Heat-Sensitive Instruments

Certain medical devices, such as flexible endoscopes, are sensitive to the high temperatures of standard steam sterilization. For these instruments, ethylene oxide (EtO) gas sterilization is employed. EtO is effective in sterilizing complex devices without causing damage, making it suitable for items with intricate channels and heat-sensitive materials .

However, EtO sterilization presents challenges:aqrdm.org

  • Extended Processing Time: The EtO sterilization cycle can take up to 12 hours, including aeration time to remove residual gas .

  • Health and Safety Concerns: EtO is a known carcinogen, necessitating stringent safety measures to protect staff and patients .

As a result, some facilities are exploring alternative methods, such as vaporized hydrogen peroxide, which offers effective sterilization with shorter cycle times and fewer health risks .verywellhealth.com+1steris.com+1

The Critical Role of the SPD in Surgical Efficiency

The efficiency of the SPD directly impacts surgical schedules and patient outcomes. Delays in instrument processing can lead to postponed surgeries, increased patient wait times, and elevated healthcare costs. Therefore, the SPD’s ability to manage complex workflows, adapt to the demands of loan instruments, and employ appropriate sterilization methods is vital to the overall success of surgical services .

In conclusion, the Sterile Processing Department is a cornerstone of patient safety and surgical efficacy. Through meticulous processes and adaptability to evolving challenges, SPD professionals ensure that every instrument meets the highest standards of cleanliness and functionality, thereby upholding the integrity of healthcare delivery.sterileprocessingtech.org+5steris.com+5sterileally.com+5

🔖 Reference List

  1. Macario, A. (2010). What does one minute of operating room time cost? Journal of Clinical Anesthesia, 22(4), 233–236. https://doi.org/10.1016/j.jclinane.2010.02.003

  2. Centers for Disease Control and Prevention. (2019). Ethylene oxide sterilization. https://www.cdc.gov/infection-control/hcp/disinfection-sterilization/ethylene-oxide-sterilization.html

  3. SpecialtyCare. (n.d.). The Importance of the Sterile Processing Department in Hospitals. https://specialtycareus.com/hospital-sterile-processing

  4. STERIS. (n.d.). What is sterile processing? https://www.steris.com/healthcare/knowledge-center/sterile-processing/what-is-sterile-processing

  5. OSPECS Consulting. (2021). Vendor-loaned instrument reprocessing reality. https://ospecsconsulting.com/healthmarket-digest-vendor-loaned-instrument-reprocessing-reality

  6. Infection Control Today. (2020). Challenges associated with loaner instrumentation. https://www.infectioncontroltoday.com/view/challenges-associated-loaner-instrumentation

  7. Association of periOperative Registered Nurses (AORN). (n.d.). Sample Policy: Loaned Instruments. https://www.aorn.org/docs/default-source/aorndocuments/toolkits/perioperative-efficiency/instrument-turnover/sample-policy-loaned-instruments.pdf

  8. Verywell Health. (2023). Vaporized hydrogen peroxide: A safer sterilization alternative. https://www.verywellhealth.com/vaporized-hydrogen-peroxide-sterilize-medical-devices-8553818

Clinical Governance, Healthcare Technology, Perioperative Education, Professional Development, Surgical Best Practice

📚 Why Time and Education Matter in Instilling Best Practice

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Embedding best practices into clinical skills requires deliberate time investment, structured education, and ongoing reinforcement. Research indicates that:

  • 🔍 Deliberate practice over time improves clinical performance.
    Ericsson et al.’s seminal work on skill acquisition demonstrates that expert performance arises from structured, repetitive practice—not merely experience. In surgical settings, this entails building skills through repeated exposure to procedural norms, instrument setup, and workflow protocols.
    (Ericsson KA et al., 1993. Psychological Review)

  • 🕒 Operating rooms are complex environments with high cognitive demands.
    A prospective observational study by Göras et al. (2019) found that surgical teams performed an average of 64 tasks per hour, with nearly half involving communication. Multitasking accounted for 48.2% of the time, and interruptions occurred at a rate of 3.0 per hour, predominantly due to equipment issues. These findings highlight the necessity for structured education and time allocation to manage the complexities of the OR effectively.
    (Göras C et al., 2019. BMJ Open)

  • 🧠 Simulation and structured education improve retention of best practices.
    A study in the Journal of the American College of Surgeons found that OR team members who engaged in simulation-based education were more likely to adhere to best practice protocols, such as surgical safety checklists and aseptic setup techniques.
    (Barsuk JH et al., 2009. J Am Coll Surg)

  • 📈 Structured learning platforms help consolidate complex clinical knowledge.
    Digital tools that reinforce policy-based workflows (like ACORN, AORN, AFPP) assist learners in absorbing, applying, and reflecting on clinical procedures in real-time. Platforms like ScrubUp bridge the gap between formal education and day-to-day clinical needs.

Final Thought (Updated):

By investing time in education and reinforcing evidence-based standards, we don’t just teach a skill—we nurture clinical judgment, adaptability, and professionalism. Whether it’s the first surgical tray setup or a case pivot under pressure, clinicians trained with time and structure are best equipped to deliver safe, efficient care.

References:

https://psycnet.apa.org/record/1993-40718-001

https://pubmed.ncbi.nlm.nih.gov/31097486/

https://pubmed.ncbi.nlm.nih.gov/19667306/

Operating Room Efficiency, Perioperative Practice

“Operating Room Time Is Precious: Here’s Why Every Minute Counts”

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⏱️ Every Minute Matters: The True Cost of Surgical Time

 

In the operating room, time is more than just a metric — it’s a matter of cost, safety, and care. Every additional minute a patient spends under anesthesia increases the financial burden on healthcare systems and escalates the risk of complications. Whether it’s a delay due to missing instruments or a scheduling backlog, the consequences of lost OR time are profound.

💰 The Financial Toll of Operating Room Time

 

Research estimates that each minute of operating room time costs between $15 and $100. A U.S. hospital survey reported an average OR charge of $62 per minute, with high-complexity surgeries topping $133/minute. That means a 10-minute delay could cost up to $1,000 — money lost on idle staff, extended prep, or inefficient scheduling.

Hospitals absorb these costs in the form of overtime wages, surgical backlogs, and reduced daily throughput. One U.S. health system lost 631 hours of OR time and nearly $390,000 annually due to late starts for the first case of the day.

⚠️ Time and Patient Safety Are Inseparable

 

The longer a patient is on the operating table, the higher their risk of harm. Compelling data supports this:

  • Surgical complication risk increases by 14% for every 30 extra minutes in the OR.

  • Surgical site infections rise by 13% for every additional 15 minutes.

  • When surgeries exceed 2 hours, the risk of adverse events nearly doubles.

Extended surgical duration not only affects clinical outcomes but also contributes to longer recovery stays, increased bed blockages, and greater pressure on postoperative teams.

🚨 The Ripple Effect of Delay

 

Delays in the OR don’t just affect one case — they cascade across the entire surgical schedule. Late starts, case overruns, and equipment errors result in:

  • Cancelled surgeries, extending waitlists and frustrating patients.

  • Overtime labor, straining budgets and causing staff burnout.

  • Reduced surgical throughput, which means fewer patients treated each day.

Hospitals aiming to optimize their workflow must treat OR time as the limited, high-value resource it is.

✅ ScrubUp: Optimizing Every Surgical Minute

 

This is where ScrubUp steps in. ScrubUp is a digital platform built to support surgical teams with real-time preparation, streamlined equipment checklists, and surgeon preference tracking. By ensuring all surgical setup details are documented, shared, and ready ahead of time, ScrubUp eliminates the most common delays.

Because in the OR, the loss of one minute can mean the loss of a life or a limb.

Healthcare Education

Are You an Expert in Your Surgical Specialty? The Power of Tracking and Reflective Practice

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Introduction

In the dynamic environment of the operating room (OR), achieving expertise isn’t solely about time spent—it’s about deliberate practice, consistent reflection, and continuous learning. Roles such as Instrument Nurse, Circulator Nurse, Surgical Technologist, and Operating Department Practitioner (ODP) are pivotal, each requiring a unique blend of technical skill, clinical judgment, and experiential knowledge.

But how does one measure progress and move from competence to mastery?

The Journey to Surgical Expertise

Becoming proficient in surgical roles typically involves formal education and extensive clinical exposure. For instance, surgical technologists and nurses often complete programs combining academic study with hands-on training. However, true expertise is cultivated over years of performing, adapting, and reflecting within diverse surgical settings.

Tracking the number and variety of surgical cases handled provides tangible evidence of experience. This strengthens professional credibility, enhances clinical reasoning, and builds the confidence essential to anticipate complications and respond under pressure.

The Role of Reflective Practice

Reflective practice is a cornerstone of professional development in healthcare. It involves critically analyzing one’s clinical experiences to foster growth and improve outcomes. Evidence from NSW Health and other research institutions shows that reflective practice enhances learning, improves critical thinking, and leads to safer, more patient-centered care.

In the OR, reflective practice helps clinicians—whether they’re acting as the circulator, scrub nurse, ODP, or technologist—understand the rationale behind actions, refine processes, and collaborate more effectively as a team.

ScrubUp: Empowering Surgical Professionals

ScrubUp supports surgical professionals by offering tools to log and reflect on every procedure, by role. With ScrubUp, users can:

  • ✅ Log and categorize cases by role (Instrument Nurse, Circulator Nurse, Surgical Technologist, or ODP), procedure, and complexity

  • ✅ Track growth over time, identifying strengths and skill gaps

  • ✅ Document reflections and key learnings after each procedure

  • ✅ Generate insights and reports to support credentialing or career development

By facilitating case tracking and reflective practice, ScrubUp turns day-to-day work into measurable professional progress.

Are You Tracking Your Surgical Experience?

If you’re not logging your surgical cases or reflecting on your experience, you may be overlooking a critical tool for growth. Ask yourself:

  • 🧐 How many cases have I supported in my role—circulating, scrubbing, or assisting?

  • 📈 What have I learned from those experiences?

  • 🚀 Where could I focus to further build expertise?

Rather than simply expecting surgical staff to “do the job,” healthcare facilities must enable and protect time for reflection, learning, and documentation. These moments are not extras—they are essential components of safe, expert practice and team improvement.

ScrubUp empowers this process, giving perioperative professionals an intuitive way to track progress, reflect on procedures, and build credibility in their surgical specialty.

Conclusion

Expertise in the OR isn’t accidental—it’s built through exposure, repetition, reflection, and a drive to improve. Whether you’re a Circulator Nurse, Instrument Nurse, ODP, or Surgical Technologist, ScrubUp empowers you to track, reflect, and grow.

Start your journey toward surgical mastery today.
🔗 www.scrubupapp.com

Hospital Efficiency, Operating Room Workflow, Perioperative Nursing, Surgical Technology

Meeting Surgical Demands: How ScrubUp Reduces Delays, Waste, and Costs in the OR

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Meeting the Demands of Surgery: The Case for Smarter OR Preparation

 

In the high-stakes environment of the operating room, every minute has a cost—and not just clinical, but financial. Research shows that circulating nurses spend up to 26.3% of surgery time outside the OR, often to retrieve forgotten or missing items.

 https://www.sciencedirect.com/science/article/pii/S1743919118305338

This has a direct impact on:

  • ⏱ Surgical time (increased case duration)

  • 💸 Hospital costs (staff time, anesthesia, wasted resources)

  • 🔁 Workflow disruptions that affect safety and team focus

The Root Problem: Lack of Preoperative Clarity

 

The study found that the most common reason for surgical supply waste is the anticipation of the surgeon’s needs—nurses opening equipment that goes unused. Circulators frequently leave the OR due to:

  • Incomplete case carts

  • Unexpected surgeon requests

  • Equipment shortages or confusion

This reactive approach costs time, money, and morale.

The Solution: ScrubUp Software

 

ScrubUp is a software platform designed by a peri-operative nurse to tackle exactly these issues. It gives surgical teams access to procedure-specific intelligence before they even step into the room.

With ScrubUp, circulating nurses and techs can:
✅ See exactly which instruments and trays are needed
✅ Review special equipment or hardware preferences
✅ Understand the setup and surgical sequence
✅ Reduce the chance of mid-case supply runs

What’s the Impact?

 

  • Less time lost during surgery

  • Fewer retrievals = lower intra-operative stress

  • More accurate supply use = less waste

  • Faster, more predictable turnover = better scheduling

  • Improved confidence = better team performance

And ultimately—lower costs and better outcomes.

Final Word

 

In today’s healthcare climate, hospitals can’t afford inefficiency. Let’s support perio-perative teams with the data they need to succeed—not just for safety, but for time and cost savings.

Because every minute matters.

Clinical Best Practices, Education, Education & Training, Infection Prevention, Operating Room, Operating Room Education, OR Nursing, Perioperative Education, Skin Antisepsis, Surgical Nursing

Reducing SSIs Through Best Practice Skin Preparation: What Every OR Nurse Should Know

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Best Practice for Surgical Skin Preparation: Reducing the Risk of Surgical Site Infections (SSIs)

Surgical skin preparation is one of the most critical steps in preventing Surgical Site Infections (SSIs)—a complication that not only affects patient recovery but places a significant financial burden on healthcare systems worldwide.

🦠 Why Surgical Site Infections Matter

SSIs are among the most common types of healthcare-associated infections and can occur in up to 5% of surgical procedures. Their consequences extend beyond the immediate surgical outcome:

  • In Australia, SSIs add an average $18,814 to the direct cost of treatment per patient.

  • In the United States, SSIs cost the healthcare system $3.3 to $10 billion annually.

  • A single infection following a hip or knee replacement can add $12,689 USD in direct costs.

  • SSIs significantly prolong hospital stays, often requiring readmission, further tests, and additional treatment.

Given the clinical and economic impact, preventing SSIs is not only a patient safety priority—it’s a healthcare imperative.

🧼 What Is Surgical Skin Preparation?

Surgical skin preparation involves cleansing the skin at and around the surgical site to reduce the microbial count to the lowest possible level. The goal is to create a sterile field that minimizes the risk of microbial contamination during the procedure.

Key Principles of Best Practice:

  • Clean to Dirty: Begin at the cleanest area—typically the planned incision site—and work outward in concentric circles or squares.

  • No Double Dipping: Use a fresh swab for each pass. Never return a used applicator to the antiseptic solution.

  • Wide Coverage: Prep a generous area to accommodate any extension of the surgical incision.

  • High-Risk Zones Prepped Last: Areas such as the groin, umbilicus, open wounds, stomas, orifices should be cleaned last and with separate sponges.

  • Reverse Technique for Contaminated Areas: For high-risk zones, start at the cleaner periphery and move inward to the more contaminated center.

The AORN (Association of periOperative Registered Nurses) recommends selecting an alcohol-based prepping agent based on the anatomical location and patient assessment. Alcohol-based preps should not be used near mucosa, eyes, or ears. Iodine-based alternatives are safer in such cases.

📊 Why It’s Done This Way – The Evidence Behind the Method

The technique of prepping from clean to dirty and using separate applicators for contaminated zones is designed to:

  • Prevent cross-contamination within the sterile field.

  • Maintain the lowest possible bacterial load at the incision site.

  • Ensure compliance with infection control standards such as those outlined by AORN, ACORN, and WHO guidelines.

👩‍⚕️ Educating the Next Generation of Perioperative Professionals

Understanding why and how we perform surgical skin preparation is critical for novice operating room staff. Proper technique supports not only patient safety, but also team trust, procedure efficiency, and hospital sustainability.

Visual guides help reinforce learning by showing the correct prepping zones and motion patterns for various surgical sites.

📷 

✅ Final Thoughts

Following best practice in surgical skin preparation isn’t just a procedural checklist item—it’s a frontline defense against infection. When done correctly, it protects patients, reduces complications, and ensures that the operating team upholds the highest standards of care.

Stay vigilant, prep with purpose, and lead with best practice.

Alcohol Based-Prep, Education, Education & Training, OR Nursing, Skin Antisepsis, Surgical Fire Risk, Surgical Prep Tools

Alcohol-Based Surgical Prep Safety: Best Practices for OR Nurses, Techs & ODP’s.

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Introduction

 

Alcohol-based surgical prep safety is critical in modern operating rooms and alcohol-based surgical skin preps are a cornerstone of infection control, offering rapid and reliable antimicrobial action. But with their benefits comes a critical risk: fire hazards. For operating room nurses and surgical technologists, understanding how to safely use these solutions is essential to protect patients and prevent harm.

 

Why Alcohol-Based Preps Are Standard

 

Alcohol is fast-acting, dries quickly, and kills a broad spectrum of pathogens. It’s commonly combined with chlorhexidine or iodine, making it a go-to for preventing surgical site infections (SSIs). The CDC and WHO both support alcohol-based solutions as a best practice for surgical skin antisepsis. However, it’s extremely flammable. Vapors can ignite when exposed to electrocautery devices or lasers, turning a routine prep into a dangerous situation if not properly managed.

 

The Fire Triangle in the OR

 

Most surgical fires involve these three elements:
– Fuel: Alcohol-based prep
– Ignition: Electrosurgical devices or fiber-optic cables
– Oxidizer: Supplemental oxygen
Over 600 surgical fires are reported annually in the U.S., often due to improper skin prep protocols (ECRI Institute).

 

Best Practices for Alcohol-Based Surgical Prep Safety

 

1. Apply Carefully
Avoid excess pooling, especially around skin folds, hair, or under the patient.

2. Use Safer Application Tools
Products like BD Bard’s ChloraPrep with Tint, help standardize application and reduce risks. ChloraPrep with Tint is a single-use, prefilled applicator containing 2% chlorhexidine gluconate and 70% isopropyl alcohol. Its design supports even application and minimizes pooling, helping reduce fire risk while improving efficiency. ChloraPrep’s built-in safety features include controlled delivery and foam-tipped applicators, making it easier to ensure consistent coverage and drying.

3. Let It Dry
Wait at least 3 minutes for full evaporation. Never drape or activate devices until the prep is dry.

4. Avoid Vapor Traps
Ensure drapes do not seal off wet or moist areas. Allow for ventilation around the surgical site.

5. Communicate with the Team
Clearly announce when alcohol prep is used. Pause to confirm the site is dry before any ignition source is used and pooling is minimized.

6. Train and Audit
Conduct regular education sessions and fire risk drills. Ongoing competency supports safety culture in the OR.

 

Final Thoughts

 

Surgical prep is the foundation of a safe procedure. As OR nurses and techs, your diligence during this phase not only reduces infection risk—it can also save lives. With the support of standardized tools like ChloraPrep, you can perform effective antisepsis with added confidence and control.

 

 

References

  1. Association of periOperative Registered Nurses (AORN). Guideline for skin antisepsis. 2023.
    2. ECRI Institute. Top 10 Health Technology Hazards for 2023.
    3. CDC. Guideline for the Prevention of Surgical Site Infection. 2017.
    4. BD. ChloraPrep™ Patient Preoperative Skin Preparation. https://www.bd.com/en-au/products-and-solutions/products/product-page.m.ChloraPrep
Operating Room, Policies, Technology, Workflow

Current Trends Impacting Operating Room Professionals

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Innovation in healthcare has made a significant impact to enhance patient care and healthcare outcomes.

The operating room focuses on improving surgical outcomes, by implementing strategies and technology that optimise patient care.

 

As an experienced operating room nurse, I have observed the positive impact of technology on patient care.

However, successful implementation of intra-operative technology necessitates a strategic plan and continuous monitoring.

 

According to the Australian Government, 2023-2035, The Nursing Supply and Demand Study,’ there will be a shortage of 70,707 nurses by 2035. In acute care the estimated short fall is 26,665 nurses. Supply is not expected to keep pace with demand.’

 

It is essential to consider the wellbeing of healthcare professionals who, according to research, are experiencing burnout, lack experience, face high turnover rates, represent an ageing workforce, feel overworked and undervalued.

 

Data shows recognition and gratitude enhance healthcare professionals’ wellbeing, teamwork, and sense of value, which is crucial for a sustainable healthcare delivery system.

 

Healthcare professionals wellbeing must be prioritised when introducing new technology, requiring a balanced approach to ensure safety, support and compliance. Stable adoption needs time for adjustments, support, education, and ongoing training.

 

Innovative technology that significantly affects patient care can greatly influence clinical workflows and overall workload.

 

Any adjustments to clinical workflow/workload impacts on patient safety and a number of factors should be thought through prior to implementation.

 

Key factors include:

 

  • Current workflow
  • Technology’s impact on clinicians’ responsibilities
  • Time for setup and preparation
  • Feedback and troubleshooting
  • Clinical skill mix, staffing numbers
  • Impact on instrument handling and patient safety
  • Responsibility for equipment management
  • Policies and governance on equipment use
  • Environmental conditions
  • Equipment monitoring and maintenance

 

 

It is crucial to acknowledge that operating room personnel, especially those in the roles of instrument and circulator, already adhere to mandated legal policy directives, for each surgical procedure they are involved with, requiring contemporaneous documentation, even when using hybrid systems.

 

Prioritising tasks and responsibilities is key to a fluent workflow. Patient safety should always be placed at the forefront of any task.

 

 

The adoption of new technology, along with the modification of policies and procedures, has altered the responsibilities and dynamics faced by healthcare professionals.

 

Peri-operative teams, who work across various surgical specialties, are highly skilled, adaptable, and knowledgeable professionals.

 

Their competencies should always be regarded with the utmost respect.

 

Peri-operative professionals recognise the need for change, however, in order to effectively integrate technology, and sustain a critical workforce, we need to identify, prioritise and support the clinical impact of technology.

 

Sustaining and supporting this skilled workforce is vital to our healthcare system.

 

 

https://hwd.health.gov.au/resources/primary/nursing-supply-and-demand-study-2023-2035.pdf

 

https://onlinelibrary.wiley.com/doi/10.1155/2024/2983251

 

https://www.sciencedirect.com/science/article/pii/S2666142X25000505

 

https://onlinelibrary.wiley.com/doi/10.1155/2024/2983251

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC7164898/

 

 

Operating Room, Patient Safety, Surgical Cleaning

Point of Use (POU) Cleaning of Surgical Instruments

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Are your instruments being cleaned intra-operatively?

 

Surgical instruments are a high cost item, which is why maintaining and sustaining their lifespan is important, especially when it is a surgeon’s, ‘favorite’ or there is a minimal supply.

 

The risk of Surgical Site Infections (SSI’s) increases when surgical instruments are not cleaned effectively. During a surgical case organic material can accumulate and build up if blood and debris are left to dry. This is why it is critical for surgical instruments to be wiped over with sterile water during a surgical case. This also expand’s the life of a surgical instrument and reduces rust, pitting and the build up of biofilm.

 

 

How often have you tried to use a hemostat that is hard to open, or a metzenbaum scissor that is stiff to use?

 

 

 

 

As OR professionals are we not responsible for cleaning our instruments intra-operatively?

 

 

Research identifies that blood can be corrosive and cause pitting and staining of surgical instruments. Blood is high in salts and is very corrosive to metal.

 

 

According to research dried blood presents a serious risk to the integrity of an instrument and is capable of causing irreparable damage to a surgical instrument. Once instrument surfaces and channels begin to rust and form pitting, the metal surface is compromised, which makes it difficult to clean.

 

 

Blood proteins are identified as water soluble, however blood contains fibrin which supports blood coagulation. Research shows that coagulated blood on a hard surface sticks making it dificult to remove, this is why pre-cleaning as close as possible after contamination with sterile water can remove the greatest part of contamination.

 

 

 

Rust develops on an instrument due to spotting, staining and pitting and is a result of chlorides within blood.

 

 

 

Bioburden on Surgical Instruments

 

 

Bioburden is the result of hardened microfilm (tissue and blood) left on a surgical instrument and underneath this bioburden harbors biofilm. Biofilm can be protected and shielded when undergoing the contamination & sterilization process. Biofilm enables the growth of bacteria and can be detrimental to a patient.

 

 

The longer bioburden is left to harden on an instrument, the more time consuming it is, to effectivly decontaminate, reprocess  and ‘turn around’ instruments.

 

 

Once biofilm has formed, it can be nearly impossible to remove in a difficult-to-reach spot, like a scope lumen.

 

 

 

Damaged instruments can impact on surgical case delays, prolong surgical times and impact on patient safety.

 

 

 

Keeping a surgical instrument moist helps to prevent hardening of biofilm.

 

 

 

When OR staff fail to facilitate POU cleaning this impacts the Sterilization Department (SPD) which also impacts on OR productivity.

 

 

 

Best practice is to keep instruments moist and wiped clean of organic matter at regular intervals during a surgical case, with sterile water.

 

 

 

 

 

Failure to Adequately Clean Surgical Instruments puts Patients at Risk

 

Failure of the hospital staff at Porter Adventist Hospital to pre-clean surgical instruments contributed to contaminated instruments being used in procedures, putting nearly 5,800 patients at risk for surgical site infections, including exposure to HIV and hepatitis. The hospital reached out to the affected patients, citing pre-cleaning as the cause of inadequate sterilization. The hospital faced several lawsuits, some dating back all the way to 2015.

 

 

 

https://www.microcare.com/en-US/Point-of-Use-Cleaning

 

 

http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://patientsafety.pa.gov/ADVISORIES/documents/201706_71.pdf

 

 

https://www.hpnonline.com/surgical-critical-care/article/21146790/instrument-preservation-a-full-time-operation

 

 

https://www.ajicjournal.org/article/S0196-6553(23)00314-0/fulltext

 

 

 

Operating Room, Patient Safety

Communication in the OR

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The operating room is a culturally diverse background with various levels of multidisciplinary professionals working collaboratively to deliver optimized care.

 

 

A study by the British Journal of Anaesthesia, identifies;

 

 

 

  • Failures in peri-operative communication contributed to patient injury in 43% of 910 anaesthesia malpractice claims

 

 

  • The most common root cause of communication failure was insufficient or inaccurate information, occurring in 30% of procedures

 

 

As part of a team that assessed RCA’s and near misses, communication was highlighted as a contributing factor in a majority of cases. Nurses stated they did not feel heard and confident, especially as a novice.

 

 

Surgeons may also feel unsupported by staff they are unfamiliar with or who are unfamiliar with the flow of surgery.

 

 

We need to empower all operating room professionals to work collaboratively, but we also need to empower and provide knowledge and support to our clinicians, in order to support, and deliver enhanced patient care.

 

 

The annual cost of medical errors likely exceeds $17 billion, with 35% being surgery related

 

 

 

A recent publication, Towards the Future of Surgery, 2024 has highlighted the need for surgeons to further develop their soft skills.

 

 

This is something we should all consider. Here’s a little insight.

 

 

 

“It is clear how patient outcomes are becoming less and less dependent on technical skills (however, this is always essential) and increasingly dependent on non-technical skills. Surgeons have the potential to improve patient outcomes, reduce medical errors, and improve patient satisfaction through their leadership on the multidisciplinary team.”

 

 

“Leadership in surgery entails many non-technical skills, including professionalism, technical competence, motivation, innovation, teamwork, communication skills, decision making, business acumen, ethics, emotional competence, resilience and effective teaching.”

 

 

“Surgeons have the potential to improve patient outcomes, reduce medical errors, and improve patient satisfaction through their leadership on the multidisciplinary team.”

 

 

 

I believe we all have the ability to improve patient outcomes.

 

 

Our use of checklists, such as the Surgical Safety Checklist has reduced errors by 30%.

 

 

Research shows we can improve patient outcomes by developing a team culture by easily identifying surgical team members, via scrub or cap identification.

 

 

Team huddle has also improved team collaboration and work flow.

 

 

Effective communication aims to streamline practices and utilizing resources to share information is key when stakes and patient lives are at risk.

 

 

 

Lets all aim to improve communication, empower clinicians and share our clinical expertise.

 

 

 

 

 

 

ttps://www.bjanaesthesia.org.uk/article/S0007-0912(21)00349-4/fulltext

 

 

Towards the Future of Surgery, 2024

 

https://link.springer.com/book/10.1007/978-3-031-47623-5

Operating Room, Patient Safety

Situational Awareness in the OR

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The OR is an environment where the room for error in minimal, time is critical and perfection is expected 100% of the time.

 

 

Situational Awareness that can have a significant impact on the flow of surgery, time & costs.

 

 

Situational awareness encompasses the ability to observe, listen, absorb and act swiftly. 

 

 

A change in the environment can be sudden and simultaneous. Eg, a surgeon may have an uncontrolled bleeding vessel, whilst the anaesthetist is having problems securing a dislodged airway.

 

 

Distractions are the costly, which is why 100% attention should be focused on the patient and care delivery.

 

 

Each OR nurse/tech/ODP, should be aware of the environment in order to work as a team, prioritise and support the care required, in order to stabilise a situation.

 

 

Demonstrating situational awareness is critical to patient safety and team cohesiveness.

 

 

Recognising a change in the environment, and troubleshooting or prioritising a task prior to verbal direction can save time. An instrument nurse/tech/ODP may only need to move their eyes, in a certain direction, in order to communicate a task, to the circulator.

 

A circulator may use verbal and non-verbal communication to the instrument nurse/tech/ODP if there is an observation that is of concern, such as low irrigation fluids, especially if the surgeon has a bleeding vessel.

 

 

 

 

Timing is key and costly.

 

 

 

 

If the need to obtain a bag of fluids is required by the circulator, it is important they obtain direction by the instrument nurse/tech/ODP, as they may prefer the circulator to stay in the OR, due to the case going ‘open’, thus, requiring additional instrumentation & equipment.

 

Situational awareness requires assertiveness, listening to cues and observing minute changes, by all team members.

 

 

 

It can take years to develop & evolve these astute, efficient & life saving skills. 

 

 

 

 

Many senior OR staff have developed these astute skills over the years. Which is why experience and expertise should never be under valued or under estimated.

 

 

 

What does one minute of operating room time cost your organisation?

 

 

Education, Operating Room, Operating Room- Tips, Surgical Equipment, Surgical Supplies, Sutures

A Little About Sutures & Surgical Considerations

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About Sutures-Needle Point 

 

  1. Cutting Edge – 2x types- Conventional & Reverse
  • Has 2x opposing sides that slice through tissue
  • Cutting Conventional needles are predominantly used on skin closures

2. Taper Point

  • Needle is flattened or rounded
  • Spreads tissue without cutting, less traumatic, decreased bleeding
  • Widely used in various tissue, muscle, fat, peritoneum

3. Taper Point-Blunt

  • Tapered needle with blunt point
  • Used to prevent needle stick injuries

4. Taper Cut Needle

  • Predominantly used in Vascular & Cardio Thoracic surgery
  • Used on hard calcified tissue and on prosthetic grafts
  • Cutting needle passes through tissue easily and taper point passes through friable tissue

 

 

Surgical Considerations

 

Point sizes of a needle vary, according to the tissue and room or ‘bite’ size required

 

 

Points to consider when choosing a needle holder and loading a suture.

 

  1. Deep cavities require longer needle holders
  2. Thicker tissue may require stronger needle holders
  3. Load suture 1/3 of the distance from the swag
  4. Load suture at a 90 degree angle
  5. Needle should be loaded near the tip of the needle holder
  6. Confirm if the surgeon is right or left handed, load accordingly
  7. Needle holder should hold the needle in place and not move the needle when being used, usually the second clasp will hold in place
  8. Always be mindful of the tissue, the needle size and the length and size of the needle holder. Eg a small needle on a large & heavy needle holder may place pressure on the needle and break it.

 

 

Additional Considerations

 

  • Never give an orthopaedic surgeon a small needle holder, unless they ask for one

 

  • Always collect various size needle holders if unsure of size prior to surgery

 

  • Always confirm the suture type, needle size, needle point prior to opening a suture, they are costly and can be placed in the wrong packet at the end of a long day by a tired team member
Costs, Uncategorized

What is the Cost of Opened & Unused Sterile Supplies?

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According to a John Hopkins study, $15M US is lost in hospitals annually in unused sterile supplies.

 

Another study looking at neurosurgical procedures, identified $968.00US is wasted per surgical case on opened & unused supplies, this equates to a loss of $2.9M US, annually, in neurosurgery alone.

 

Preparation and knowledge on a surgical approach and procedure, may assist the team to determine the number of supplies required.

 

A senior colleague is able to estimate how many sterile packs are required at the beginning of a case, and the number required, on standby.

 

This preparation and forethought, reduces the time the circulator is out of the OR, and is therefore, available, to meet the immediate needs, of the surgical team.

 

Surgical cases vary, and understanding details about a patients medical background may assist the surgical team to identify the number of supplies required.

 

Eg, if a patient has not stopped anti-coagulents, may increase the need for additional items.

 

Communication with a surgeon prior to the surgery and confirming items before they are opened, reduces costs and wastage, however this may also invite unnecessary tension.

 

Situational awareness should be adhered to, at all times.

 

References

https://www.hopkinsmedicine.org/news/media/releases/study_documents_millions_in_unused_medical_supplies_in_us_operating_rooms_each_year

https://thejns.org/view/journals/j-neurosurg/126/2/article-p620.xml

https://kffhealthnews.org/news/tossing-unused-surgical-supplies-wastes-millions-of-dollars-study-finds/

Electro Surgical Unit, Patient Safety

Patient Safety using an Electro-Surgical Unit

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Patients rely on healthcare facilities & health professionals to look after them during their surgical journey. The aim is to leave a healthcare facility in a more optimal state than when they were admitted.

In the OR an electro surgical unit is used in 80% of surgical cases, this involves an electrical current that can be localised- Bipolar (cautery), or is an electrical circuit- Monopolar. Incidences of electro surgical injuries according to research are under reported.

 

Monopolar is an electrical current that flows through the patient and requires a patient return electrode which connects to the electro surgical unit.

Thermal injury is a result of a burn from the use of electro surgery. This is why jewellery, piercings and any metal implants should be flagged with the peri-operative team, prior to surgery.

Laparoscopic cases have been show to increase the incidence of a surgical burn injury.

 

Research suggests that 3.6 per 1,000 laparoscopic procedures may result in a burn injury.

 

Electro surgical units are also a fire source, they are commonly referred to as a fire stick.

 

“It is currently estimated that around 500 to 600 surgical fires occur annually in the United States”, this impacts on patient safety but also impacts on healthcare facilities, costing them ‘millions of dollars annually”.

 

In order to reduce surgical burns the surgical team are responsible for assessing equipment & instruments prior to all surgical cases.

 

It is important that all surgical instruments are checked prior to use, to prevent thermal injuries, particularly in laparoscopic/robotic cases, where the insulation of laparoscopic instruments can become worn and compromised.

Leads & connections should also be checked.

 

Patient positioning is also extremely important so that no body part is touching any metal, especially in lithotomy and prone cases.

 

There are other safety precautions healthcare workers need to be mindful of, including prep solutions- pooling, alcohol and the use of oxygen, especially in the airway.

 

Pacemakers and any metal implants should also be flagged with the peri-operative team, in order for them to prepare the right equipment in advance of the surgery.

 

Depending on the type of surgery, bipolar may be a safer option.

 

Lets educate & support our healthcare workers

 

Educating and supporting clinicians is vital to empowering and informing best and safe practice.

Training & education requires time by employees and employers.

 

The value in supporting electrosurgery education benefits the facility by empowering and encouraging safe practice in addition to increasing a clinicians level of competence and understanding, all of which impacts, on safe surgical care & outcomes.

 

 

References
https://pubmed.ncbi.nlm.nih.gov/30472721/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456630/
https://www.jscimedcentral.com/jounal-article-info/Journal-of%C2%A0Dermatology%C2%A0and-Clinical-Research/Peri-Operative-Management-of-the–Patient-with-Body-Piercings-8253
https://www.infectioncontroltoday.com/view/managing-new-class-electrosurgical-risk
https://jackson-medical.com/prevent-electrosurgical-fires/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599256/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407433/
https://www.sciencedirect.com/science/article/abs/pii/S0002961016310285
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456630/
Patient Safety, Policies

Costs of staff ‘running’ for supplies outside of the OR, could cost up to $1,500.00.

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A hospitals operating room, store room, can be overwhelming, lots of surgical trays, equipment & supplies everywhere, most of the time in an order that make sense to a supply administrator but not to the surgical team..argh and with limited details to find what you actually need, quickly.

 

This impacts on costs, why, because there are many times when a surgeon may need additional supplies, unexpectedly, intra-operatively. When equipment can not be easily found this builds tension in the OR, in addition to prolonging surgical time, which can also impact on patient outcomes.

 

Research suggests that nurses spend 26% of intra-operative time outside of the OR, attending to additional needs of the surgeon, which would involve collecting additional equipment and supplies to support an optimized surgical outcome.

 

If the equipment required is necessary this can bring the entire operating room to a stand still, costing approximately $1,500.00 for the loss of 15minutes, waiting for the nurse to find the equipment.

 

Research also suggests that nurses ‘spend 21minutes per shift looking for lost equipment, taking them away from direct patient care’.

 

Hospitals need to provide the infrastructure for clinicians to optimize patient safety and to support them in their roles which would remove unnecessary stress, that wastes critical time. Improving clinical resources to streamline practices will improve efficiency and productivity, which will impact on staff and patients.

 

https://www.sciencedirect.com/science/article/pii/S1743919118305338

 

 

https://www.himss.org/resources/applying-rtls-technology-improve-nurse-efficiency-and-patient-care#:~:text=Time%20spent%20looking%20for%20equipment%20certainly%20takes%20them%20away%20from,shift%20searching%20for%20lost%20equipment.

Patient Safety, Policies, Technology

Implications of Equipment Failure During Surgery

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Research states that, ‘Implications of equipment failure during surgery’, occurred in 92% of surgical cases.

According to research,’equipment failures occurred in 76.9% of surgical cases. Equipment availability was impacted by 37.3% of surgical cases.

Unfortunately this is not surprising to those in the industry. I have witnessed first hand the lack of operating room checks, due to, time poor staff, who are already overloaded with paperwork and surgical setups.

When I first started working in the operating room as an instrument and circulating nurse, one of the first things I was taught, was to check the OR environment. This involved turning wall switches on and off, increasing/decreasing hardware settings.

Fast forward twenty plus years and there is more equipment to check, that is more technical and complex.

Staff are not given time to check equipment and the environment, which leads to intra-operative delays, stress and tension. Surgical time is impacted, patient safety is impacted, the waitlist is impacted and costs increase.

I hope that as we engage in more specialised practices that time is spent on checking the surgical environment and hard ware prior to the start of a surgical case load, or that specialised technical support is available to take the load off our already time poor health care professionals.

If you are a facility that provides your staff with additional time to setup and check equipment or has a technical support person. I would love to hear from you.

Contact Us

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685966/

 

https://qualitysafety.bmj.com/content/22/9/710

 

 

Patient Safety, Uncategorized

Intra-Operative Pressure Injuries (PI)

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A patient has surgery to address a disease, illness, or trauma. They are vulnerable and anxious and surgery maybe the final option.

Surgery can be costly and a patient does not need another complication, such as a Pressure Injury (PI).

According to the Agency for Healthcare Research & Quality, pressure ulcers cost $9.1-$11.6 billion per year in the US. Cost of individual patient care ranges from $20,900 to 151,700 per pressure ulcer.

https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu1.html#:~:text=Cost%3A%20Pressure%20ulcers%20cost%20%249.1-%2411.6%20billion%20per%20year,ranges%20from%20%2420%2C900%20to%20151%2C700%20per%20pressure%20ulcer.

As healthcare professionals it is our role and responsibility to provide the best care we can, to our patients.

This is why pressure area care should be assessed and addressed.

There are a number factors that impact on intra-operative pressure care and what equipment should be used to support blood circulation and minimise pressure on vessels and tissue.

A patients own health and comorbidity can also impact on the predisposition for a postoperative PI.

Correct patient positioning, monitoring pressure sites and utilising equipment can aid in reducing PI. Moisture and heat sources such as a warming blankets can also play a role in the likelihood of skin breaking down.

It can be difficult to identify early stages of skin breakdown intra-operatively, which is why assessments and precautions should be undertaken preoperatively and postoperatively.

Research in identifying and educating health care workers is necessary to reduce the risks to patients. A 2019 study detected that 1 in 150 patients developed an intra-operative stage 1 PI. This study highlights the need for education and further research to assess a patients risk and implement strategies to reduce PI.

See more from AORN about how much a PI is costing your facility.

https://www.aorn.org/syntegrity/resources/tools-calculators/pressure-injury-calc#:~:text=Pressure%20ulcers%20costs%20hospitals%20up%20to%20%2426.8%20billion,first%2C%20calculate%20how%20much%20they%E2%80%99re%20costing%20your%20facility.

Patient Safety, Scrub

Communication in the OR & Valuing Senior OR Staff

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The operating room is an environment where the room for error is minimal and time is always critical.
Surgery is becoming more complex, technical & challenging, which is why, communication & experience should be valued, especially when it comes to operating room professionals.

Effective verbal, observation & listening skills are qualities all surgical team members must demonstrate. Rothrock (2011) states that, “ improved communication is imbedded in human factors, culture, and social systems, all of which are more complex than checklists, mnemonics, and acronyms”.

A senior and experienced OR nurse, ST or ODP is able to recognise a change in the environment, they are able to ‘read the room’ & assess where attention should be focused.

They are able to ask concise questions at pivotal moments.

Example, does the laparoscopic or robotic case need to be ‘opened’? If so what trays & equipment do I require? Is there a bleeding vessel, are more fluids required for irrigation, are additional clips, ties, endoloops required?

Senior staff are able to think ahead because of their experience and surgical exposure especially if they are skilled across multiple surgical specialties.

Time can be critical during these intense moments and cohesive teamwork is vital in reducing surgical time. Surgical errors and complications arise when there is tension.

Time and experience matter, and there is usually a higher cost for these skilled clinicians, is the money worth it? Yes indeed!

Experienced OR staff  bring a wealth of experience, they have trouble shooting skills & clinical knowledge, they are able to think quickly and prioritize the needs of the surgical team.

Surgical time can have a direct impact on a patient, leading to longer post-op recovery which can impact on reduced bed availability and increased hospital costs.

Thank you to all the senior operating room professionals who have a wealth of skills and experience. Never forget how valuable you are.

Patient Safety, Policies

Who is responsible for monitoring the Intra-Operative IDC?

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I wanted to get your feedback on this issue as I observe this intermittently across varying OR’s and I wondered who should take ownership or is it a collective level of responsibility?
The IDC (indwelling catheter) may have been placed by the surgical team, nurse or OR professional, once insitu, who is responsible for monitoring the urine output and if needed updating the fluid balance chart?
I have observed catheters not draining as the catheter was kinked after positioning the patient and this was only observed after I had completed a surgical count, connected equipment and opened all supplies, as a circulator there are other priorities which take place.
I have also observed the catheter being full, requiring a jug to empty it intra-operatively, and the other day the catheter had not drained anything after 1.5hrs into the case.
There are a number of reasons why the urine was not draining, this is for another blog, however my main concern is, who should be responsible for observing and monitoring urine output intra-operatively, or is it a collective level of responsibility?
Technology

Supporting All Operating Room Professionals

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So tell me what are your thoughts on the amount of documentation we are asked to complete whilst we are caring for our patient under anaesthetic.

In the hospitals I have worked, we have a scrub nurse, anaesthetic nurse & circulator or scout nurse. The documentation is both paper and electronic. Responsibilities about paper work vary, as a rule this is how it generally plays out, here in Australia.

1) Pre admission checklist usually completed by the anaesthetic nurse

2) Scanning of instrument trays or attaching stickers to patient notes

3) Time Out Checklist/ VTE Assessment- scrub/scout team

4) Intra – Operative nursing care form- scout nurse

5) Count Sheet- scrub/scout team

6) Chargeable Sheet- scout nurse

7) Prosthesis Sheet-scout nurse

Not to forget

8) Pathology documentation

I am sure that I may have missed some, please contact me regarding any other types of documentation your health facility may have.

I know there are a number of hospitals who still do not have computers in their operating rooms, as a result this documentation is completed manually. Then there are some OR’s that do have computers but not all of the documentation can be accessed via a PC, this requires us multi tasking on paper and PC.

What are your thoughts on this, is there an easier and more efficient way of managing this mandatory paper work. I think we are all in the same vote, although I am not sure if this process works any better in other parts of the world. Would appreciate your thoughts on this.

Regards

Marrianne (Allis Technology)